"Your smile is a messenger of your good will.  Your smile brightens the lives of all who see it.  To someone who has seen a dozen people frown, scowl or turn their faces away, your smile is like the sun breaking through the clouds.   Especially when that someone is under pressure from his bosses, his customers, his teachers or parents or children, a smile can help him realize that all is not hopeless—that there is joy in the world."--Dale Carnegie     

Allow us to create the smile that will not only brighten your life but all those who are so fortunate enough to receive it!  Let's impact all those around us by making the world a brighter and more cheerful place to live, one smile at a time!

Gum Disease

Recent studies, conducted by the Centers for Disease Control and published by the American Academy of Periodontology, state that approximately half of all American adults ages thirty and over exhibit some form of periodontal disease whether mild, moderate, or advanced.   For those sixty five years of age or older this percentage increases to a whopping seventy percent and increases in severity with age.   It has also been reported that an unfathomable ninety five percent of those with diabetes, a pandemic affecting an approximate 29 million people in the U.S.,  are at risk of developing periodontal disease.  Therefore, this population is at extremely high risk for loosing teeth to this devastating disease. 

A new study reported in the Journal of Periodontology indicated that periodontal disease has a higher predilection in some ethic groups with 63.5% of Hispanic Americans, 59.1% of Non-Hispanic Black Americans and 50% of Non-Hispanic Asian Americans having the disease.  

Periodontal disease is the leading cause of adult tooth loss in the U.S..  Thus, early diagnosis and treatment is imperative if one is to maintain their teeth for a lifetime.  In order to be diagnosed and treated properly, a thorough comprehensive oral evaluation performed by a dentist is absolutely crucial.  

Tooth loss can be utterly debilitating!   Study after study has been cited correlating loss of teeth to shortened life spans.   When teeth are removed, sometimes the only affordable option is a denture(s).  Dentures, without implant support, can severely diminish the patient's ability to chew and therefore obtain the proper nutrients needed to maintain a long healthy life.  With natural teeth, people can generate a bite force of approximately 200 psi(pounds per square inch).  With upper and lower dentures the same patient can only generate an average bite force of 50psi or one fourth that of what they did with natural teeth.   After 15 years of wearing dentures, the maximum bite force decreases to a ridiculous 5.6 psi. In addition,  it is a know fact that there exists a correlation between periodontal disease and cardiovascular disease and stroke.  Periodontal disease can also be linked to premature labor and low-birth weight infants as well as osteoporosis and numerous other systemic diseases.

There exists two forms of gum disease, one of which is completely reversible and the other form which, at this point in time, is not.
The two forms of gum disease are respectively termed 1)gingivitis and 2)periodontitis.  
    

Gingivitis  


The suffix "itis" means "inflammation of" therefore, gingivitis means inflammation of the gingiva or gums.   Gingivitis is an inflammation of the gums caused by an interaction of plaque(a combination of food debris and bacteria) with host's immune system causing signs of redness, swelling, and bleeding.  Symptoms, although rare, can manifest as tenderness or pain.   This inflammatory process can be acute(short term) or chronic(long term) in nature depending on local factors such as bacterial load, environmental insult such as smoking, and/or host factors such as presence of diabetes or hormonal changes.  What differentiates gingivitis from periodontitis is simply the loss of bone or supporting structures surrounding the tooth.   If left untreated gingivitis can develop into periodontitis
Picture of Oral Health(Healthy Gums)
Gingivitis

