Gum (periodontal) Disease  FAQs Frequently Asked Questions and Answers

Millions of people have periodontal disease and don’t know it. The American Academy of Periodontology's patient self-assessment tool will help you become familiar with the main risk factors and assess your own risk for periodontal disease.Take the risk assessment test.

A periodontist is a dentist who specializes in the prevention, diagnosis and treatment of periodontal disease and in the placement of dental implants. Periodontists receive extensive training in these areas, including three additional years of education beyond dental school. Periodontists are familiar with the latest techniques for diagnosing and treating periodontal disease. In addition, they can perform cosmetic periodontal procedures to help you achieve the smile you desire. Often, dentists refer their patients to a periodontist when their periodontal disease is advanced. However, you don't need a referral to see a periodontist. In fact, there are occasions when you may choose to go directly to a periodontist or to refer a family member or friend to your own periodontist.

Studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease. Smokers are much more likely than non-smokers to have calculus form on their teeth, have deeper pockets between the teeth and gums and lose more of the bone and tissue that support the teeth.

Bleeding gums are one of the signs of gum disease. Think of gum tissue as the skin on your hand. If your hands bled every time you washed them, you would know something was wrong. There are a number of other warning signs of gum disease.

Your bone and gum tissue should fit snugly around your teeth like a turtleneck around your neck. When you have periodontal disease, this supporting tissue and bone is destroyed, forming "pockets" around the teeth. Over time, these pockets become deeper, providing a larger space in which bacteria can live. As bacteria develop around the teeth, they can accumulate and advance under the gum tissue. These deep pockets collect even more bacteria, resulting in further bone and tissue loss. Eventually, if too much bone is lost, the teeth will need to be extracted.

Research proves that up to 30% of the population may be genetically susceptible to gum disease. Despite aggressive oral care habits, these people may be six times more likely to develop periodontal disease. Identifying these people with a genetic test before they even show signs of the disease and getting them into early interventive treatment may help them keep their teeth for a lifetime.

Periodontal disease may be passed from parents to children and between couples, according to an article in the September 1997 issue of the Journal of the American Dental Association. Researchers suggest that bacteria causing periodontal disease are passed though saliva. This means that when a family or couple come into contact with each other's saliva, they're at risk for contracting the periodontal disease of another family member. Based on this research, the American Academy of Periodontology recognizes that treatment of gum disease may involve entire families. If one family member has periodontal disease, the AAP recommends that all family members see a dental professional for a periodontal disease screening.

To keep your teeth for a lifetime, you must remove the plaque from your teeth and gums every day with proper brushing and flossing. Regular dental visits are also important. Daily cleaning will help keep calculus formation to a minimum, but it won't completely prevent it. A professional cleaning at least twice a year is necessary to remove calculus from places your toothbrush and floss may have missed.

Your chances of developing periodontal disease increase considerably as you get older. More than half of people aged 55 and older have periodontitis. The good news is that research suggests that these higher rates may be related to risk factors other than age. So, periodontal disease is not an inevitable part of aging. Risk factors that may make older people more susceptible include general health status, diminished immune status, medications, depression, worsening memory, diminished salivary flow, functional impairments and change in financial status.

If you value your oral as well as overall health, anytime is a good time to see a periodontist for a periodontal evaluation. Sometimes the only way to detect periodontal disease is through a periodontal evaluation. A periodontal evaluation may be especially important in the following situations: If you notice any symptoms of periodontal disease, including:
- gums that bleed easily, such as during brushing or flossing
-red, swollen or tender gums
-gums that have pulled away from the teeth
-persistent bad breath
-pus between the teeth and gums
-loose or separating teeth
-a change in the way your teeth fit together when you bite
-a sore or irritation in your mouth that does not get better within two weeks

If you are thinking of becoming pregnant. Pregnant women who have periodontal disease may be seven times more likely to have a baby born too early and too small. In addition, about half of women experience "pregnancy gingivitis." However, women who have good oral hygiene and have no gingivitis before pregnancy are very unlikely to experience this condition.

