What is Periodontal Disease?

Periodontal disease is an infectious and contagious disease where harmful bacteria attack the supporting structures of the teeth. These include the gums (gingiva) and the portions of the jawbone surrounding the roots of the teeth. Because these harmful bacteria live in saliva, they are easily transmissible from person to person with such activities as kissing or sharing drinking or eating utensils. As a result of damage to supporting gums and bone, periodontal disease is a leading cause of tooth loss around the world.

Not many years ago, it was believed that periodontal disease was “only caused by local factors and only affected local structures”. What this means is that it was believed that periodontal disease was only caused or affected by factors within the mouth (e.g. oral hygiene and the bite) and only affected structures within the mouth – the teeth, gums, and supporting bone. It was not affected by nor did it affect other conditions or parts of the body. We now know this belief to be untrue.

The Connection Between Periodontal Disease and Other Diseases

It is now known that there are important relationships between the health of periodontal tissues and other conditions and diseases of the body. Furthermore, we know that this relationship works in two directions. For example, patients with diabetes are more susceptible to initially developing periodontal disease, and it is more likely to cause tooth loss in them. However the presence of periodontal disease also contributes to patients initially developing diabetes and for patients with diabetes having more difficulty controlling their blood sugar levels. The list of other important diseases or conditions which share a similar relationship with periodontal disease is long and includes Heart Attack, Stroke, Aneurism, Rheumatoid Arthritis, Dementia, Alzheimer’s, Infertility, Low Birth Weight Babies, Miscarriage, Multiple Sclerosis, and Respiratory Disease. For this reason, when we are evaluating or treating periodontal disease, we are not only concerned with helping patients keep their teeth, but also helping them maintain good whole body health.

Diagnosing Periodontal Disease

In addition to changes in our understanding of the relationship between periodontal disease and whole body health, our methods of evaluating and treating periodontal disease have also changed. In the past, the evaluation of periodontal tissues was based nearly entirely on visual or radiographic (from x-rays) evidence. These included such things as gum tissue color or bleeding, gum probing depths, and bone levels as seen on x-rays.

While these evaluative methods are still important tools, they do not tell us whether the disease is active at this time or if we are seeing evidence of past disease that is not currently active. In addition, if the disease is active, they do not tell us which specific bacteria are responsible. There are more than one hundred types of bacteria present in the mouth, most of which actually help keep us healthy. Only a handful cause periodontal disease, and among these harmful bacteria, different types present different health risks. Therefore, it is important to know which specific bacteria are present so that treatment can target those organisms and associated health risks. At this time, the most effective way of determining which organisms are present is with Oral DNA testing – a simple and non-invasive test that involves evaluating a patient’s saliva. Combined with traditional evaluations, oral DNA testing is the most important test in dentistry today to determine your current periodontal health status, the overall health risks associated with your periodontal condition, and appropriate treatment. (see www.oraldnalabs.com for oral DNA testing information)

Treating Periodontal Disease

At one time, treating periodontal disease primarily involved the surgical removal of diseased gum tissue and recontouring the underlying bone. While there are still situations where this type of treatment is appropriate, in most cases, periodontal disease is treated more effectively and more conservatively by addressing the factors that cause or contribute to the disease. These factors include specific whole body health issues such as diabetes and smoking. They also include factors within the mouth including infection from microorganisms and excessive forces from biomechanical disharmony (see “Dental Biomechanical Harmony – the Key to Predictable Dental Comfort, Health, and Esthetics” and “Biomechanical Disharmony – Problems, Evaluation, and Treatment”).

Treatments addressing factors within the mouth include:

• Removal of the bacteria and the soft (plaque) and hard (calculus) deposits they live in with deep cleanings of the gums and root surfaces.
• Antibacterial agents used either systemically or in the mouth around the affected areas. These agents should be directed at the specific bacteria types present.
• Probiotics are used to reintroduce healthy-type microorganisms into your mouth to compete with and reduce the number of harmful bacteria.
• Bite adjustments (RedAddibration) are appropriate when excessive forces from biomechanical disharmony are present. Not only are these adjustments beneficial to the health of the periodontium, but also to all other parts of the jaw system including the teeth, jaw joints (TMJ’s), and jaw muscles.

As with most types of treatments, the success of periodontal therapy is very much affected by the patient’s participation. It affects the initial healing process as well as the maintenance of health after treatment. The good news is that when the causes are removed, the periodontal tissues have a remarkable ability to heal themselves.