In the 1950's Crest toothpaste started the advertising campaign that patients should see the dentist every six months to get their teeth cleaned. This was determined by the advertising department not dentists or research. Here we are over 50 years later except we know a lot more now about the effects of bacteria between the gums and teeth on our oral health and systemic health. In the 1950's the average 60 year old only had 8 teeth left, most had dentures by then. Today we know that bacteria under the gum makes us at higher risk for heart disease, respiratory disease and low birth weight babies in pregnant women. We also know that bacteria above the gum reforms in 24 hours and the deadly bacteria below the gum reforms in 2 months once it is removed. once the bacteria has had a chance to take hold below the gum for a while they form a "biofilm" layer in the connective tissue which is very difficult to remove as it is a "living environment" for forming bacteria inside our tissues. We also know that these bacteria can be transmitted from oral fluid exchange between people, so not flossing is not the only problem. This bacteria causes no pain, and that is why our parents lost their teeth from gum disease as we cannot see or feel them. Even when we treat it in the dental office science has found the bacteria live deep in the gum tissue in the "biofilm" which cannot be easily removed, but must be retreated repeatedly. Even this is not always successful, but again science is helping us and we now have DNA testing of the bacteria sample taken from between the teeth. This allows us to identify particularly aggressive strains of bacteria which may need local and systemic specific antibiotics. The first stage is gingivitis which means the bacteria have invaded the gum tissue making it bleed easier when we floss for example but it has not affected the bone support around the teeth yet. Gingivitis is present in 80% of the general population because it always starts between the teeth and most people do not floss daily effectively. This stage is reversible once treated by a periodontal therapist like Kim but if daily home care including flossing does not follow the treatment then it will return in as quickly as 2-3 months in some cases. The next stage is Periodontitis which means the bacteria have advanced to cause the loss of some bone support around the teeth. Periodontitis is present in 40% of the general population but in a much higher percentage in the population over 40 years of age. Thus gum disease becomes more advanced the older we get and more complex to treat. Tradition treatment is removal of the bacteria from under the gum with the biofilm in the tissue and mineralized bacteria on the root surfaces. Today we use ultrasonics; time released localized antibiotics and topical anesthetics to make it comfortable. In for advanced cases or non responsive cases we use DNA testing, system antibiotics, and Laser instruments. Laser technology helps us treat severe gum disease we could not treat before as the beam penetrates and kills bacteria previously not reachable , creating a sterile zone where bacteria previously thrived and lived.
Many patients have conditions which make it them more susceptible to the bacteria of gum disease such as pregnant women, diabetics, smokers, older patients with limited motor skills, patients with old dental work who have put off have their teeth restored (bacteria trapped in and around old corroded surfaces), patients on medications which makes their month dry (reduces saliva flow) or cause overgrowth of gums (hyperplasia) like Dilantin. Patient who are on radiation or chemo therapy have little resistance to these bacteria, bulimic patients, patient's who have chronic Halitosis , kids with severe gingivitis from not brushing and flossing or have braces on. Any patient with dentures or partials or anyone who does not floss regularly. Then there is patients under emotional stress from work or relationships which results in a compromised immune response to non invasive bacteria. When we do smile makeovers we require our patients to get their gums healthy through active treatment with our periodontal therapist Kim. This helps achieve a beautiful result, but too often patients let their gums go after their makeover and slowly the gum disease returns ultimately resulting in gum recession, root exposure and new spaces between their teeth at the gum line that look like dark holes between their teeth where gum used to be. So health and esthetic or beauty go hand in hand, you cannot have one without the other.
Slowly we are becoming aware of the far reaching effects of gum disease on our bodies. The bacteria between our teeth and in our gums get into our blood stream and is carried through our bodies. Physicians have discovered this link and now I get regular requests for consultations from MD's wanting to do surgery on their patients but require the patient to be free of gum disease before they will go to surgery. The risk of doing surgery with bacteria from gum disease in the blood stream is too great unless it is a life threatening emergency. The connection to heart disease was discovered by the cardiologists as they realized these bacteria in the blood stream triggered the body's immune system to release agents to eat or encapsulate this bacteria resulting in "plaque" in our arteries. This plague clogs our coronary arteries resulting in heart attacks.
Treatment for gum disease starts in the gingivitis stage in our office. Why wait till you have bone loose and biofilm in your tissue and bacteria in your blood stream? Interesting enough often periodontist (gum specialists) do not suggest treatment till the disease gets to the more advanced stage of periodontitis. Their offices are set up to handle more advanced gum disease many general dentists are not trained to treat and refer to the specialist. This presents a problem, as some people are under the opinion that they will get the best gum treatment in a periodontist office, and if they have periodontitis (bone involvement this is often true, but if they have gingivitis they may not be treated aggressively to stop the disease. In our office our goal is to keep the gum disease from advancing by treating the disease as early as possible. Unfortunately gingivitis often goes under treated as the insurance companies do not cover it. Hopefully our profession will correct this approach is the future as more research becomes available and the public become aware of it.
Many patients have conditions which make it them more susceptible to the bacteria of gum disease such as pregnant women, diabetics, smokers, older patients with limited motor skills, patients with old dental work who have put off have their teeth restored (bacteria trapped in and around old corroded surfaces), patients on medications which makes their month dry (reduces saliva flow) or cause overgrowth of gums (hyperplasia) like Dilantin. Patient who are on radiation or chemo therapy have little resistance to these bacteria, bulimic patients, patient's who have chronic Halitosis , kids with severe gingivitis from not brushing and flossing or have braces on. Any patient with dentures or partials or anyone who does not floss regularly. Then there is patients under emotional stress from work or relationships which results in a compromised immune response to non invasive bacteria. When we do smile makeovers we require our patients to get their gums healthy through active treatment with our periodontal therapist Kim. This helps achieve a beautiful result, but too often patients let their gums go after their makeover and slowly the gum disease returns ultimately resulting in gum recession, root exposure and new spaces between their teeth at the gum line that look like dark holes between their teeth where gum used to be. So health and esthetic or beauty go hand in hand, you cannot have one without the other.
Slowly we are becoming aware of the far reaching effects of gum disease on our bodies. The bacteria between our teeth and in our gums get into our blood stream and is carried through our bodies. Physicians have discovered this link and now I get regular requests for consultations from MD's wanting to do surgery on their patients but require the patient to be free of gum disease before they will go to surgery. The risk of doing surgery with bacteria from gum disease in the blood stream is too great unless it is a life threatening emergency. The connection to heart disease was discovered by the cardiologists as they realized these bacteria in the blood stream triggered the body's immune system to release agents to eat or encapsulate this bacteria resulting in "plaque" in our arteries. This plague clogs our coronary arteries resulting in heart attacks.
Treatment for gum disease starts in the gingivitis stage in our office. Why wait till you have bone loose and biofilm in your tissue and bacteria in your blood stream? Interesting enough often periodontist (gum specialists) do not suggest treatment till the disease gets to the more advanced stage of periodontitis. Their offices are set up to handle more advanced gum disease many general dentists are not trained to treat and refer to the specialist. This presents a problem, as some people are under the opinion that they will get the best gum treatment in a periodontist office, and if they have periodontitis (bone involvement this is often true, but if they have gingivitis they may not be treated aggressively to stop the disease. In our office our goal is to keep the gum disease from advancing by treating the disease as early as possible. Unfortunately gingivitis often goes under treated as the insurance companies do not cover it. Hopefully our profession will correct this approach is the future as more research becomes available and the public become aware of it.
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