Periodontal Disease


You can't see it or even feel it. But gum disease may be throwing your diabetes control out of whack.

Imagine you had an infection the size of a tennis ball on your leg. Knowing that infections stress the body and affect glucose control, you probably wouldn't be surprised to find that your blood glucose levels were higher than normal.

You might actually have an infection that big--in your mouth. Severe gum disease involves as large a surface area as a tennis ball. Several studies have shown that people with severe periodontitis (gum disease) have worse blood glucose control that those without periodontitis. Treatment of gum disease has been associated with significant improvement in blood glucose control.

Yet you may not know you have periodontitis. It tends to be "silent," with most of the destructive activity of gum disease occurring below the gum line. You may not notice any signs until the advanced destruction of supporting bone and gum tissue attachment to the roots has occurred.  About 45 percent of adult Americans have gingivitis (gum inflammation). About 40 percent have early periodontitis (loss of bone and gum attachment to the root) on at least one tooth, and more advanced periodontitis is seen in 10 percent to 15 percent.

Gum disease can worsen blood glucose control. It goes the other way, too: Having diabetes puts you at higher risk for severe periodontitis. Since the early 1960s, studies have shown that people with diabetes have worse gum disease and more bone loss around the teeth than people who don't have diabetes. In fact, periodontal diseases have been called the sixth complication of diabetes. Many of the mechanisms responsible for diabetic retinopathy, nephropathy, neuropathy, and cardiovascular diseases may also play a very active role in periodontal destruction. In addition, people with poor glucose control often produce less saliva than normal, and this contributes to gum disease.  But it's not a done deal. You can do a great deal--starting today--to avoid gum disease and other dental problems.

A Pocket Full of ..........Bacteria!!!!

The space between your gum tissue and the root of a tooth is called the pocket. When your gums are healthy, the pocket is relatively shallow--about 1 to 3 mm deep. This shallow pocket is accessible to brushing and flossing, which maintain a healthy environment occupied by small numbers of aerobic (oxygen-using) bacteria.

If you don't brush and floss regularly, bacteria accumulate and form a white, slimy substance called plaque. If the plaque isn't removed, you'll develop gingivitis--an infection of the gum tissue. As your immune system fights off the increased bacterial load, you may notice that your gums are swollen, tender, and bleed easily. In addition, the bacteria may calcify to form tartar above and below the gum line.  As the bacteria continue to multiply, the environment of the pocket shifts to one that is deprived of oxygen. The bacterial population also shifts--the healthy, aerobic bacteria are replaced by large numbers of anaerobic (nonoxygen-using) bacteria.

These bacteria produce toxins. The toxins stimulate a local immune response in the pocket, and the attachment of the gum and bone to the tooth is destroyed. The pocket gets deeper. You now have periodontitis.  Eventually, enough bone support is lost that your teeth become loose and may shift positions, resulting in crowding or gaps between teeth. If left untreated, severe periodontitis often results in tooth loss.  Besides the effects on your gums and teeth, you may also find that your blood glucose levels are harder to control.  How can an oral disease like periodontitis possibly have a system-wide effect on diabetes? Periodontitis is an infection caused by aggressive anaerobic bacteria, similar to the bacteria that cause other severe infections. The substances produced by these bacteria enter the bloodstream and have potentially widespread effects. Recent research has shown that pregnant women with severe periodontitis have a higher risk of giving birth to preterm low-birth-weight babies. In addition, studies have shown that the risk of major cardiovascular events such as heart attack and stroke is significantly higher in those people with severe periodontal disease.

Full Depth of Treatment

Due to its "silent" nature, periodontitis is not easy to detect. You'll need a thorough examination. Your dentist will probe around your teeth to determine how deep the gum pockets are. You'll also have X-rays taken so your dentist can see if you have lost any bone support for your teeth.

Treatment of gingivitis is relatively simple. Your dental hygienist or dentist will scrape away any tartar and bacterial plaque both above and below your gum line and teach you how to keep your teeth clean.

