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Periodontal disease

Two common types of gum disease are gingivitis and periodontitis. The majority of adults have inflammation periodontium with 5 to 15 % of American adults having severe periodontitis.   




Gingivitis is a local inflammatory reaction to a film of bacteria (plaque, biofilm) that encircles the tooth at the gum line. Plaque accumulation signals the body’s defense cells causing a local inflammatory response, which ultimately is the body’s futile attempt to neutralize the plaque (biofilm).  Unless the patient helps out with a toothbrush and dental floss the inflammation continues and can result in loss of the gum tissue connection to the tooth.  Healthy gingiva (gum tissue) will show signs of gingivitis: redness, bleeding, and slight swelling after about one week of plaque accumulation.    Likewise, daily removal of the biofilm by brushing and flossing results in a return of gingival health after a few days.  Gingivitis is treatable and reversible.


Without treatment, this long standing plaque (biofilm) begins to change and grow deeper along the tooth root as the gum and bone connection deteriorates.    As this process proceeds, the availability of oxygen decreases favoring growth of bacteria that only live in the absence of oxygen (anaerobic bacteria).  The patient now has periodontitis.  Periodontitis is treatable, but not reversible.




Periodontitis has long been thought to be the result of plaque containing a small group of disease producing (pathologic) bacteria not found in the film that causes gingivitis.  We are now beginning to understand that it is the interaction of bacteria with the patient’s own immune system which results in pocket formation, which is the event that separates gingivitis from periodontitis.  With the lack of oxygen in deep pockets causing bacteria to evolve into pathologic anaerobes. Medical and dental literature speculate these anaerobic bacteria and products of their cell wall participate in inflammatory systemic diseases including cardiovascular disease and diabetes. 


Treatment :




Obviously since complete removal of plaque every day, or at least every few days, is required to prevent gingivitis, it is not practical for a dentist to treat this disease.  Treatment is in your hands-please brush and floss.




In a perfect world, a periodontist would be able to fix all the pockets by regrowing the gum and bone connection to the tooth.  The pockets would then be gone and the patient

could remove all new plaque accumulation with brushing and flossing, and therefore preventing reoccurrence.


But this does not commonly happen.  Once a significant pocket is present, it is pretty much there for good.  Periodontists can only rarely make a significant pocket completely go away, but can commonly make pockets less deep and prevent the pockets from becoming worse.  Periodontitis is a chronic disease, and like all diseases which are chronic, it can only be controlled, not cured.  Periodontal maintenance care (professional cleanings) is the only procedure shown to be effective in controlling periodontitis long term.


Although periodontal surgery is often beneficial, the benefit is only derived if the surgical procedure is successful in making the maintenance care more predictable, and if the patient complies with maintenance care for a lifetime.  Periodontal surgery can sometimes be avoided or refused and the patient may still have a successful outcome with maintenance complience.  However maintenance care can never be avoided if one expects a successful outcome. 


New Thoughts and Treatment (Perio Protect)


The term biofilm is starting to replace the term plaque in the periodontal lexicon.  A biofilm is a complex association of bacteria that behave much like a tightly knit community.  They protect one another, communicate with each other, and in general cooperate to insure survival and spread of the biofilm.  It is being shown that the biofilm is extremely resistant to antibiotics, both topical (placed in the pocket) and systemic (taken by mouth).  The biofilm can be removed mechanically by scaling, but starts to reform in a just a few hours.


Dr. Kaiser is beginning to test a tray system (Perio Protect) that places and holds a chemical that is naturally occurring in the body in close proximity to the film, thereby degrading the film from the surface inward.  Research has demonstrated the biofilm is removed after several days of frequent application, and that then wearing the trays 10 minutes daily may significantly contribute to the treatment of periodontitis, gingivitis, and tooth decay.

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