What are the common signs of periodontal disease?
Swollen, painful gums, bleeding, mobility, malodor, shifting teeth, rotating teeth, pain when chewing.
Who should treat my periodontal disease: my general dentist or a periodontist?
This is a complex answer to explain. General dentists go through extensive training in all facets of dental conditions and oral diseases. Periodontists, however, receive extensive training in treating periodontal disease, including three additional years of education beyond dental school. They are constantly learning the latest techniques for diagnosing and treating periodontal disease. Periodontists often treat more severe periodontal disease patients, such as those with a complex medical history. Periodontists provide all types of treatments, such as scaling and root planing (in which the infected surface of the root is cleaned) or root surface debridement (in which damaged tissue is removed). They are also trained in a vast array of surgical procedures to treat periodontitis.
Why do I need a Periodontist for scaling and root planing?
The answer is simple. Periodontal disease does not have a cure. Any treatment that is completed needs to be evaluated for efficacy and monitored for recurrence. Additionally, home care procedures are evaluated and tweaked if necessary in order to maximize the benefit of treatment and to prevent a recurrence.
What is the first visit like?
During the first visit, we will review the patient’s complete medical and dental histories. It is extremely important for the periodontist to know if any medications are being taken or if the patient is being treated for any condition that can affect periodontal care, such as heart disease, diabetes, or pregnancy.
Dr. Kuznia or Dr. Storch will examine the gums, check to see if there is any gum line recession, assesses how the teeth fit together when biting, and check the teeth to see if any are loose. We will also take a small measuring instrument called a probe and place it between the teeth and gums to determine the depth of those spaces, known as periodontal pockets; this helps assess the health of the gums. X-rays may also be taken to observe the health of the bone below the gum line.
What are the consequences of missing teeth?
A missing tooth may not seem to have many immediate consequences. The truth is, of course, much more complicated. Clearly, missing one of your front teeth can cause significant esthetic concerns. A back tooth, while maybe not an esthetic concern, can cause a very serious immediate loss in function. Over time teeth will shift to try to compensate for the change. Shifting can damage the remaining teeth by leaving them in a position where they cannot effectively withstand the forces of chewing. This can lead to tooth mobility, pain, and additional tooth loss. The more teeth that are missing, the harder it becomes to restore the natural appearance and function of your smile.
How is gum disease linked to cardiovascular disease?
Experts agree that periodontal disease increases the risks of the following atherosclerotic cardiovascular diseases (ACVD) and their events:
- Coronary Heart Disease which presents as angina or heart attack
- Ischemic Cerebrovascular Diseases such as stroke or mini-stroke (transient ischemic attack or TIA)
- Peripheral Vascular Diseases such as deep vein thrombosis
This risk association has been demonstrated independent of other well-known cardiovascular risk factors such as smoking and diabetes. It is thought that periodontal bacteria and the by-products leak into the circulation through periodontal pockets. This initiates a chronic inflammatory response in the bloodstream which promotes development, maturation, and instability of fatty lesions (atheroma) in the arteries leading to an ACVD event. In addition, multiple studies prove the existence periodontal pathogens, viable and non-viable, within atheroma in all locations in the body. Also, antibodies that normally fight these bacteria can cross-react with the cells lining the arteries and other blood-borne compounds, perpetuating the inflammatory process.
Thankfully, periodontal therapy has been shown to reduce the overall level of inflammation within the circulation, as shown in the reduction of a number of biomarkers such as C-reactive protein, endothelial cell function, blood clotting ability, and arterial blood pressure among others. It is widely accepted among health professionals that periodontal therapy, along with improved oral hygiene, can help reduce overall systemic inflammation and should be part of a patients plan toward improved cardiovascular health.
Is there a link between periodontal disease and diabetes?
Research has proven time and again that there is a very close link between periodontal disease and diabetes mellitus. Not only can poorly controlled Diabetes lead to a progression in periodontal disease, but untreated periodontal disease can increase the bodies’ inflammatory load making it more difficult to control their blood sugar.
Diabetes patients have a higher susceptibility to infection, thus are at greater risk for developing periodontal disease, even in patients with well-controlled diabetes. Increased sugar in the blood impairs the body’s defense system against infection, mainly the white blood cells.
Diabetes can also cause thickened blood vessels, making it harder for immune cells to travel to an area of infection. Even worse, diabetes also damages the collagen repair mechanism in our body, so the body has even more trouble healing from a wound. Uncontrolled diabetes allows all of these destructive effects to occur at an even faster rate.
On the other hand, periodontal disease has been shown to increase blood sugar. This allows greater periods of time when the body has to function with higher blood sugar. Bacterial infections, like gum disease, have a negative effect on the body’s metabolism. This makes it more difficult for the patient to consistently control healthy blood sugar levels. Periodontal disease may be a chronic infection, but its’ effects increase the risks of many complications of diabetes: glaucoma, neuropathy, high blood pressure, stroke, and many others.
The good news is that evidence shows that periodontal therapy helps! Treating periodontal disease may help prevent complications of diabetes by helping maintain your blood sugar. Recent evidence suggests treating periodontitis can decrease HbA1c% by approximately 0.4%.
Maintaining oral health allows you to better control your blood sugar. If you or someone you know has diabetes, we urge you to schedule an appointment today to test for periodontal disease.