Gum Disease

Periodontal (gum) diseases, including gingivitis and periodontitis, are serious infections that, left untreated, can lead to tooth loss. The word periodontalliterally 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.

There are 2 main stages of gum disease: Gingivitis and then periodontitis.

1. Gingivitis

Gingivitis is early gum disease and occurs when dental plaque builds up on teeth, particularly where the gum joins the tooth. The signs of gingivitis are bleeding gums, redness and swollen gums.
2. Periodontitis

Periodontitis is an advanced gum disease that may occur if gingivitis is not treated. The gingivitis may progress to affect the deeper supporting tissues and this is called periodontitis*. Periodontitis is not usually painful until the later stages of the disease.
There are many forms of periodontitis.

The most common ones include the following.

Aggressive periodontitis occurs in patients who are otherwise clinically healthy. Common features include rapid attachment loss and bone destruction and familial aggregation.
Chronic periodontitis results in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss. This is the most frequently occurring form of periodontitis and is characterized by pocket formation and/or recession of the gingiva. It is prevalent in adults, but can occur at any age. Progression of attachment loss usually occurs slowly, but periods of rapid progression can occur.

Periodontitis as a manifestation of systemic diseases often begins at a young age. Systemic conditions such as heart disease, respiratory disease, and diabetes are associated with this form of periodontitis.
Necrotizing periodontal disease is an infection characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions such as HIV infection, malnutrition and immunosuppression.

Symptoms of gum disease include:


Bad breath that won’t go away
Red or swollen gums
Tender or bleeding gums
Painful chewing
Loose teeth
Sensitive teeth
Receding gums or longer appearing teeth
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Any of these symptoms may be a sign of a serious problem, which should be checked by a dentist. At your dental visit the dentist or hygienist should:

Ask about your medical history to identify underlying conditions or risk factors (such as smoking) that may contribute to gum disease.
Examine your gums and note any signs of inflammation.
Use a tiny ruler called a ‘probe’ to check for and measure any pockets. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimeters. This test for pocket depth is usually painless.
The dentist or hygienist may also
Take an x-ray to see whether there is any bone loss.
Refer you to a periodontist. Periodontists are experts in the diagnosis and treatment of gum disease and may provide you with treatment options that are not offered by your dentist.

Causes:

Periodontal disease is marked by bacterial overgrowth. However, a persistent immune response to chronic infections in the mouth is believed to play a major role in gum destruction.
Bacterial Culprits

Reachers have found more than 350 species of microorganisms in the typical healthy mouth. Periodontal infections are linked to fewer than 5% of these species. Healthy and disease-causing bacteria can generally be grouped into two categories:

The harmless or helpful bacteria are usually known as gram positive aerobic bacteria.
In periodontal disease, the bacterial balance shifts over to gram negative anaerobic bacteria. Inflammatory disease and injury cannot develop without these bacteria.

Following are some of the bacteria most implicated in periodontal disease and bone loss:

Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis. These two bacteria appear to be particularly likely to cause aggressive periodontal disease. Both P. gingivalis and A. actinomycetemcomitans, along with multiple deep pockets in the gum, are associated with resistance to standard treatments for gum disease. P. gingivalis may double the risk for serious gum disease. P. gingivalis produces enzymes, such as one called arginine-specific cysteine proteinase, that may disrupt the immune system and lead to subsequent periodontal connective tissue destruction.
Bacteroides forsythus is also strongly linked to periodontal disease.
Other bacteria associated with periodontal disease are Treponema denticola, T. socranskii, and P. intermedia. These bacteria, together with P. gingivalis, are frequently present at the same sites, and are associated with deep periodontal pockets.

Some bacteria are related to gingivitis, but not plaque development. They include various streptococcal species.
The Autoimmune and Inflammatory Response

Evidence indicates that periodontal disease is an autoimmune disorder, in which immune factors in the body attack the person’s own cells and tissue — in this case, those in the gum. It appears to work like this:

The bacteria that form plaque and tartar release toxins that stimulate the immune system to overproduce powerful infection-fighting factors called cytokines.
Ordinarily, cytokines are important for healing. In excess, however, they can cause inflammation and severe damage.
In addition, white blood cells produced by the immune response to bacteria also release a family of enzymes called matrix metalloproteinases (MMPs), which break down connective tissue.

