The Progression and Control of Periodontal Disease

The Progression and Control of Periodontal Disease

We have a vast knowledge of Periodontal Disease. Why is it that there are 75-80% of Americans who have this disease?

Periodontal Disease is a silent disease in that it does not hurt (until advanced stages) and can go undetected in its earliest stage. Too often, people don't go to the dentist regularly and start to build up plaque between their teeth. If the person is not a flosser, the plaque starts to accumulate more and more between their teeth. The once healthy gums, pink and firm around each tooth, now start to become inflammed between the back teeth where the plaque is building up. With gingivitis now established, the bacteria residing in the plaque produce toxins that start to break down the attachment of the gums to the teeth. The body's inflammatory response is to bring increased amounts of blood to those areas to fight off the toxins. The gums become puffy, tender and swollen, and can bleed easily with brushing and flossing (not likely any flossing is occuring in this person).

Getting a professional cleaning at the dental office is the place to start to turn things around and get things under control. Flossing and brushing would go a long way toward health. Of course, this person doesn't have any pain, and is unaware of this situation.

Periodontal Disease starts to progress as the toxins, plaque by-products, destroy the tissues that hold the teeth in the bone. The attachment of the gum to the root surfaces start to be destroyed and pockets develop between the gum and the teeth. The gums pull away from the teeth and recede. More plaque is now accumulating below the gum line in these pockets. Some of the plaque on the root surfaces is hardening into tartar. Like the barnacles forming on the piers at the ocean, the tartar is rough and more plaque sticks to the rough surfaces and become hardened. As the disease progresses, bone under the gums that anchors the teeth begins to dissolve away. An unpleasant odor in the mouth, bad breath, is another progressive trait of periodontal disease - bad breath. The gums may bleed when brushing. At this point, with less bone anchoring the teeth and less gum tissue covering the roots, the teeth appear longer and are sensitive to cold and are more susceptible to decay.

In advanced periodontitis, the toxins deep in the pockets continue to destroy the periodontal ligaments and bone, causing the teeth to lose more support. Unless treated, the affected teeth become more mobile amd may fall out. The key, is to not let this all get started. Should you find yourself progressing down the path described above, work hard on brushing and flossing and get into the dental office for evaluation and necessary treatment. You do not have to lose teeth to periodontal disease!

Prevention of Periodontal Disease should be a major concern for all of us. In 75-80% of the adults, the concern really should be cleaning up the gums and getting control of the PD (since it can NOT be cured). First, let's focus more on prevention in the young people and in the 20-25% of adults not affected by PD.

Floss daily, preferably before you go to bed. Then, brush well with a good fluoride toothpaste for approximately two minutes. The flossing will loosen up food and plaque particles that the brush can then help remove. Rinse, swishing the water around. Spit out and repeat. Rinse and swish 2 or 3 times. Go to the dentist regularly. For some, that means every six months. For others, the need may be more frequently. If you have dental insurance, great! However, your insurance coverage should not be the deciding factor in how often you see your dentisy and/or dental hygienist. Your dental professional, either your dentist or hygienist, can provide more (and personalized) ideas on your home care.

Eat a well balanced diet, which means you need to meet your nutritional needs while not providing any nutrients in excess. Eat items from the following groups: milk and milk products, meat and meat substitutes, fruits and vegetables, and the grains group. Don't use tobacco products in any way, shape, or form.

Now, for the 75-80% of us who have (had) some form of gingivitis or periodontitis, prevention of gum disease really means preventing it from recurring once we have it under control. Regular dental visits, once again, is one of the top things to do. The dental hygienist and dentist can tailor the frequency of visits to the individual person. Also, the more frequently you visit us, the more need for a personalized home care program to meet your specific needs. And, the dental team can give advice on selecting dental products that will work best for each individual.

Homecare is a MAJOR factor in controlling gum disease. Morning, midday, and evening. Floss, brush and usually rubbertip. A good fluoride toothpaste should be used as well as a fluoride mouthrinse. Most people in this situation have recession, and fluoride helps protect the root surfaces. Eat a well balanced diet, and exercise as often as possible. And, once again, stay away from tobacco products.

Periodontal Disease Facts and Reminders
1. Plaque forms 20 seconds after eating and 20 minutes after brushing. It hardens into tartar in 24 hours and stays on your teeth.
2. Healthy gums DO NOT BLEED. If you have bleeding gums, pay more attention to your home care instructions. Salt water rinses can help sensitive and swollen gums (1 tsp. salt dissolved into one cup water). If your gums continue to bleed after a thorough home care routine, please contact our office.
3. Experiencing a bad taste or odor is a sign of gum disease/infection.
4. Mouthwashes have no effect on periodontitis. Some mouthwashes can reduce gingivitis.
5. When subgingival plaque reaches a certain threshold level, it produces periodontal disease. Periodontal Disease, therefore, occurs in episodes of activity and quiescenece. That is why daily removal of the bacteria in your mouth is important in reducing your risk of periodontal disease.

Home Care Tips
1. Floss twice a day (morning and night). Wrap the dental floss around your middle finger and guide the floss with your index fingers and/or your thumbs as instructed in a "C" shape and scrap up and down.
2. Brush three times a day (morning, lunch, and bedtime). Hold the toothbrush at a 45 degree angle toward the gum line and direct the toothbrush under the gums using a small circular stroke. DO NOT RUSH! Spend 3 to 5 minutes brushing. Dry brushing is fine if it is more convenient. Rinse with water and expectorate.
3. Rubber tip one or two times a day. Using the tip of the stimulator, trace around the gum line of the teeth. Place the rubber tip between the teeth from the inside and outside surfaces and use gentle pressure to massage the gum tissue.
4. Proxabrush one or two times a day if recommended by your dental hygienist. Work the brush between open spaces and around bridgework.
5. If using a water pik, fill the tank with warm water and use medium speed directing the water at the right angle to the long axis of the tooth (never angle the waterjet down into the gum tissue). If you have a heart murmur, heart disease, or an artificial joint, check with your physician before using a water jet device.
6. If recommended, use desensitizing toothpaste and/or fluoride on a daily basis.

Additional Home Care Tips
1. Always brush your tongue or use a tongue scraper daily. Your tongue retains approximately 80% of the bacteria in your mouth.
2. Replace your toothbrush or other home care products if they appear worn out. Toothbrushes should not look flattened or spread out. Every six to eigth weeks you should replace your old toothbrush.
3. Toothpastes for sensitive teeth or fluorides are very useful for sensitive root surfaces. Use as directed.
4. Prescription fluoride gels are used to prevent decay, reduce sensitivity and decrease microbial (bacteria) count. After brushing your teeth, put gel on a dry toothbrush, proxabrush, or rubber tip and use for sixty seconds. Then swish with the remaining gel for another sixty seconds. Do not swallow the fluoride as it may upset your stomach. Fluoride rinses (non-alcohol) you can purchase over the counter such as Act, can also help decrease sensitivity and strengthen teeth. Use one to two times a day. Do not eat or drink for thirty minutes after using.


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Periodontal disease is a progressive disease but it can also be controlled. You cannot "cure" it but can maintain your mouth in a healthy state by following simple home care tips and visiting your dental office on a regular basis.


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