Periodontitis

Periodontitis, as mentioned previously, means inflammation of the periodontium or more specifically inflammation of any of the supporting structures of the teeth whether it be the gums, periodontial ligament or most importantly the bone or boney socket surrounding the tooth.   Differentiated from gingivitis periodontitis is characterized by loss of bone.   As with gingivitis, periodontitis also develops as response to plaque and bacterial load.   If plaque is allowed to remain around the neck of the tooth for long periods of time, a formation called calculus develops.   Calculus is essentially hardened or mineralized plaque.   Calculus allows for colonization of harmful bacterial and accumulation of more plaque and later more calculus.   As the body mounts an inflammatory response against the plaque and bacteria, the bacteria continue to produce toxins.   The combination of our immune response or inflammatory response to attempt to get rid of the insult and the production of toxins by the bacteria leads to a loss or melting away of bone if you will.    Periodontitis can be acute or chronic in nature, as well, but unlike gingivitis due to the fact that bone has been lost the effects are irreversible.  There are some promising techniques and procedures using lasers that claim to regrow bone but as of yet there is no definitive proof of such.   Therefore, treatment is aimed at slowing or cessation of the progression of the disease process.   Periodontitis can be termed mild/early(meaning there is a less than a twenty percent bone loss circumferentially), moderate(meaning there is an approximate twenty to fifty percent bone loss circumferentially) or advanced(meaning a greater than fifty percent bone loss).   Generally advanced periodontitis requires removal of the teeth and mobility is very apparent.    The following is a representation of  mild/early, moderate, and advanced periodontitis.  Make note that periodontitis occurs circumferentially yet, the following pictorials are demonstrating a healthy periodontium on left and on the right the unhealthy(or respective degree of periodontitis) state.   

  Early Periodontitis
Moderate Periodontitis
Advanced Periodontitis

Diagnosis and Treatment

Each and every patient is thoroughly evaluated and screened for periodontal disease during the comprehensive oral evaluation.   If an appointment is made to address pain, a broken tooth, or another immediate concern, this is seen on an urgent care basis and treatment will be rendered accordingly so as to remedy the pain or immediate concern.  If this is the case, a comprehensive oral evaluation will follow.  If a new patient schedules an appointment for a cleaning and/or exam, generally the appointment time varies between forty-five minutes to an hour.   During this time, as mentioned above, a thorough comprehensive oral evaluation will be performed.  Based on the comprehensive findings a cleaning may or may not be deemed appropriate on that visit.  If in fact, the oral tissues are deemed healthy or if gingivitis is present a cleaning(prophy) will be performed.   If a diagnosis of periodontitis is rendered, a second and sometimes a third appointment lasting between one to two hours will be scheduled for the appropriate treatment to be rendered.  Not to worry, the majority of patients are delighted as to how thorough and more importantly how comfortable the procedure is.  Part of the periodontal evaluation will be measurement of sulcus depth.   Everyone has a canal(sulcus) that runs circumferentially around the tooth.   Through much study it has been ascertained that a measurement of 3mm or less  is deemed healthy whereas, 4mm or greater is deemed unhealthy.   Generally, a probing depth of 5mm or greater clearly indicates the presence of periodontal disease.  Bleeding on probing, recession, and mobility are other factors that are evaluated amongst many.   Above you should note that the probe is marked off in 3mm increments to demonstrate the lack or presence of periodontal disease.   The hygienist  will probe six sites on each tooth, recording each measurement in a computer program for reference.   The Dr. will read the depths, evaluate the patient and make a diagnosis.   From the diagnosis a comprehensive treatment plan will be formulated.   In some instances recommendation to a specialist or periodontist is deemed appropriate.    If it is determined that periodontal disease is present, depending on the severity, periodontal scaling and root planning will be recommended as the first modality of treatment.  Scaling and root planning, more commonly known as a deep cleaning, aims at removing all calculus and plaque and lessening the bacterial load so as to allow for the body to heal.  Four to six weeks post-treatment the patient will be re-assessed and a touch up cleaning performed.   The patient will then be placed on a 3-4 month re-evlauation and maintenance schedule, each time re-assesing the progress and ensuring we are proceeding in the best interest of the patient.  As stated earlier, treatment is focused on slowing or hopefully stopping the progression of the disease or progression of bone loss.   If it is determined that neither of these is being accomplished through our efforts, a recommendation to the periodontist will be made accordingly.    Most cases of periodontitis are chronic in nature and progress very slowly although there are some instances where bone loss is rapid.   Regardless, of whether chronic or acute, immediate action is required in order to maintain a healthy dentition for a lifetime.