An Iraqi girl learns how to brush her teeth for the first time.

Dental decay is not much of an issue in modern society (thanks to fluoridated water and toothpaste), but a proper hygiene routine is still necessary to prevent gum disease and/or cavities. Brushing and flossing is essential, as this both cleans the smooth surfaces of the teeth, and also helps break up food particles and plaque in between the teeth and gum line. Gum disease starts in between the teeth, and some toothbrushes can’t reach critical areas necessary to be cleaned to prevent bacteria from growing.

Although gingivitis – the bacterial infection that invades your gums – is reversible, periodontitis is gum and bone disease, and is not irreversible! Because periodontal disease is so serious, and can only be managed under the strict supervision of a dental professional, it is important to understand just how periodontal disease can affect you. This disease has been linked to heart disease, stroke, diabetes and other degenerative diseases that can be life threatening! I’ve blogged about periodontitis before, and I can’t stress enough how important and serious it can be to have regular cleanings and check-ups from a dental professional twice yearly. Periodontal disease can disfigure even the most beautiful of smiles. Your gums can be so swollen, receded and bloody that your teeth will look longer, will become loose and eventually will need removal. If you detect gum disease early, you will need a management program that includes regular treatment with your dentist and/or hygienist and solid home care to manage the disease.

Root planing and scaling is the common form of soft tissue management treatment, when a hygienist or dentist uses a precise tool to detoxify the tooth surfaces below the gum line and in between each tooth, and then rinses with antiseptic. With advanced technology, laser energy can also be utilized to remove diseased tissues and eliminate bacteria to allow healing to take place. Your dental professional will discuss the best treatment plan for you  – a routine cleaning is not enough by itself to treat periodontal disease! You may need to visit your dental hygienist more often, up to four times per year in order to properly manage the disease. On a daily basis, a solid home care program (which should be designed by you and your dentist) will help you maintain your oral health. Besides brushing and flossing after every meal, other tools like prescription tooth brushes (like Rotadent) and water irrigators (like Hydrofloss) could be helpful for your hygiene routine. Antiseptic rinses like Tooth and Gum Tonic Herbal Rinse, a healthy diet and/or supplements and antioxidants like vitamin C and B can also help to fight and manage gum disease. Healthy gum supports a healthy smile, which supports a healthy body!

Healthy gum appears pink and firm. Brushing and flossing in the healthy stages of gum tissue will be a pleasant experience and there will be no bleeding. This is the phase that all gum tissue should be in if it is healthy and clean. Once gingivitis sets in (the beginning stages of gum disease), gums will take on a red and puffy look, and bleed easily upon brushing and flossing. Once gum disease progresses, the chances of returning to a healthy condition deceases drastically – once gum tissue has reached the advanced level, it is likely past of the point of no return and will result in tooth loss. Periodontal disease is the #1 reason of tooth loss.

Healthy gums and teeth

Gingivitis, which is the early stage of gum disease, if treated professionally (with an implemented solid home care program), gum can return to be healthy again without further consequences. So how do we categorize the stages of gum disease (besides the clinical characteristics)? A bleeding index and dental radiographs help, along with periodontal probing depths, which are universally used as guide to diagnose and monitor the progress of the treatment and condition of gum disease. The periodontal probing depths are obtained with a read-out, by lightly inserting a needle (thin and finely marked instrument) sliding between the space between the gum and tooth.

The stage of gingivitis.

Gingivitis, could have a normal pocket reading of 0 to 3 mm. Gum will be red, puffy, and tender, it will bleed easily and possibly exhibit bad breath and bad taste.

Early (mild) periodontitis will show a pocket reading range from 3 t o 5 mm. At this stage, gum gets more tender, bleeds more easily, and there is always looming bad breath and bad taste. At this stage of gum disease, immediate attention and treatment is required if there is any chance of reversing the condition to an easily-manageable and healthy state.

Mild Periodontitis

Moderate Periodontitis is characterized by a periodontal pocket depth of 5-7mm. Gum tissue may become even redder and puffier, it will bleed easily, and bad breath and bad mouth taste are constant.Often times teeth may begin to look longer as gum tissue recedes, and gum boils or abscesses may develop. Front teeth may begin to drift apart showing space or becoming loose.

Moderate Periodontitis

Advanced Periodotitis gets a pocket measurement of more than 7 millimeters, and may progress to 11 or 12 mm, indicating that bone and connective tissues have been continuously destroyed. This is the terminal stage of gum disease. If a patient has just been diagnosed with advanced periodontitis and the teeth are still firm (pockets are less than 9mm, with longer roots, and more localized condition), then there is possibility that with gum surgery and graft, bone regeneration still is possible. Keep in mind however, that the prognosis is guarded. In most situations, advanced periodontitis will result in tooth loss. Replacement implant therapy or other restorative options will be advised.

