Pete N Mellas DMD MS PLLC

Gum Disease Definitions

Periodontal (gum) diseases, including gingivitis and periodontitis, are serious infections that, left untreated, can lead to tooth loss. The word periodontal literally means “around the tooth.” Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth.

Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) causes the gums to become inflamed.

In the mildest form of the disease, gingivitis, the gums redden, swell and bleed easily. There is usually little or no discomfort. Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with professional treatment and good oral home care.

Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.

Causes of Periodontal Disease

The main cause of periodontal disease is bacterial plaque, a sticky, colorless film that constantly forms on your teeth. However, factors like the following also affect the health of your gums.

Smoking/Tobacco Use
As you probably already know, tobacco use is linked with many serious illnesses such as cancer, lung disease and heart disease, as well as numerous other health problems. What you may not know is that tobacco users also are at increased risk for periodontal disease. In fact, recent studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease.

Genetics
Research proves that up to 30% of the population may be genetically susceptible to gum disease. Despite aggressive oral care habits, these people may be six times more likely to develop periodontal disease. Identifying these people with a genetic test before they even show signs of the disease and getting them into early interceptive treatment may help them keep their teeth for a lifetime.

Pregnancy and Puberty
As a woman, you know that your health needs are unique. You know that brushing and flossing daily, a healthy diet, and regular exercise are all important to help you stay in shape. You also know that at specific times in your life, you need to take extra care of yourself. Times when you mature and change, for example, puberty or menopause, and times when you have special health needs, such as menstruation or pregnancy. During these particular times, your body experiences hormonal changes. These changes can affect many of the tissues in your body, including your gums. Your gums can become sensitive, and at times react strongly to the hormonal fluctuations. This may make you more susceptible to gum disease. Additionally, recent studies suggest that pregnant women with gum disease are seven times more likely to deliver preterm, low birth weight babies.

Stress
As you probably already know, stress is linked to many serious conditions such as hypertension, cancer, and numerous other health problems. What you may not know is that stress also is a risk factor for periodontal disease. Research demonstrates that stress can make it more difficult for the body to fight off infection, including periodontal diseases.
Medications
Some drugs, such as oral contraceptives, anti-depressants, and certain heart medicines, can affect your oral health. Just as you notify your pharmacist and other health care providers of all medicines you are taking and any changes in your overall health, you should also inform your dental care provider.

Clenching or Grinding Your Teeth
Has anyone ever told you that you grind your teeth at night? Is your jaw sore from clenching your teeth when you’re taking a test or solving a problem at work? Clenching or grinding your teeth can put excess force on the supporting tissues of the teeth and could speed up the rate at which these periodontal tissues are destroyed.

Diabetes
Diabetes is a disease that causes altered levels of sugar in the blood. Diabetes develops from either a deficiency in insulin production (a hormone that is the key component in the body’s ability to use blood sugars) or the body’s inability to use insulin correctly. According to the American Diabetes Association, approximately 16 million Americans have diabetes; however, more than half have not been diagnosed with this disease. If you are diabetic, you are at higher risk for developing infections, including periodontal diseases. These infections can impair the ability to process and/or utilize insulin, which may cause your diabetes to be more difficult to control and your infection to be more severe than a non-diabetic.

Poor Nutrition
As you may already know, a diet low in important nutrients can compromise the body’s immune system and make it harder for the body to fight off infection. Because periodontal disease is a serious infection, poor nutrition can worsen the condition of your gums.
Other Systemic Diseases
Diseases that interfere with the body’s immune system may worsen the condition of the gums.

Types of Periodontal Disease

There are many forms of periodontal disease. The most common ones include the following.

Gingivitis
Gingivitis is the mildest form of periodontal disease. It causes the gums to become red, swollen, and bleed easily. There is usually little or no discomfort at this stage. Gingivitis is reversible with professional treatment and good at home oral care.
Mild Periodontitis
If gingivitis, the mildest form of periodontal disease, is left untreated, it can advance to periodontitis. In the mild stage, periodontal diseases begin to destroy the bone and tissue that support the teeth.

Moderate to Advanced Periodontitis
Moderate to advanced periodontitis develops if earlier forms of the disease like gingivitis and mild periodontitis are left untreated. This is the most advanced form of the disease in which extensive bone and tissue loss occurs.

