Periodontal Disease

Preventing Gum Disease

The best way to prevent gum disease is effective daily brushing and flossing as well as regular professional examinations and cleanings. Unfortunately, even with the most diligent home dental care, people still can develop some form of periodontal disease. Once this disease starts, professional intervention is necessary to prevent its progress.

Other important factors affecting the health of your gums include:

• Smoking
• Diabetes
• Stress
• Clenching and grinding teeth
• Medication
• Poor nutrition

Smoking: The utilization of tobacco products has long been linked to periodontal disease. Far and away the most research falls under cigarette smoking as it pertains to bone loss around the teeth. Cigarette smoking alone does not cause periodontal disease. As previously mentioned, periodontal disease is caused by bacterial plaque that gets under the gum tissues and initiates a process by which the infection initiates bone loss around the teeth. In smokers, once periodontal disease starts, smokers lose bone at a faster rate than non smokers. This is because of the heat form the cigarette which cuts down on the blood supply and therefore retards the body’s ability to fight the infection and bone resorption. Smokers have a greater incidence of recurrence of periodontal infection for this same reason. Smoking cessation is a key component to the success of periodontal therapy. It was originally feared that smokers could not have successful implant therapy. Research over the last several years has shown great success placing implants into smokers. Previously the small percentage rate of failed implants showed approximately 40% were smokers. It has been Dr. Ross’ experience that smoking has had no ill effects on implant success rates clinically in his private practice since 1996.

Diabetes: There is more research linking Diabetes to periodontal disease than other systemic disease. Certainly poorly controlled diabetics and brittle diabetics are not good candidates for periodontal treatment. The research indicates that diabetics are more likely to develop periodontal disease. The research also indicates that people with periodontal disease can have difficulty controlling blood sugar levels. This infection has distinct effects that have periodontists and endocrinologists working together for four decades. The good news is that the research also shows that well controlled diabetics heal as well as people without diabetes.

Stress: There are several decades of sound research linking stress to periodontal breakdown. Much like in smokers, stress cannot cause a periodontal infection, but can expedite the loss of attachment around the teeth. Certainly any alteration in our bodies ability to fight infection can result in negative changes.

Clenching and grinding teeth: As mentioned above, clenching and grinding the teeth are not the primary etiology of periodontal disease, But excess forces on our teeth which get transmitted to the attachment apparatus (i.e. periodontal ligament, etc.) and the bone can have a negative effect. Clenching and grinding teeth can have several ill effects on the masticatory system. These effects include: Temporomandibular Disorder (TMD or what is commonly know as “TMJ”), pain, loosened teeth, fractured teeth, etc. in addition people that suffer from periodontal disease and also bruxism, form a difficult group to treat. Many times a simple device to wear while you sleep (“nightguard”) can alleviate some of the symptoms. The key to the success of these appliances is the amount of diagnostic work the dentist does prior to and at the time of delivery. Store bought (overt he counter) self formatted nightguards are not in any way a treatment modality for TMD. The drugstore bought nightguards cannot stop a patient from teeth grinding. Never confuse these products with the appliance a well trained dentist delivers to you after properly taking models of both arches, manipulating your jaw into the most comfortable therapeutic position, transferring that position to the model with things like a face-bow, bite registration and articulator and then spending a significant amount of time delivering this and adjusting your bite properly. Any patient with a grinding or clenching habit that has periodontal disease or dental implants should be properly fitted for a night guard by the restorative dentist.

Medication: There are many medications commonly prescribed that can cause proliferation of the gum tissue (gingiva). Typically hypertensive medications and medications taken post-surgically to reduce risk of transplant rejection are guilty of gingival overgrowth. This medication induced hyperplasia can be from an increase in the number of gingival cells and/or the size of these cells. For this reason we are not always certain if dental plaque proliferates the problem or not. It may be possible to simply change to a different medication (often in the same chemical family) or change the dosage of these medications to alter the gingival overgrowth. Without a change in the medication or dosage, one can only hope that gingivectomy (surgical removal of the excess gum tissue now frequently accomplished with laser therapy) simply affords the patient more room for oral hygiene. If plaque is more efficiently removed, then sometimes the recurrence of gingival overgrowth is reduced.

Poor nutrition: it has long been surmised that nutritional deficiencies can attribute to periodontal health. Dr. Ross is a firm believer in a healthy diet to accommodate any periodontal therapy. Dr. Ross’ wife Evelyn earned her graduate decree (Masters in Nutrition) from the University of Florida and is a Certified Diabetes Educator. Evelyn can be available to our patients on a case by case basis if they prefer.”