If you have periodontitis, you may need to see a periodontist (gum disease specialist). Treatment of periodontitis may involve more advanced techniques to allow access to the root surfaces of the teeth. Only by removing the plaque and calculus all the way to the bottom of the pocket can periodontal health be reestablished. In many cases, this can be accomplished without surgery. But if you have advanced periodontal disease, surgery may be required to thoroughly clean the root surfaces, to reshape the bone defects caused by bacteria, or to attempt to regenerate lost bone and gum tissue attachment to the tooth. You may need to take antibiotics, too.  But treatment doesn't end in the dentist's office. Good blood glucose control and thorough oral hygiene at home are critical to the success of periodontal treatment.

After the initial treatments are completed, you'll be placed on a recall schedule, visiting your dentist or periodontist every three or four months for examination and cleanings. This "periodontal maintenance" stage of treatment is important to attaining and maintaining long-term health for your teeth and gums.

Early & Often

You can avoid gum disease--and you can start today. Basic oral health care begins at home.

•Avoid eating sugary foods.

•Brush your teeth twice a day with fluoride toothpaste. Brush gently with the toothbrush bristles angled toward and below the gum line. With a circular motion, sweep away from the gum line. This removes bacterial plaque from the pocket and helps maintain periodontal health.

You may have heard of a new, antibacterial toothpaste. It does have some unique properties, but you don't need to use such a toothpaste to achieve and maintain oral health. Any fluoride toothpaste will work just fine when used properly.

  1. Floss once a day. Flossing removes bacteria from the pockets in between your teeth--the places periodontal disease usually starts.

Do You HAve Gum Disease?

•Do your gums bleed when you brush your teeth?

•Do you have a bad taste in your mouth?

•Do your teeth hurt when you chew?

•Do your have twinges in your teeth even when you're not chewing?

•Have your teeth shifted?

If you have any of these signs, see your dentist. You may have gum disease.

One more question:

Do you have none of the above signs, and has it been more than six months since your last visit to the dentist?

You may have gum disease. Gum disease is often "silent."


For killer bacteria, the way to a man's heart, brain, and bloodstream is through his mouth

FARMERS, COWBOYS, and other sensible men always examine a horse s mouth before buying it. One good look can sum up the horse's health history and even predict how long the old boy will live. A human mouth isn't much different.

This horse test is based on the old 'focal-infection theory,' which says that an oral infection affects the whole body," says Raul G. Caffesse, D.D.S., of the University of Texas-Houston Health Science Center. It was the excuse for lots of tooth pulling until dentists abandoned the theory 40 years ago.  But the focal-infection theory is making a big comeback (minus the fun of the extractions). And now it's supported by more than frontier hunches. In fact, there's growing clinical evidence that small infections in your kisser may be a contributing factor to several diseases. Although the theories are still controversial, dentists and other physicians think that the following five afflictions may be related to your mouth. That makes five excellent reasons to buy some floss--now.

Heart Attack

Robert J. Genco, D.D.S., Ph.D., of the University of Buffalo, studied 1,372 people at the Gila River Indian community in Arizona and found that those with gum disease had triple the risk of heart attacks over a 10-year period. He believes that oral bacteria (there are 350 different types in your mouth) enter your bloodstream through small tears in your gums. The bacteria, Dr. Genco suggests, may infect your liver and cause it to produce artery-clogging proteins, or they may directly infect your heart arteries and somehow cause blockages. The exact mode of attack is still a mystery, he says, but Porphyromonas gingivalis bacteria have been found in fatty arterial blockages that cause heart failure.

You've probably heard that oral bacteria can be especially dangerous to people who have heart disease. If you have an ailment involving the heart valves, such as mitral valve prolapse or a heart murmur, you may need to take antibiotics before receiving dental treatment, says Mark V. Thomas, D.M.D., of the University of Kentucky college of dentistry. Dental work dislodges bacteria and nicks your gums, sending a rush of germs into your bloodstream. That can cause bacterial endocarditis, an often fatal infection that strikes about 20,000 people each year.


Men with gum disease could be destined for drooling and Depends. University of Buffalo researchers surveyed the health histories of 9,982 people from 25 to 75 and found that the 35 percent with severe gum disease were twice as likely to have had a stroke. Oral bacteria may cause fatty accumulations in the carotid arteries in your neck, causing blockages, says John Mailer, M.D., of the National Institute of Neurological Disorders and Stroke. These little logjams often break apart, float upstream, and lodge in your brain. And if a tiny chunk dams up a blood vessel, your dancing days are over.