Juvenile Periodontitis
Localized juvenile periodontitis (LJP) occurs in adolescents and is characterized by the rapid loss of bone around permanent teeth. Ironically, youngsters with LJP form very little dental plaque or tartar. Generalized juvenile periodontitis is often considered a disease of young adults, although it can begin around puberty. It is characterized by marked inflammation and heavy accumulations of plaque and calculus. Pockets can form around the affected teeth, filling with infection. If not treated early, infection can lead to bone loss which may cause the teeth to become loose.

Treatment of Periodontal Disease

If you’re diagnosed with periodontal disease, your periodontist may recommend periodontal surgery. Periodontal surgery is necessary when your periodontist determines that the tissue around your teeth is unhealthy and cannot be repaired with non-surgical treatment. Following are the four types of surgical treatments most commonly prescribed:

• Gum Irrigation

• Ultrasonic Therapy

• Scaling and Root Planing (SRP)

• Antimicrobial therapy

• Pocket Reduction Procedures

• Regenerative Procedures

• Crown Lengthening

• Soft Tissue Grafts: for lost gums and aesthetics

• Dental Implants: If you’ve already lost a tooth to periodontal disease, you may be interested in dental implants –the permanent tooth replacement option.

Don’t Ignore Your Oral Health
If you value your oral as well as your overall health, a periodontal evaluation is a good idea. Sometimes the only way to detect periodontal disease is through a periodontal evaluation. A periodontal evaluation may be especially important if you:
Notice any symptoms of periodontal disease.
Have heart disease, diabetes, respiratory disease or osteoporosis.
Are thinking of becoming pregnant.
Have a family member with periodontal disease. Research suggests that the bacteria that cause periodontal disease can pass through saliva. This means the common contact of saliva in families puts children and couples at risk for contracting the periodontal disease of another family member.
Have a sore or irritation in your mouth that does not get better within two weeks.

Find Out More

Determine if you are at risk for periodontal disease.
Take a Self-Evaluation Quiz
You may not realize that persistent swollen, red or bleeding gums, tooth sensitivity, and bad breath are warning signs of periodontal (gum) disease — a serious infection that, left untreated, can lead to tooth loss.
Jot down your answers to the following questions to find out if you have the symptoms of periodontal disease.

• Do you ever have pain in your mouth?

• Do your gums ever bleed when you brush your teeth or when you eat hard food?

• Have you noticed any spaces developing between your teeth?

• Do your gums ever feel swollen or tender?

• Have you noticed that your gums are receding (pulling back from your teeth) or your teeth appear longer than before?

• Do you have persistent bad breath?

• Have you noticed pus between your teeth and gums?

• Have you noticed any change in the way your teeth fit together when you bite?

• Do you ever develop sores in your mouth?

If you answered yes to any of these questions, you have a high chance of periodontal disease.
Your comfort is our concern in our office!

Our goal is to provide all of our patients with a relaxed and comfortable setting for their periodontal care. Our experience has shown that when our patients are relaxed, they do much better during and after their periodontal treatment.

For this reason, we will tailor sedation methods to achieve an optimum comfort level for each patient.

Local Anesthesia
Because of our extraordinary gentle care most patients elect to be treated just with local anesthesia. We use very gentle injection techniques to achieve profound anesthesia. We will ensure that you are completely numbed before we commence any procedure.

Oral Sedation
In addition to local anesthesia, you may prefer to be lightly sedated for your procedure. Often we will prescribe oral sedatives to our patients, that are taken before the appointment. With this medication, most patients are relaxed sufficiently to fall asleep during the treatment.

Conscious IV Sedation
For the more difficult procedures, or for patients that experience significant anxiety during their dental visits we recommend IV conscious sedation. This procedure is performed by an experienced anesthesiologist who comes to our office. Medications specific for the patient’s needs are used during this procedure, to relax the patient through out the procedure. This type of sedation has a very safe track record and is a also a great option for patients on a busy schedule who wish to perform a number of procedures in one setting.

Pain Management
Pain management is a main focus of our practice. We perform a number of very specific procedures to ensure total comfort before, during, and after patient care.
These procedures include gentle and effective local anesthesia, gentle surgical techniques, micro-surgery and effective pain relievers dispensed after your care.
Most of our patients experience only minimal discomfort following their periodontal procedures.

