American Medical Association Family Medical Guide - American Medical Association [801]
Some people need to have their teeth cleaned professionally every few months despite careful tooth care. For these people, dentists often recommend an antibacterial mouthwash. Most cases of gingivitis respond well to treatment, and the gums gradually return to their usual healthy condition. It is up to you to take the steps necessary to prevent another case of gingivitis.
Periodontitis can often be treated and reversed before it reaches an advanced stage. See your dentist as soon as possible if you have any symptoms such as red, swollen gums. If the disease is at an early stage, your dentist can help keep it under control by treating any pockets, which encourage plaque to form. He or she may place inserts that contain antibiotics or anti-inflammatory drugs directly into the pockets to fight the infection. If treatment with antibiotics begins early, no other treatment may be necessary. Ask your dentist if you should use toothpastes and mouth rinses that contain medication or antimicrobial agents. If you smoke or chew tobacco, stop; using tobacco products causes inflammation of the gums and promotes periodontitis.
Gum disease caused by neglect
Inadequate brushing and flossing allows plaque to build up, which promotes gum disease. Without treatment, the disease progresses and can eventually lead to tooth loss. Healthy gums (left) fit firmly around the necks of the teeth and do not bleed easily. Plaque that builds up between the teeth and gums can cause painful inflammation (center). Untreated plaque can harden to form a substance called calculus, which can cause the gums to recede (right). The bacteria in calculus can cause severe damage to the teeth, gums, and jawbone.
Evaluating periodontal disease
The bacteria in plaque can destroy the bone and gum tissue that surround and anchor the teeth. If not removed, plaque forms a hardened material called calculus, which can pry the gum away from the tooth, loosening it. Eventually the tooth may have to be removed. To evaluate the severity of periodontal disease, a dentist inserts an instrument called a periodontal probe between the tooth and gum (beneath the gum line) to measure and record the depth of the gum pockets. In general, the deeper the pocket, the more severe the disease.
If the pockets between the teeth and gums are very deep, you may need periodontal surgery. A gingivectomy is a minor surgical procedure performed in the office by a periodontist (gum specialist) in which the soft tissue wall of the pocket is removed. If the bone has been damaged, you may need to undergo a procedure called osseous surgery, in which the periodontist removes infected tissue and reshapes the gum and bone. After the surgery, the gum line is covered with a protective coating called a periodontal pack, which is left in place for 1 to 2 weeks until the gum heals. You can eat and drink normally with a periodontal pack in place. In some cases, the periodontist or an oral surgeon performs a procedure called regenerative surgery, which uses special inserts to try to regrow the jawbone and supporting tissue.
Cementum that has been worn away can be replaced by bonding a synthetic material to the tooth. Cementum that is especially sensitive can be protected with a layer of sodium fluoride or a prescription toothpaste that protects against sensitivity. Very loose teeth can be anchored.
The bacteria that cause periodontitis can be transmitted among family members, so, if one member of your family has periodontal disease, all other family members should also see a dentist for a checkup and evaluation.
Gingivectomy
The buildup of plaque and calculus between the teeth and gums forms a deep pocket (top) between