When a diabetic is fighting a bacterial infection, insulin works less efficiently. That can raise his blood-sugar level, says Perry R. Klokkevold, D.D.S., of the UCLA school of dentistry. If you're battling diabetes--and about one in 17 Americans is--a gum infection can make managing the disease much tougher. When University of Buffalo researchers examined 168 diabetics, they found that those with periodontitis (severe gum disease) had the most trouble controlling their blood-sugar levels. That's what eventually causes the kidney disease, heart disease, and blindness that plague diabetics.

Gum disease probably doesn't directly cause diabetes, says Dr. Klokkevold. "This is a relatively new field of research, but we know that having gum disease will worsen diabetes," says Christopher Saudek, M.D., a diabetes specialist at Johns Hopkins University in Maryland. "People with diabetes should be careful to keep their gums healthy." And if you have both a gum infection and a family history of diabetes, get checked for diabetes immediately.


This point is still controversial, but some evidence suggests that the Helicobacter pylori bacterium, which can cause stomach ulcers, resides in dental plaque, says Sherle Dowsett, D.D.S., of the Indiana University school of dentistry. She and her colleagues found that among 242 study subjects, 210 of them carried the bacteria in their mouths. H. Pylori may migrate down to your stomach and proceed to eat painful little holes, which is why we think every bottle of Pepto-Bismol should come with a free toothbrush.


With every breath, your lungs suck down a stew of bacteria, including Chlamydia pneumoniae and Pseudomonas aeruginosa, two bugs that cause respiratory diseases. Careful readers will have guessed one source: the plaque buildup around your teeth. Your immune system usually destroys these invaders. But when your resistance is low, such as during an illness or after surgery, they can infect your lungs and cause bacterial pneumonia, says Dr. Caffesse. This infection kills about 83,000 people a year.

"Get your teeth cleaned before you have surgery," he advises. The day before surgery is best, but a week before is still helpful. And bug your parents to floss daily and visit the dentist every 6 months; they're much more vulnerable to pneumonia than you are, young man.

Floss, Scrape, or ........Die!!

Avoid gum disease, and a premature death awaits!!!

Your gums don't bleed when you brush? They're not inflamed or receding? Not painful to the touch? Great. But you still may have gum disease. That's because periodontitis (an advanced form of gum disease) often shows no symptoms. So let a dentist probe your pie-hole every 6 months as if your life depended on it, because it does. And follow the five tips below. They'll help ensure that you won't bite the dust with plastic teeth.

Don't be half-assed about flossing. Flossing is 10 times more important than brushing. The broad, flat surfaces of your teeth harbor few bacteria, but the unbrushable crevices between teeth are loaded with garbage. If you won't floss after every meal, at least do it once a day. But do it.

  1. Scrape, fool, scrape! Your tongue holds more bacteria than the floor of the men's room at Grand Central Station. If you don't scrape your tongue after you brush your teeth, bacteria will instantly re-infest your mouth, Buy a tongue scraper at the drugstore and take a few good swipes every morning and night. Brushing your tongue isn't nearly as effective.

Go dry. Brush your teeth with a dry toothbrush once a day, advises Dr. Bunn. Research has shown that people who dry-brush have significantly less tartar buildup than people who brush with toothpaste. Use gentle side-to-side strokes in which the brush is half on the gums and half on the tooth.

Periodontal Plastic Therapy

All of us strive to look and feel our very best. A critical part of our overall appearance is our smile, which mirrors our personality. Your dentist has the ability to offer a wide range of services to enhance your teeth and beautify your smile. Specialists in Periodontics, support your dentist in ensuring the health and stability of your teeth and smile. Often times, the gums may be a contributing factor to the overall appearance and health of your smile.


Periodontal plastic surgery, or mucogingival surgery, involves the management of gingival deficits and deformities that may prevent you from having the smile you always wanted. Among these are:


1. Insufficient clinical crown length (also known as a "gummy smile") 

2.Uneven gum line due to "short" teeth or gum recession  ("long" teeth)

3.Lost or "collapsed" gums due to extracted or missing teeth

4.Dark, void spaces between your teeth, crowns, bridges, or implants (known as “Black holes")

5.The exposure of un-erupted teeth.

6.Tooth sensitivity due to gum recession.