Gum Disease, 410-696-4624, Dr. Trepp, Orthodontist

Gum/Periodontal Disease

Gum disease (periodontal disease) can occur at any age. Many people think of periodontal disease as an adult problem. However, studies indicate that nearly all children and adolescents have gingivitis, the first stage of periodontal disease. Advanced forms of periodontal disease are more rare in children than adults, but can occur. Periodontal disease is an inflammatory infection of your gums and bone caused by the bacteria that adhere to your teeth. The bacteria often congregate in invisible colonies called biofilm. The bacteria produce toxins or poisons that irritate your gums. The toxins also stimulate a chronic inflammatory response in which your body in essence turns on itself. Your body produces protein hormones called cytokines. They allow the tissues and bone that support the teeth to be broken down and destroyed. These cytokines act as a form of communication between other inflammatory cells not only in the gums and bone but also in other body organs far from the mouth and can have serious consequences. Additionally, physicians are beginning to measure the blood level of C-reactive protein (CRP) which is produced by the liver. The level of CRP rises when there is inflammation throughout the body and may be associated with the following:
    * Cancer
    * Connective tissue disease
    * Heart attack
    * Infections (such as gum disease)
    * Inflammatory bowel disease (IBD)
    * Lupus
    * Pneumococcal pneumonia
    * Rheumatoid arthritis
    * Rheumatic fever
    * Tuberculosis

Periodontal Disease Can Affect Your General Health Adverely

Gum Disease Can Effect The Health Of Other Parts Of Your Body

In the early stage of the disease, called gingivitis, gums may swell, turn red and bleed easily. Eventually, these toxins cause the tissues to separate from the tooth and form deepened spaces called pockets. If left untreated, the disease can progress to the bone. Because gum inflamation and bone destruction are largely painless, people may wrongly assume that the painless bleeding after teeth cleaning is insignificant.

Basic signs will alert you to periodontal disease:

Bleeding Gums Indicate Inflamation And Disease Puffy, Swollen Gums Indicate Inflamation And Disease Receding Gums Indicate Gum And Bone Destruction
Bleeding Gums - Puffy, Tender, Bright Red Gums - Receding Gums

In later stages of the disease called periodontitis, the bone and the soft tissues that support the teeth can be destroyed. This can cause the teeth to become loose, fall out, or have to be removed by your dentist. Periodontitis is the most frequent cause of tooth removal for people over 40 years of age.

A May 2000 article in the Journal of Periodontology states that cigarette smoking may be responsible for more than half the gum disease in US adults. Current smokers are four times more likely to have gum disease than those who have never smoked.. The more cigarettes you smoke each day, the greater the odds you'll get gum disease. Quitting smoking seems to gradually reduce the harmful effects of tobacco on your gums.

Periodontal (gum) disease may be passed from parents to children and between couples, according to an article in the September 1997 issue of the Journal of the American Dental Association. Researchers suggest that the bacteria that cause periodontal disease pass though saliva. This means that the common contact of saliva in families puts children and couples at risk for contracting the periodontal disease of another family member. If one family member has periodontal disease, all family members should see a dental professional for a periodontal evaluation.

In addition, it's well documented that women who are pregnant and have periodontal disease are far more likely to give birth earlier (prematurely) and give birth to low birth weight babies than women with healthy gums. The mouth is the portal to the body, it should be no surprise that an infected mouth can affect your unborn baby. Premature babies are born with serious health complications that last throughout life, from cerebral palsy to mental disabilities to blindness. Prematurity is also the leading cause of neonatal death in this country. The American Dental Association is working with the March of Dimes Prematurity Campaign to raise awareness of the link between gum disease and premature births.

Diabetics with gum disease have a harder time controlling their blood sugar as measured by their A1c.

Obese patients are 8 times more likely to have periodontal disease.

Recently, a link between gum disease and gastric ulcers has been established. Gastric ulcers are caused by a particular type of bacteria. That same bacteria is also found in periodontal pockets. It is theorized that this type of bacteria can be swallowed from the mouth to the stomach where it contributes to gastric ulcer formation.

Harvard researchers reported in January 2007, that men with a history of gum disease were at a 64% higher risk for pancreatic cancer compared with those with healthy mouths. This study's lead author said, "People think of gum disease as being in their mouth. But when it gets severe, it's not just in the mouth. It's probably in the entire body."

A study published in the September 2008 Journal of Periodontology concluded that controlling gum disease may reduce the incidence and progression of chronic kidney disease.

Are you starting to see the connection, an unhealthy mouth may lead to an unhealthy body.

Be aware that Biophosphate drugs (Fosamax, Boniva, Actonel and Reclast) that fight osteoporosis and prevent broken bones can make fighting gum disease more difficult because these drugs make bone more dense. This makes it difficult for gum disease fighting antibiotics to reach the gum infection and slows down the rate of bony repair. Please tell your dentist about all drugs that you are taking.

Your periodontal risk factors as determined by your history, x-rays and probing will dictate how aggressively and quickly your dentist work to eliminate your inflammation. Because periodontal disease can cycle up and down in intensity over time, your dentist will also set up a monitoring program based on your risk factors and your body's response to your initial therapy.

If you are at low risk, simple physical removal of the bacteria called debridement may eliminate the inflammation. Dentists used to scrape the bacteria off by hand, but now many use ultrasonic devices that disable the bacteria by a combination mechanical chipping at their colonies, cavitation shock waves similar to mini tornados with turbulence that strips the bacteria of their hair like feet/flagella and the forceful flushing of the loosened and bombarded colonies by the water stream at the ultrasonic device tip. The elimination of bleeding at previous bleeding sites is the measure of successful periodontal therapy. If you are a medium to high risk patient, your dentist will work to neutralize the bacteria by debridement and may place high dose localized antibiotics next to your teeth in the more severe areas. In addition to neutralizing the bacteria, if you are at medium to high risk, your dentist may prescribe a low dose systemic antibiotic such as doxycycline to reduce the harmful production of inflammatory mediators by your body. The highest risk patients and those lower risk patients who show little inflammatory improvement as measured at original bleeding sites, will need to be referred to a periodontal specialist. The periodontal specialist may need to do outpatient surgery to temporarily move the gum tissue out of the way so bacteria in the hardest to reach places can be removed and the healing process can begin. Some gum and bone damage cannot be restored by the best of therapy. This finding makes it essential to see your dentist for an inflammation evaluation on a regular basis before damage is irreversible.

You may schedule an orthodontic appointment with Dr. William Trepp in his Severna Park, MD office by calling 410.696.4624 or in his Clinton, MD office by calling 301.868.6200. Written inquiries should be mailed to: 69 Robinson RD, Severna Park, MD 21146, USA or 8918 Woodyard RD, Clinton, MD 20735, USA