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Periodontal Disease

Periodontitis
(peri = around, odont = tooth, -itis = inflammation)

Periodontal Disease
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Refers to a number of inflammatory diseases affecting the periodontium — that is, the tissues that surround and support the teeth. Periodontitis involves progressive loss of the alveolar bone around the teeth, and if left untreated, can lead to the loosening and subsequent loss of teeth. Periodontitis is caused by a convergence of bacteria that adhere to and grow on the tooth's surfaces, along with an overly aggressive immune response against these bacteria. A diagnosis of periodontitis is established by inspecting the soft gum tissues around the teeth with a probe and radiographs by visual analysis, to determine the amount of bone loss around the teeth. Specialists in the treatment of periodontitis are periodontists; their field is known as "periodontology" and "periodontics".

Although the different forms of periodontitis are all caused by bacterial infections, a variety of factors affect the severity of the disease. Important "risk factors" include smoking, poorly controlled diabetes, and inherited (genetic) susceptibility. This genetic susceptibility to destructive periodontal disease can now be tested with the PST® test, however the efficacy of this test remains to be studied in a long-term peer-reviewed prospective trials.

The Bel Air Dental Care Team has extensive experience in managing the majority of periodontal related emergencies and treatments.

Our hygienists use the latest equipment and techniques to prevent and treat periodontal disease. Our hygiene appointments are longer than the average dental office, giving the providers adequate time to properly diagnosis disease and treat it accordingly. Our non-surgical hygiene approach includes, but is not limited to, using pain-free ultrasonic cleaners, antimicrobial rinses, and antibiotic chips placed into the gums. These procedures are inexpensive and highly effective in addressing minor, moderate, and even severe cases of periodontitis.

The doctors at Bel Air Dental Care provide a variety of surgical and non-surgical periodontal therapy. Procedures that used to cost thousands of dollars and required referral to a specialist can now be done here on location. Crown lengthening, bone grafting, and implant therapy are just a few of the periodontal procedures that can be performed in our office.

Symptoms may include the following:

  • Occasional redness or bleeding of gums while brushing teeth, using dental floss or biting into hard food (e.g. apples) (though this may occur even in gingivitis, where there is no attachment loss)
  • Occasional gum swelling that recurs
  • Halitosis, or bad breath, and a persistent metallic taste in the mouth
  • Gingival recession, resulting in apparent lengthening of teeth. (This may also be caused by heavy handed brushing or with a stiff toothbrush.)
  • Deep pockets between the teeth and the gums (pockets are sites where the attachment has been gradually destroyed by collagen-destroying enzymes, known as collagenases)
  • Loose teeth, in the later stages (though this may occur for other reasons as well)

Patients should realize that the gingival inflammation and bone destruction are largely painless. Hence, people may wrongly assume that painless bleeding after teeth cleaning is insignificant, although this may be a symptom of progressing periodontitis in that patient.

Daily oral hygiene measures to prevent periodontal disease include:

  • Brushing properly on a regular basis (at least twice daily), with the patient attempting to direct the toothbrush bristles underneath the gum-line, so as to help disrupt the bacterial growth and formation of subgingival plaque.
  • Flossing daily and using interdental brushes (if there is a sufficiently large space between teeth), as well as cleaning behind the last tooth in each quarter.
  • Using an antiseptic mouthwash. Chlorhexidine gluconate based mouthwash or hydrogen peroxide in combination with careful oral hygiene may cure gingivitis, although they cannot reverse any attachment loss due to periodontitis.
  • Using periodontal trays to maintain hydrogen peroxide or other dentist-prescribed medications at the source of the disease. The use of trays allows the medication to stay in place long enough to penetrate the biofilms where the bacteria are found.
  • Regular dental check-ups and professional teeth cleaning as required. Dental check-ups serve to monitor the person's oral hygiene methods and levels of attachment around teeth, identify any early signs of periodontitis, and monitor response to treatment.

Typically dental hygienists (or dentists) use special instruments to clean (debride) teeth below the gum line and disrupt any plaque growing below the gum line. This is a standard treatment to prevent any further progress of established periodontitis. Studies show that after such a professional cleaning (periodontal debridement), bacteria and plaque tend to grow back to pre-cleaning levels after about 3-4 months. Hence, in theory, cleanings every 3-4 months might be expected to also prevent the initial onset of periodontitis. However, analysis of published research has reported little evidence either to support this or the intervals at which this should occur. Instead it is advocated that the interval between dental check-ups should be determined specifically for each patient between every 3 to 24 months.