Advanced Periodontitis

Remember that prevention is the best treatment, especially for gum disease. You are the person who can best take care of yourself, be disciplined with your home care program (including hygiene) and schedule regular check-ups with both your dentist and dental hygienist who can help you stay away of big problems.

Thanks to a grant awarded by the National Institutes of Health, West Virginia University has found an obscure link between periodontitis (gum disease) and memory loss. A test sample (of over 270 seniors) was chosen to be part of the university study, during which School of Dentistry researchers checked the oral and cognitive health of patients every day over a period of roughly two years. Initial conclusions showed that 23% of the group who suffered from mild to moderate memory loss also had relatively poor oral hygiene habits.

Dr. Crout of the WVU School of Dentistry explains that although the specific genetic link between periodontitis and memory loss has not yet been defined, the team hopes to have more details soon. “If you have a gum infection, you’ll have an increased level of inflammatory byproducts,” Crout explained. “We’re looking for markers in the blood that show inflammation to see if there is a link to memory problems. We’d like to go full circle and do an intervention — to clean up some of the problems in the mouth and then see if the inflammatory markers go down.”

We’re not quite sure about whether bacteria or the body’s inflammatory response is the contributing factor of observed memory loss; it may be a combination of both, or a result of other environmental and physiological factors. What we do know, however, is that the rate of Alzheimer’s cases is skyrocketing. Imagine the benefits of knowing that keeping the mouth free of infection could cut down cases of dementia – it could be revolutionary!

Keep brushing and flossing to keep the mind sharp – or maybe we need a sharp mind to keep brushing and flossing?  As a clinician, when I see a patient who can’t keep their oral hygiene in reasonable condition, I become concerned. The risk of heart attack and stroke are heightened in patients who suffer from poor oral hygiene. Knowing that memory loss is somewhat associated with inflammatory factors in the mouth, we should all improve our oral health in order to keep our mind sharp!

The association between periodontitis and coronary heart disease is not a new concept, but a genetic link between the two is a new concept which provides startling information for dental professionals and patients regarding the gravity of gum disease, as well as its potentially devastating systemic effects throughout the body. Specifically, the researchers were noted as finding “that the two diseases share a genetic variant on chromosome 9. The genetic variation associated with the clinical pictures of both diseases was identical.” The link between the two diseases postulated the following conclusion: “we think that periodontitis should be taken very seriously by dentists and diagnosed and treated as early as possible,” Dr. Schaefer said, noting that periodontitis and heart disease share risk factors such as smoking and obesity.

Although this information doesn’t change how we should treat oral hygiene or periodontitis, it does serve as a wake-up call for everyone regarding how important our oral hygiene routines should be. It is vital to brush your teeth after every meal (and after that midnight snack)! Late-night and mid-day nibbling can cause the most harm to one’s oral environment, from a lack of desire or motivation to clean both the surface and crevices of the teeth. Bacteria thrive in dirty surroundings! Drinking sugary liquids like soda not only provides zero nutritional value, it also creates unhealthy habits which wreak havoc on the oral environment – stick to water or tea if you can. Remember, once the deterioration of dental structures starts, damage may be very difficult or impossible to reverse or restore completely! Prevention is the best measurement, and it is within your reach. Ask your dental professional about prevention – it is easy to work on, both for a cleaner oral environment and for a stronger bacterial host resistance.  A healthy mouth may lead to a healthy heart, and such health is priceless.

Take caution at the first signs of Gingivitis!

Typical signs of gum disease include bleeding gums, red or swollen gums, loose teeth or halitosis (bad breath). It all starts with inflammation of the gum tissue, which is called gingivitis: symptoms are light and include occasional bleeding, which can if left undiagnosed can progress to irreversible periodontal disease. This in turn can cause unhealthy systemic conditions such as heart attacks and hypertension! Of course, a fully implemented oral hygiene routine is your first and safest bet in preventing bacterial agents that cause gum disease. Brush and floss your teeth for two minutes minimum twice a day and after every meal. This will prevent bacteria and plaque from building up between your teeth and between your gums, which cause the beginning stages of both gingivitis and halitosis. It is also important to build up your host resistance to prevent tissue break down by maintaining a healthy diet rich in antioxidants, like Vitamin C, B and E, calcium, magnesium and silica.

If you do have signs of gum disease, try these remedies to reduce your symptoms. Salt water: this old home remedy can help you not only relieve the symptom of a sore throat, but can also reduce the swelling and bleeding of gum tissues. It can also reduce halitosis in minor cases. Eating right, as mentioned by foods rich in vitamin C (or take supplements) will also help. Tea tree oil can aid in reducing gingivitis conditions. Add a few drops of a tea tree oil supplement to your toothbrush after brushing to add a protective layer to the oral tissues. Finally, massaging your gums with your fingertips can stimulate blood circulation within your gums, and often times provide pain relief!