Treatment of Periodontal Disease

If you’re diagnosed with periodontal disease, your periodontist may recommend periodontal surgery. Periodontal surgery is necessary when your periodontist determines that the tissue around your teeth is unhealthy and cannot be repaired with non-surgical treatment. Following are our types of treatments most commonly prescribed:

• Gum Irrigation
• Ultrasonic Therapy
• Scaling and Root Planing (SRP)
• Antimicrobial therapy
• Pocket Reduction Procedures
• Regenerative Procedures
• Crown Lengthening
• Soft Tissue Grafts: for lost gums and aesthetics
• Dental Implants: If you’ve already lost a tooth to periodontal disease, you may be interested in dental implants –the permanent tooth replacement option.

Dentists often use a strong stream of water to help wash plaque and bacteria off of teeth. This is done by directing the water so that it penetrates below the gum line. As the body responds to this pressure, the bond between tooth and gum is made more solid.

Ultrasonic Therapy
This procedure uses an instrument that directs ultrasonic vibrations through the gums and teeth. Similar to gum irrigation, this procedure strengthens tooth and gum stability and encourages your own immune cells to destroy harmful bacteria.

Scaling and Root Planing (SRP)
Depending upon the findings at the time of your examination, we may recommend a course of non-surgical, non-invasive therapy. This stage of treatment will often include comprehensive oral hygiene instruction, teaching you methods to keep your teeth clean and healthy for years to come. In addition, we may recommend a thorough deep cleaning known as scaling and root planing. Sometimes these deep cleanings and good home care are all that are required to obtain the state of oral health we are trying to help you reach.
Other non-invasive techniques which may be beneficial in select cases include both systemic and locally applied drug therapies.
Bite guard appliances may be recommended to help manage clenching and grinding habits. These appliances may also be beneficial for certain people where the bite may effect the severity and progression of periodontal disease.

Your comfort is our concern in our office!
Our goal is to provide all of our patients with a relaxed and comfortable setting for their periodontal care. Our experience has shown that when our patients are relaxed, they do much better during and after their periodontal treatment.
For this reason, we will tailor sedation methods to achieve an optimum comfort level for each patient.

Local Anesthesia
Because of our extraordinary gentle care most patients elect to be treated just with local anesthesia. We use very gentle injection techniques to achieve profound anesthesia. We will ensure that you are completely numbed before we commence any procedure.

Oral Sedation
In addition to local anesthesia, you may prefer to be lightly sedated for your procedure. Often we will prescribe oral sedatives to our patients, that are taken before the appointment. With this medication, most patients are relaxed sufficiently to fall asleep during the treatment.

Conscious IV Sedation
For the more difficult procedures, or for patients that experience significant anxiety during their dental visits we recommend IV conscious sedation. This procedure is performed by an experienced anesthesiologist who comes to our office. Medications specific for the patient’s needs are used during this procedure, to relax the patient through out the procedure. This type of sedation has a very safe track record and is a also a great option for patients on a busy schedule who wish to perform a number of procedures in one setting.

Pain Management
Pain management is a main focus of our practice. We perform a number of very specific procedures to ensure total comfort before, during, and after patient care.
These procedures include gentle and effective local anesthesia, gentle surgical techniques, micro-surgery and effective pain relievers dispensed after your care.
Most of our patients experience only minimal discomfort following their periodontal procedures.

Antimicrobial therapy
It is well established that many cases of periodontal disease are caused by bacteria. That’s why antibiotic therapy is widely used today to help eliminate these harmful bacteria. This treatment includes oral medication, locally applied antibiotics.

Pocket Reduction Procedures
Periodontal (gum) diseases attack the gums and bone supporting the teeth. The tissues separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Eventually, if too much bone is lost, the teeth will need to be extracted.

A pocket reduction procedure may be recommended because you have pockets that are unhealthy and too deep to clean with daily oral hygiene and a professional recall program.

This treatment involves folding back the gum tissue, removing diseased tissues and bacteria, and thoroughly cleaning the exposed root surfaces. We may also smooth the damaged bone to help set up a more optimal healing environment.

