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Periodontal (Gum) Disease

1 out of 2 Americans adults suffer from gum disease, could this be you? Gum disease is an inflammation of the gums triggered by bacteria in the form of plaque film at the gum line and or below. The progression of periodontal disease is influenced by a number of factors which include oral hygiene, diet, age and genetic predisposition. For people who don’t seek regular dental care, periodontal disease is challenging detect since they may not know they have it because it does not cause any pain. Thus, most people don't proactively seek advice from a dentist. 

Dr. Hanah Pham and associates often treat periodontal disease at the early-moderate periodontal stages, and sometimes at the advanced stages, which requires more gum treatment procedures and visits to get the gums back to health. Periodontal disease starts with gingivitis and may progress into periodontitis. Gingivitis is very easy to treat at this early treatment and it is reversible, but advanced periodontist can lead to tooth loss. 

In general, pocket depths range for different diagnosis, HOWEVER other health conditions, age, and hereditary risks are factored into the diagnosis to enable a treatment plan that is optimal for each individual patient's needs. Below are the gum diagnosis of pocket depth ranges:  

  • HEALTHY: 1-3 MM
  • EARLY TO MODERATE PERIODONTITIS: 3-4 MM
  • MILD-MODERATE PERIODONTITIS : 4-6 MM
  • ADVANCED PERIODONTITIS: 6-12MM + 

Healthy Gums and Bone X-Ray
(Notice good bone support around the root)

Advanced Periodontitis X-Ray
(Notice the severe bone loss around the root)

Healthy Gums

Healthy Gums

Healthy gums should look pink and tight, not red and swollen (signs of inflammation). To keep your gums healthy, routine oral home care (regular brushing and flossing) for your gums and teeth is a must, and also getting a routine professional teeth cleaning is recommended to optimize your oral health. With healthy gums, the gum tissue forms a tight seal around your teeth (normal healthy pocket depth is 1-3 mm) to support the bone and provide a barrier from bacteria in the mouth. The goal is to minimize plaque (bacteria, food particles) on tooth surfaces. The less plaque you have the cleaner your teeth and gums will be, and therefore the better you can maintain your oral health.

Gingivitis

Gingivitis is the inflammation of the gum. It is the most common and mild form of gum disease (periodontal disease) that causes irritation, redness, and swelling (inflammation) of the gum line. This occurs when oral hygiene is lacking at home or not optimal, and common patients usually are overdue for their routine dental cleaning (which is recommended to get twice a year for healthy teeth). Over time, plaque (bacteria and food in the mouth) builds up along the gum line, and sometimes a noticeable layer plaque on teeth causing gingivitis. The good news is that gingivitis is treatable and reversible. However, if untreated, it can progress to periodontitis. Symptoms: include gums that are swollen, puffy, receding, sometimes tender, or that bleed easily on brushing/flossing, cleaning between teeth or probing (at the dentist). 

Treatments with varying in severity of gingivitis and health factors: Factors that affect treatment options for severe gingivitis are age, medical condition, and length of time bacteria has been accumulating in the mouth.

  • In Mild to Moderate Gingivitis -- Most of the time it requires just a simple professional cleaning with oral antibacterial rinse and irrigation
  • In Moderate to Severe Gingivitis -- It may require an extended professional cleanings with medicaments requiring two simple visits

In Severe Gingivitis (with the special needs population and the immunocompromised population), normally, these population groups require a more aggressive gum treatment that is on the same line as the initiate therapy of gum treatment (scaling and root planing) for periodontitis. This usually recommended for patients with limited dexterity and or cognitive impairment and the aging population with systemic health issues, or sometimes for patients who need a dental clearance to make sure their gums are healthy and infection-free before a major surgery. In some cases, patients may not need the full mouth deep cleaning (4 quadrants of scaling and root planing) but just in some localized areas needing deep cleaning.  

Below is an actual patient with severe gingivitis:

The patient above has severe gingivitis

This photo shows how severe gingivitis affects the teeth

Periodontitis

If gingivitis are left untreated for a long time, it will lead to periodontist. Plaque typically continues to build up along and beneath the gum line. Mature plaque over time hardens or calcifies into calculus (tartar). Studies have revealed that periodontitis is associated with other systemic diseases. It is a constant potential source of low grade chronic infection and has been considered a risk factor for cardiovascular (heart), respiratory (lungs), endocrine, musculoskeletal (joints) and reproductive (preterm birth) system related abnormalities. Therefore, periodontitis and oral health should not be seen as a separate, distant, and less important area of health.

Periodontitis has all the symptoms of gingivitis but worse: 

  • Bone Loss 
  • Gum Recession with Root Showing
  • Pus Present - Sometimes this is not visible in early to moderate periodontitis because it is mixed with saliva, but may be noticeable in advanced periodontitis

EARLY TO MODERATE PERIODONTITIS: Gum tissues begins to break down, pockets form, teeth begin to lose support around the roots (started to be evident on x-rays depending on the severity), mild to moderate bone loss, pus (exudates) begins to form but not apparent because it is mixed with saliva and blood. 

This is a patient with early to moderate periodontitis

A photo diagram of early to moderate periodontitis

ADVANCED PERIODONTITIS: Plaque can continue to build up on top of old tartar and below the gum line and eventually thickens the tartar layers and getting deep down into the pockets. More bone loss and more supporting tissues break down. Deeper pocket present. Pus (exudates) becoming noticeable and can have a strong odor coming for the mouth due to gum infection at this stage.

The patient above has severe periodontitis

This diagram demonstrates advanced periodontitis


Gum Treatments at Reston Sunrise Dentistry 

  • Initial Therapy -- Scaling and Root Planing and reevaluation with maintenance intervals (2-3 months, 4, months, 6 months). This maintenance cleaning interval is very important to ensure periodontal health and to hopefully avoid the regression of gum treatment needing to repeat the deep cleanings 
  • Surgical Therapy -- Some teeth that fail to respond to initial therapy or they have advanced periodontitis may need to go to surgical therapy
  • Periodontal Maintenance -- This is similar to a routine cleaning, which is a prophylaxis recommended for patients who do have healthy gums, where as periodontal maintenance is recommended for patients who do have a history of gums disease

Early treatment in Periodontal disease is the key to success and preservation of existing bone and gum and it also benefit on the cost perspectives as well. Please call our office at (703) 860-4148 or request an appointment to ask our dentists in Reston, VA any questions you may have. Reston Sunrise Dentistry serves people in our Reston, Herndon, Fairfax, Sterling and in the NOVA area.

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