Try these home remedies if you can not get to your dentist right away and believe you may be suffering from gum disease. No home solution is a substute for professional service. Schedule a visit to your dental professional if you have experienced bleeding gums, loose teeth or bad breath. Listen to your body and take care your dental problems as soon as possible – bringing your oral health back to a healthy condition is always your wisest move!

Periodontal disease in particular is a fantastic candidate for laser treatment. The nature of periodontitis (gum disease) involves bacterial growth which affects the supporting structures of the teeth, destroying attachment tissues which create deep periodontal pockets that are not easily cleanable (causing the gum disease to progress). Gum tissue responds very well to laser energy, which removes diseased  linings in the periodontal pocket and also kills the bacteria. The laser-tissue interaction is thermal, controlled  energy  from the selected  tip of the laser fiber will evaporate the inflamed unhealthy  lining tissue ; its rising temperature will also kill any pathogen present in the tissue. The clean and less traumatic site becomes more efficient and comfortable for your healing. Other benefits of laser treatment include biostimulation (photo-biomodulation) on the  cellular level , which energizes damaged cells through  light receptors , allowing tissue to heal promptly!

The laser gum treatment is usually administered in conjunction with traditional scaling and root planning (SRP) services, performed with ultrasonic or hand instruments that remove toxic calculus from the root surface. Unlike more traditional methods which use a scaler to scrape away diseased tissue, the laser approach treats the diseased tissues with electromagnetic energy to ablate diseased tissues non-evasively, followed by irrigation with antiseptic solution (chlorhexidine) to flush away and clean the periodontal pockets. For more severe cases, localized placement of certain antibiotic agents (like Arestin minocycline hydrochloride) inside the treated periodontal pocket can assure a complication-free healing process without systemic effects. Low level laser therapy can also be applied to decrease post-operative discomfort and promote healing through photo-biomodulation.

Laser gum treatment has provided tremendous patient benefits as I have witnessed since it has been incorporated into my practice  since 1997, but this treatment modality has raised some eyebrows in the periodontal community. It is difficult to establish a parameter with energy and expect  to have consistent result on different subjects; there are too many variables from the color, texture, composition and condition of the tissues, whether the origin of the cause has been managed and how the different laser energy is handled by various operators. There are studies which have proven different results, and over-promising commercials also exist which have discouraged development of laser gum treatment.

When properly conducted, laser gum treatment provides a cleaner and more comfortable site for healing.  The predictability of tissue regeneration, however, is too complicated for a blog discussion! I do recommend you go to a reliable, non-biased source like The Academy of Laser Dentistry to learn more about the benefits of laser treatment or referrals of certified laser dentists.

I looked at Jenny, as I have with many similar pretty young ladies, and really felt for her.

“Jenny, you will be fine – you are here to make sure you can have a healthy and beautiful smile. It is challenging, but work with me – together we can get your mouth back in shape.” And we did.

Jenny is not alone. Among the susceptible figure-conscious young female group, eating disorders are quite common, and teeth erosion is a side effect of the acidic oral environment resulting from either purging or a poor diet.

Eating disorders, including bulimia (binge eating followed by self-induced vomiting), anorexia and poor dieting habits carry side effects which are detrimental to your bodily and mental well being – they can also rot your teeth. Studies have shown that up to 2.1% of males and 7.3% of females purge (self-induced vomiting) at least once a week, and the numbers are even higher for adolescents.

Tooth surface loss from erosion caused by chemicals such as dietary, gastric or environmental acids typically wear away tooth enamel, which leads to sensitive teeth, caries or gum disease. If untreated, these effects can exacerbate leading to teeth grinding and gastric reflux disease. Soft tissue lesions, malnutrition,  a suppressed immune system, low self-esteem, an addictive personality (smoking, drinking or drugs), peptic ulcers and esophagitis are common among people who suffer from bulimia and anorexia. Oral damage from such disorders can include a severe breakdown of the teeth or their supporting structures which can affect the facial muscular system, negatively affecting your daily quality of life; the effort to restore a damaged mouth can become extremely challenging and costly.

Treatment of the problem, besides education and being supportive to the person suffering from the disorder, involves precise dental management; controlling the oral environment, drinking water or healthier juice instead of diet soda, eating healthier (as opposed to binge eating and purging) are all part of the solution. Getting prescription strength fluoride from your dentist to harden and desensitize your teeth and maintaining your oral hygiene by brushing and flossing at least twice a day is also crucial. if you regurgitate or vomit, rinse your mouth out right away. Adding baking soda to your brushing can also neutralize the acidic environment.

Regarding dental treatment, additive composite bonding to cover exposed dentin or to replace lost tooth surface is a possibility. Getting a custom-fitted night guard to prevent further loss of tooth structure from bruxism and maybe veneers or crowns to restore your mouth to ideal health are other possibilities. Of course, a professional assessment would be the first step of the process. The earlier you start treating the problem the better. A healthy mouth is essential for a healthy life.