Studies suggest that this inflammatory response may have damaging effects not only in the gums but also in organs throughout the body, including the heart.
Viral Causes
Certain herpes viruses (herpes simplex and varicella-zoster virus, the cause of chickenpox and shingles) are known causes of gingivitis. Other herpes viruses (cytomegalovirus and Epstein-Barr) may also play a role in the onset or progression of some types of periodontal disease, including aggressive and severe chronic periodontal disease. All herpes viruses go through an active phase followed by a latent phase and possibly reactivation.

These viruses may cause periodontal disease in different ways, including release of tissue-destructive cytokines, overgrowth of periodontal bacteria, suppressing immune factors, and initiation of other disease processes that lead to cell death.
Treatment:

Following are some of the procedures that periodontists use to treat patients diagnosed with a periodontal (gum)disease. A periodontist is a dentist who specializes in the prevention, diagnosis and treatment of periodontal disease. Periodontists receive extensive training in these areas, including three additional years of education beyond dental school. Periodontists are familiar with the latest techniques for diagnosing and treating periodontal disease. In addition, they can perform cosmetic periodontal procedures to help you achieve the smile you desire.



Non-Surgical Treatments

AAP treatment guidelines stress that periodontal health should be achieved in the least invasive and most cost-effective manner. This is often accomplished through non-surgical periodontal treatment, including scaling and root planing (a careful cleaning of the root surfaces to remove plaque and calculus [tartar] from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins), followed by adjunctive therapy such as local delivery antimicrobials and host modulation, as needed on a case-by-case basis.

Most periodontists would agree that after scaling and root planing, many patients do not require any further active treatment, including surgical therapy. However, the majority of patients will require ongoing maintenance therapy to sustain health. Non-surgical therapy does have its limitations, however, and when it does not achieve periodontal health, surgery may be indicated to restore periodontal anatomy damaged by periodontal diseases and to facilitate oral hygiene practices.

Surgical Treatments for Gum Disease

Some treatments for gum disease are surgical. Some examples are:

Flap surgery/pocket reduction surgery. During this procedure the gums are lifted back and the tarter is removed. In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. The gums are then placed so that the tissue fits snugly around the tooth. This method reduces the size of the space between the gum and tooth, thereby decreasing the areas where harmful bacteria can grow and decreasing the chance of serious health problems associated with periodontal disease.

Bone grafts. Involves using fragments of your own bone, synthetic bone, or donated bone to replace bone destroyed by gum disease. The grafts serve as a platform for the regrowth of bone, which restores stability to teeth. New technology, called tissue engineering, encourages your own body to regenerate bone and tissue at an accelerated rate.
Soft tissue grafts. This procedure reinforces thin gums or fills in places where gums have receded. Grafted tissue, most often taken from the roof of the mouth, is stitched in place, adding tissue to the affected area.

Guided tissue regeneration. Performed when the bone supporting your teeth has been destroyed, this procedure stimulates bone and gum tissue growth. Done in combination with flap surgery, a small piece of mesh-like fabric is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow to better support the teeth.
Bone surgery. Smoothes shallow craters in the bone due to moderate and advanced bone loss. Following flap surgery, the bone around the tooth is reshaped to decrease the craters. This makes it harder for bacteria to collect and grow.

In some patients, the nonsurgical procedure of scaling and root planing is all that is needed to treat gum diseases. Surgery is needed when the tissue around your teeth is unhealthy and cannot be repaired with nonsurgical options.

