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What causes periodontal disease?
Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless "plaque" on teeth. Brushing and flossing help get rid of plaque. Difficult-to-reach areas can worsen as the plaque matures into a more harmful ecosystem that permits bacteria to thrive in a more acidic environment that also has less oxygen. These acid-loving anaerobes as they are referred to, destroy the lining of the tissues facing the teeth (the pockets) and can destroy nearby bone. Plaque that is not removed can also harden and form bacteria-harboring "tartar" that brushing doesn't clean. Bacteria hide and live in the tartar the way fish live and scoot about coral reefs. Only a professional cleaning by a dentist or dental hygienist can remove tartar. Left over a period of time, gum disease becomes establish and more treatment than a routine cleaning is required to return the gums back to health.

The longer plaque and tartar are on teeth, the more harmful they become. When bacteria cause inflammation of the gums, it is called "gingivitis." In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place. The LANAP™ is not required to treat gingivitis.

When gingivitis is not treated, it can advance to "periodontitis" in which the gums pull away from the teeth and form "pockets" that are infected with harmful bacteria. The body's immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body's enzymes fighting the infection actually start to break down the bone and connective tissue that hold teeth in place. Left untreated, the bones, gums, and connective tissue that support the teeth are destroyed. The teeth may eventually become loose and need to be removed. Leaving severely diseased teeth in the mouth too long may limit the ease of inserting dental implants for replacements.

Risk Factors
  • Smoking. Need another reason to quit smoking? Smoking is one of the most significant risk factors associated with the development of periodontitis. Additionally, smoking can lower the chances of success of some treatments, including the LANAP™.
  • Hormonal changes in girls/women. These changes can make gums more sensitive, swollen, and inflamed, and make it easier for gingivitis to develop. An established periodontal condition tends to worsen in patients sensitive to hormonal changes or those on hormone replacement therapy.
  • Diabetes. People with diabetes are at higher risk for developing infections, including periodontal disease.
  • Stress. Research shows that stress can make it more difficult for our bodies to fight infection, including periodontal disease. Certain bacteria that are causative agents for periodontal disease thrive on the hormonal changes to our body associated with stress.
  • Medications. Some drugs, such as antidepressants and some heart medicines, can affect oral health because they lessen the flow of saliva. (Saliva has a protective effect on teeth and gums.) Others, like calcium channel blockers and Dilantin, can made the gums swell.
  • Illnesses. Diseases like cancer or AIDS and their treatments can also affect the health of gums.
  • Genetic susceptibility. Some people are more prone to severe periodontal disease than others.

Who gets periodontal disease?
Most people will eventually demonstrate some form of gum disease. People usually don't show signs of gum disease until they are in their 30s or 40s. When it occurs earlier, it is a sign that genetics may play a role in the disease process, or that an individual has a poor host response to the organisms in their mouths. Regardless, gum disease discovered at any age should be treated when it is discovered so that it does not progress and/or to limit the destructive forces at work.

What can I do to prevent gum disease?
Here are some things you can do to prevent periodontal diseases:

  • Brush your teeth twice a day (with a fluoride toothpaste)
  • Floss every day
  • Visit the dentist routinely for a check-up and professional cleaning
  • Eat a well balanced diet. Avoid simple sugars (especially sticky candies like taffy or caramels) and sweetened drinks such as soda.
  • Don't use tobacco products

How is periodontal disease treated?
The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. Additionally, modifying certain behaviors, such as quitting tobacco use, will be suggested as a way to improve treatment outcome.

Deep Cleaning (Scaling and Root Planing)
The dental profession a dentist, periodontist, or dental hygienist - removes the plaque and tartar through a deep-cleaning method called scaling and root planing. In incipient and mild cases, scaling and root planning may be all that are necessary (along with good oral hygiene habits that include flossing and brushing) to treat the condition.

Surgery vs. Laser
SURGERY. When significant inflammation and deep pockets are present at the onset, scaling and root planing will not be enough to remove the tartar on the roots under the gums to make the pockets smaller. Next gum treatment may involve surgery that lifts back the gums and removes the tartar. Roots are scaled again during this procedure and, often, the bone is recontoured in an effort to reduce the residual gum pockets. Gum recession often results from this step which may not be avoided. The gums are then sutured and a dressing is often placed around the teeth during the first week of healing.

Bone and tissue grafts are often suggested to replace or encourage new growth of bone or gum tissue destroyed by periodontitis. A technique that may be used with bone grafting is called guided tissue regeneration, in which a small piece of mesh-like fabric is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow.

Since each case is different, it is not possible to predict with certainty which grafts will be successful over the long-term. Treatment results depend on many things, including severity of the disease, ability to maintain oral hygiene at home, and certain risk factors, such as smoking, which may lower the chances of success.

LASER. While traditional periodontal surgery provides many benefits and advantages in treating gum disease, LASER gum surgery approaches the problem from a different perspective. The Nd:YAG (Neodymium: Yttrium Aluminum Garnet) Periolase™ by Millenium Dental Technologies is able to remove only the diseased tissue and it leaves the normal tissue intact. Gum recession, if any, is at a minimum. It accomplishes this by detecting changes in color so that red, inflamed tissue is treated and healthy, pink tissue is nominally affected.

By understanding this distinction between LASER treatment and traditional gum surgery that incises and cuts away the collar of tissue that surrounds the neck of each tooth, the sequence of gum treatment should be altered. If LASER gum treatment is considered, then it is preferred NOT to scale and root plane the teeth because these steps, while beneficial to the gums, reduce the amount of bleeding and redness in the gum; this affects the efficiencies of the LASER.


Recent studies suggest gum disease may contribute to, or be a warning sign of potentially life threatening conditions such as:

Heart Disease and Stroke - Studies suggest gingivitis may increase the risk of heart disease and stroke because of the high levels of bacteria found in infected areas of the mouth. As the level of periodontal disease increases, the risk of cardiovascular disease may increase with it. Other studies have suggested that the inflammation in the gums may create a chronic inflammation response in other parts of the body that has also been implicated in increasing the risk of heart disease and stroke.

Diabetes - People with diabetes often have some form of gum disease, likely caused by high blood glucose, according to the CDC. People with diabetes need to take extra care to ensure proper brushing and flossing techniques are used to prevent the advancement of the gum disease. Regular check-ups and cleanings with your dental hygienist should be followed.

Chronic Kidney Disease - A study, conducted by Case Western Reserve University, suggests that people without any natural teeth, known as edentulous, are more likely to have chronic kidney disease (CDK), than people with natural teeth. CDK affects blood pressure potentially causing heart disease, contributed to kidney failure, and affects bone health.

Pre-term Birth - Babies that are born premature - before 37 weeks of gestation - may face numerous health complications. Research indicates that women with untreated periodontal disease are three to five times more likely to have a baby born pre-term compared to women without any form of gum disease. Women are more susceptible to gingivitis when pregnant and should follow their regular brushing habits, and continue with dental cleanings and examinations.

For a dental appointment to have Dr. Winter evaluate your condition, call: 212-838-0940
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