When you have periodontal disease, the supporting tissue and bone is destroyed and pockets develop. Eventually, if too much bone is lost, the teeth will need to be extracted.

Recent advances in periodontal therapy allow us the opportunity to reverse some of the damage caused by periodontal disease by regenerating lost bone and tissue. In very specific situations, we may recommend a regenerative procedure when the bone supporting your teeth has been destroyed.

During this procedure, we fold back the gum tissue and remove the diseased tissues and bacteria. We may utilize bone grafts and various types of regenerative membranes to enhance your body’s ability to regenerate bone and tissue.

Crown Lengthening
Periodontal procedures are often utilized to support high quality restorative and cosmetic dentistry as well as to improve the esthetics of your gum line.

You may be interested in procedures to improve a “gummy” smile because your teeth appear short. Oftentimes, we can correct this by performing an esthetic crown lengthening.

This procedure involves reshaping of excess gum and bone tissue to expose more of the natural tooth. This can be done to one tooth or to several teeth in order to enhance your smile by evening your gum line and exposing a natural, broad smile.

Your referring dentist may also recommend crown lengthening to make a high quality restorative or cosmetic dental procedure possible. This is often performed when your tooth is decayed, broken below the gum line, or has insufficient tooth structure for a restoration. Crown lengthening adjusts the gum and bone level to expose more of the tooth so it can be restored properly.

Soft Tissue Grafts
Exposed tooth roots are the result of gum recession. Cosmetic periodontal procedures are available to improve the esthetics of your gum line and stop problems associated with gum recession, including sensitivity to hot and cold foods.

Once contributing factors such as aggressive tooth brushing and periodontal disease are controlled, a soft tissue graft can cover the exposed root and help prevent additional recession and bone loss. During this procedure, we take tissue from the roof of your mouth or another donor source to cover the exposed root.

You may also be referred for a grafting procedure before orthodontic treatment. This procedure is often done to prevent anticipated problems associated with movement of your teeth.

Dental Implants
Dental implants are an ideal option for people in good general oral health who have lost a tooth or teeth due to periodontal disease, an injury, or some other reason.

Dental implants look and feel like your own teeth! Oftentimes, it is very difficult for people to tell that you have a replacement tooth because implants are so esthetic.

Dental implants don’t sacrifice the quality of your adjacent teeth like more traditional treatment options because neighboring teeth are not altered to support the implant.

Dental implants are secure, allowing you to forget the annoying worries of dentures.
Success rates for dental implants are highly predictable. They are considered an excellent option for reliable tooth replacement.

A dental implant is an artificial tooth root that we place into your jaw to hold a replacement tooth or bridge without affecting adjacent teeth while eliminating the need for removable partial dentures. They can also be used to support a denture in order to make it more comfortable and secure.

If you are missing one or more teeth and would like to smile, speak and eat again with comfort and confidence, dental implants may be a tremendous option for you. Working in close cooperation with a well trained restorative dentist along with proper patient maintenance, we can provide implants to last a lifetime.

The ideal candidate for a dental implant is in good general health with healthy gum tissues that are free of periodontal disease. Adequate bone is needed to support the implant.

As periodontists, we specialize in precisely these areas, and we are ideal members of your dental implant team. We work closely with other dental professionals, and we have the special knowledge and training that you need to have teeth that look and feel just like your own.

Find Out More

Determine if you are at risk for periodontal disease.

Take a Self-Evaluation Quiz
You may not realize that persistent swollen, red or bleeding gums, tooth sensitivity, and bad breath are warning signs of periodontal (gum) disease — a serious infection that, left untreated, can lead to tooth loss.

Jot down your answers to the following questions to find out if you have the symptoms of periodontal disease.

• Do you ever have pain in your mouth?
• Do your gums ever bleed when you brush your teeth or when you eat hard food?
• Have you noticed any spaces developing between your teeth?
• Do your gums ever feel swollen or tender?
• Have you noticed that your gums are receding (pulling back from your teeth) or your teeth appear longer than before?
• Do you have persistent bad breath?
• Have you noticed pus between your teeth and gums?
• Have you noticed any change in the way your teeth fit together when you bite?
• Do you ever develop sores in your mouth?

If you answered yes to any of these questions, you have a high chance of periodontal disease.