Conventional medications used to treat periodontal disease may deplete nutrients or interfere with nutrient absorption, as well as potentially cause other adverse side effects. Following is a list of conventional medications that may be used for periodontal disease:

Antibacterial medications – Most often used to control and kill bacteria:

Chlorhexidine (Peridex®, PerioGard®) – Prescription antibacterial mouthwash frequently used to treat gum inflammation. Controls bacteria, resulting in less plaque and gingivitis.9,15
Periochip® – Tiny piece of gelatin filled with chlorhexidine. Used to control bacteria and reduce the size of periodontal pockets. Chip is placed in the pockets after root planning, where the medicine is slowly released over time.15
Tetracyclines – This group of antibiotics deplete many good bacteria such as B. bifidum and L. acidophilus, as well as nutrients: biotin, calcium, inositol, iron, magnesium, vitamins B-1, B-2, B-3, B-6, B-12, and K. Common side effects of these depletions are diarrhea as well as yeast overgrowth in the intestines, mouth, and vagina. This overgrowth can further inhibit the digestion and absorption of nutrients and cause a weakening of the immune system. A depleted level of calcium causes osteoporosis, heart/blood pressure irregularities, and tooth decay. Depletion of magnesium causes cardiovascular problems, asthma, cramps, and PMS. A lack of iron leads to anemia, weakness, fatigue, hair loss, and brittle nails.15 The following medications are the most often prescribed:
Atridox® – Gel that contains the antibiotic doxycycline. Used to control bacteria and reduce the size of periodontal pockets. Placed in pockets after scaling and root planning. Antibiotic is released slowly over a period of about seven days.15
Actisite® – Thread-like fiber that contains the antibiotic tetracycline. Used to control bacteria and reduce the size of periodontal pockets. These fibers are placed in the pockets. The medicine is released slowly over 10 days. The fibers are then removed.15
Arestin microspheres® – Tiny round particles that contain the antibiotic minocycline. Used to control bacteria and reduce the size of periodontal pockets. Microspheres placed into pockets after scaling and root planning. Particles release minocycline slowly over time.15
Periostat® – A low dose of the medication doxycycline that keeps destructive enzymes in check. Used to hold back the body’s enzyme response—if not controlled, certain enzymes can break down bone and connective tissue. This medication is in pill form. It is used in combination with scaling and root planning.15

Warning about Antibiotics: Antibiotics, especially broad-spectrum antibiotics, will destroy all of the bacteria—both good and bad—in the intestinal tract. You should avoid antibiotics as much as possible and reserve their use for life-threatening situations only. For those times when you must take an antibiotic, you should supplement with heavy and extended use of probiotics (good bacteria) to recolonize the intestinal tract.

Antifungal medications – Used if periodontitis is caused or amplified by the presence of a fungus:

Nystatin® – A drug generally used to treat fungal infections of the intestinal tract. Most effective for fungal-related periodontal disease when taken systemically and topically. Rare side effects include diarrhea, upset stomach, stomach pain, and skin rash. It is not known to deplete any nutrients.14,15
Diflucan® – Considered by many doctors as the best overall antifungal medication. It can be taken intravenously or by mouth. It is not known to deplete any nutrients.15
Nizoral® – Can be administered orally or topically and is not known to deplete any nutrients. However, Nizoral does interfere with the adrenal hormones, cortisol and DHEA, which may produce feelings of weakness and fatigue.15
Sporanox® – An oral antifungal. It is not known to deplete any nutrients.15

Prevention:

It is very important to not allow calculus to form on your teeth, simply by brushing the plaque off on a daily basis. Floss can be used to remove plaque that forms in-between teeth.



The only way you can detect gum disease is by going for regular dental check-ups. Your dentist will check for disease signs with a probe as well as with x-rays. Only a professional can diagnose gum disease in it’s early stages, when it is easiest to treat. Prevention and treatment of gum disease involves the combined efforts of your dentist and yourself. Your dentist will remove the calculus present on your teeth. He will also check for other contributing factors – defective fillings, crowns, bite problems, etc. He will explain the correct method of brushing and flossing, and will provide maintenance care after the initial treatment. You are required to put in your efforts towards daily brushing and flossing, and fhttp://www.blogger.com/img/blank.gifollowinghttp://www.blogger.com/img/blank.gif other instructions.






About The Author
Rehan Gul is a Pharmacist, work on new research and studies that would satisfy his zeal about searching and finding out new techniques and methods for producing medication for prevalent diseases. His Articles are the extract of Journals and Medical publications, information collected and latest development after a comprehensive review.