If you have a family member with periodontal disease. Research suggests that the bacteria that cause periodontal disease can pass through saliva. This means the common contact of saliva in families puts children and couples at risk for contracting the periodontal disease of another family member.

If you have heart disease, diabetes, respiratory disease or osteoporosis. Ongoing research is showing that periodontal disease may be linked to these conditions. The bacteria associated with periodontal disease can travel into the blood stream and pose a threat to other parts of the body. Healthy gums may lead to a healthier body. If you feel that your teeth are too short or that your smile is too "gummy." Or, if you are missing one or more of your teeth and are interested in a long-lasting replacement option.

If you are not satisfied with your current tooth replacement option, such as a bridge or dentures, and may be interested in dental implants.

During your first visit, your periodontist will review your complete medical and dental history with you. It's extremely important for your periodontist to know if you are taking any medications or being treated for any condition that can affect your periodontal care. You will be given a complete oral and periodontal exam. Your periodontist will examine your gums, check to see if there is any gum line recession, assess how your teeth fit together when you bite and check your teeth to see if any are loose. Your periodontist will also take a small measuring instrument and place it between your teeth and gums to determine the depth of those spaces, known as periodontal pockets. This helps your periodontist assess the health of your gums. Radiographs (x-rays) may be used to show the bone levels between your teeth to check for possible bone loss.

During your first visit, your periodontist will review your complete medical and dental history with you. It's extremely important for your periodontist to know if you are taking any medications or being treated for any condition that can affect your periodontal care. You will be given a complete oral and periodontal exam. Your periodontist will examine your gums, check to see if there is any gum line recession, assess how your teeth fit together when you bite and check your teeth to see if any are loose. Your periodontist will also take a small measuring instrument and place it between your teeth and gums to determine the depth of those spaces, known as periodontal pockets. This helps your periodontist assess the health of your gums. Radiographs (x-rays) may be used to show the bone levels between your teeth to check for possible bone loss.

Here are some guidelines for choosing dental care products – what works for most patients most of the time. To find out what is best for your particular needs, talk to your periodontist. Begin with the right equipment – a soft bristled toothbrush that allows you to reach every surface of each tooth. If the bristles on your toothbrush are bent or frayed, buy a new one. A worn-out brush will not clean your teeth properly. In addition to manual toothbrushes, your choices include automatic toothbrushes and "high tech" electronic toothbrushes. These are safe and effective for the majority of patients.

Oral irrigators (water spraying devices) will not remove plaque from your teeth unless used in conjunction with brushing and flossing.

Another aid is the rubber tip, often found on the handle end of a toothbrush used to massage the gums after brushing and flossing.

Other options include interproximal toothbrushes (tiny brushes that clean plaque between teeth) and interdental cleaners (small sticks or picks that remove plaque between teeth). If used improperly, these dental aids can injure the gums, so it is important to discuss proper use with your periodontist.

Choose products that carry the Indian / American Dental Association Seal of Acceptance – an important symbol of a dental product's safety and effectiveness.

Dental implants look and feel like your own teeth. They can help prevent the bone loss and gum recession that often accompany bridgework or dentures. In addition, they don't sacrifice the quality of your adjacent teeth like a bridge because neighboring teeth are not altered to support the implant. Implants are secure and offer freedom from the clicks and wobbles of dentures. The success rate of implants is highly predictable.

Dental implants are like your own teeth and will require the same care. In order to keep your implant clean and plaque-free, brushing and flossing still apply.

Depending on how far your periodontal disease has progressed, treatment can vary widely. If the disease is caught early, simple procedures can be done that will remove the plaque and calculus from below the gum line and eliminate the infection-causing bacteria. If the disease has advanced to the point where the periodontal pockets are deep and the supporting bone is lost, surgery might be necessary. You may have heard about new products on the market that claim to cure periodontal disease. However, they do not replace traditional periodontal therapy. Rather, the intent of these products is to improve the effectiveness of traditional therapies.

New treatment options using refined techniques can be performed comfortably as office procedures. Improvements in medications, local anesthesia, anxiety and pain control, and, in some cases, conscious sedation are available to make your treatment more pleasant and comfortable.

Maintenance or supportive periodontal therapy is an ongoing program designed to prevent periodontal disease from recurring in patients who have undergone periodontal treatment. This ongoing phase of treatment will allow your periodontist to assess your periodontal health and make sure infection stays under control. During maintenance therapy, your mouth is examined, new calculus and plaque are removed, and, if necessary your teeth are polished and your bite is checked.

The answer varies from person to person. Your dentist or periodontist will recommend a schedule that best that is tailored to protect your periodontal health. The intervals between visits may range from every few weeks to four times per year, in addition to checkups by your general dentist.

These are non-surgical procedures in which the periodontist removes plaque and tartar from below the gum line. Tooth root surfaces are cleaned and smoothed with specially designed instruments. It is important to remove the plaque and tartar from the pockets, because aside from the bacterial toxins that irritate the gums, plaque and the rough surfaces of tartar make it easier for bacteria to get a foothold.

Limited research suggests that the use of lasers as an adjunct to scaling and root planing (SRP) may improve the effectiveness of this procedure. SRP is a non-surgical therapy used to treat periodontal diseases. In addition, when the lasers are used properly during periodontal therapy there can be less bleeding, swelling and discomfort to the patient during surgery.

Yes and no. Each laser has different wavelengths and power levels that can be used safely during different periodontal procedures. However, damage to periodontal tissues can result if an inappropriate wavelength and/or power level is used during a periodontal procedure.

At this time, there is insufficient evidence to suggest that any specific laser wavelength is superior to the traditional treatment methods of the common periodontal diseases, such as periodontitis.

Crown lengthening is a procedure to remove excess gum tissue to expose more of the "crown" of the tooth. Your gumline can be sculpted to give your new smile just the right look.

Soft tissue grafts and other root coverage procedures are designed to conceal exposed roots, reduce further gum recession, and protect your vulnerable roots from decay. During this procedure, your periodontist takes gum tissue from your palate or another donor source to cover the exposed root. This can be done for one tooth or several teeth to even your gum line and reduce sensitivity.

More research is needed to confirm how periodontal disease may put people at increased risk for respiratory disease. What we do know is that mouth infections like periodontal disease are associated with increased risk of respiratory infection. An analysis of research has revealed that periodontal (gum) disease may be a far more serious threat to your health than previously realized.

Several theories exist to explain the link between periodontal disease and heart disease. One theory is that oral bacteria can affect the heart when they enter the bloodstream, attaching to fatty plaques in the coronary arteries (heart blood vessels) and contributing to clot formation. Coronary artery disease is characterized by a thickening of the walls of the coronary arteries due to the buildup of fatty proteins. Blood clots can obstruct normal blood flow, restricting the amount of nutrients and oxygen required for the heart to function properly. This may lead to heart attacks. Researchers have found that people with periodontal disease are almost twice as likely to suffer from coronary artery disease as those without periodontal disease.

Pregnant women who have periodontal disease may be seven times more likely to have a baby that is born too early and too small. More research is needed to confirm how periodontal disease may affect pregnancy outcomes. What we do know is that periodontal disease is an infection and all infections are cause for concern during pregnancy because they pose a risk to the health of the baby. If you are thinking about becoming pregnant, be sure to include an evaluation with a periodontist as part of your prenatal care.

For years we've known that people with diabetes are more likely to have periodontal disease than people without diabetes. Recently, research has emerged suggesting that the relationship goes both ways – periodontal disease may make it more difficult for people who have diabetes to control their blood sugar. Though more research is needed, what we do know is that severe periodontal disease can increase blood sugar, putting diabetics at increased risk for complications.

Sometimes the only way to detect periodontal disease is through a periodontal evaluation. If you value your oral health as well as your overall health, a periodontal evaluation is a good idea—especially if you notice any symptoms of periodontal disease; have heart disease, diabetes, respiratory disease or osteoporosis; are thinking of becoming pregnant; have a family member with periodontal disease; or have a sore or irritation in your mouth that does not get better within two weeks.