Thank you for visiting the ZCY Perio Education Center! Here you will find general information about gum disease, and other topics that reveal how your smile can affect your health.
About the Health of Your Teeth and Gums
What is Periodontal Disease?
Periodontal diseases – also known as gum diseases – account for some of the most common infections in the United States. More than 75% of American adults over age 35 have some form of periodontal disease, but most are unaware that they are affected by it.
Periodontal diseases attacks the soft tissue and bone surrounding and supporting the teeth. They usually develop slowly and are often painless in their early stages, but if left untreated they can result in bad breath; red swollen and bleeding gums; and eventually tooth loss. In fact, gum diseases are the leading cause of adult tooth loss. The good news is that gum diseases are treatable, and even preventable.
These 8 eight silent symptoms may indicate periodontal disease:
1. Gums that bleed when you brush your teeth.
2. Red, swollen, or tender gums.
3. Gums that have pulled away from your teeth.
4. Pus that appears between your teeth and gums when
5. Teeth that are becoming loose or changing in position.
6. Any change in the way your teeth fit together when you bite.
7. Any change in the way your partial dentures fit.
8. Bad breath or bad taste in your mouth.
Types of Gum Disease
Periodontitis can be a manifestation of systemic diseases such as heart disease, respiratory disease, and diabetes. Periodontitis resulting from systemic conditions can begin at a young age.
Gingivitis occurs when tarter and bacteria trapped under the gum line lead to infection, causing the gums to become inflamed. Eventually, pockets form between tooth and gum making plaque harder to remove. If left untreated the disease advances and bone damage occurs, which can lead to the loss of one or more teeth.
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.
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.
Gingivitis is the early stage of gum disease. Warning signs include an occasional swelling of the gums, gums that bleed after brushing or flossing, itchy gums, or bright red or purple gums.
Chronic gingivitis is a common condition that affects over 90% of the U.S. population. If treated, the prognosis for those with gingivitis is good, but if left untreated gingivitis can worsen to become periodontitis, a more serious gum disease.
Gingivitis, when combined with receding gums, periodontal disease or other conditions, can create serious health problems. Gingivitis almost always leads to bad breath, and can also lead to loose teeth and eventually tooth loss. Studies show that gum disease has been linked to many other serious illnesses including stoke and heart attacks.
Treatment Gingivitis is a recurring condition, but it can be treated with a professional cleaning, followed by a strict home care regimen that includes tooth brushing, flossing, the use of antibacterial products - and regularly scheduled cleanings.
Left untreated, gingivitis can escalate into periodontitis. Periodontitis symptoms include those of gingivitis, plus a metallic taste in your mouth, receding gums, enlarged spaces between the gums and teeth, severe halitosis (bad breath), and even loose teeth (from loss of bone).
Drug Induced Gingival Overgrowth
by Dr. Alec Yen
Does your gum look excessively overgrown and puffy? Do you take medications for epilepsy, immunosuppressant, or high blood pressure? If you answer "yes" to both questions, you may have a condition call "drug induced gingival overgrowth".
Anticonvulsant such as phenytoin (Dilantin) is used in the treatment for epilepsy. Gingival enlargement occurs in about 50% of patients receiving the drug.(1) It is not dependent on whether patient has good oral hygiene or not but poor home care does exacerbate the condition.
Cyclosporine (Sandimmune, Neoral) is a potent immunosuppressive agent used to prevent organ transplant rejection and to treat several diseases of autoimmune origin.(2) Around 30% of patients on this type of drug show some form of gingival overgrowth. Children are affected more often than adults.
Calcium channel blockers (Nifedipine, Amlodipine, Diltiazem) are drugs commonly prescribed to treat cardiovascular conditions such as hypertension, angina pectoris, coronary artery spasms, and cardiac arrhythmias. Around 20% of patients on Nifedipine have been found to be affected with gingival enlargement.(3)
Drug induced gingival overgrowth is a condition not dependent on your home care but poor plaque control can worsen the condition and initiates periodontal disease or bone loss for your teeth. It is important that you seek consultation and possible treatment from your periodontist. With his help, you can reduce the overgrowth and learn to keep the condition at its minimum. In the long run, this will help prevent tooth loss and preserve your gum health so that you can smile with confident.
(1) Seymour RA, Thomason JM, Ellis JS: The pathogenesis of drug-induced gingival overgrowth. Journal of Clinical Periodontology 1996;23:165. (2) Calne R, Rolles K, White DJ, et al: Cyclosporin-A initially as the only immunosuppressant in 34 recipients of cadaveric organs: 32 kidneys, 2 pancreas and 2 livers. Lancet 1979;2:1033. (3) Barclay S, Thomason JM, Idle JR, et al: The incidence and severity of nifedipine-induced gingival overgrowth. Journal of Clinical Periodontology 1992;19:311.
Halitosis, also known as bad breath, is a common problem that can have a wide variety of causes, from dry mouth and eating specific foods to poor dental hygiene, bacterial gum infections, sinus infections and cavities. More serious causes of halitosis include stomach or blood disorders, cancer, diabetes, liver and lung diseases. Due to the varying nature of possible causes, individual halitosis problems should be assessed on a case-by-case basis.
From The American Academy of Periodontology
A Healthy Smile May Promote a Healthy Heart
Research continues to suggest the importance of periodontal health as related to cardiovascular health
CHICAGO - January 08, 2008 - Each year, cardiovascular disease kills more Americans than cancer. And while most people are aware that lifestyle choices such as eating right, getting enough exercise and quitting smoking can help prevent cardiovascular disease, they may not know that by just brushing and flossing their teeth each day, they might also be avoiding this potentially lethal condition.
An article published in the December issue of the Journal of Periodontology (JOP), the official publication of the American Academy of Periodontology (AAP), suggests that periodontal patients whose bodies show evidence of a reaction to the bacteria associated with periodontitis may have an increased risk of developing cardiovascular disease.
"Although there have been many studies associating gum disease with heart disease, what we have not known is exactly why this happens and under what circumstances," said JOP editor Kenneth Kornman, DDS, PhD. "The findings of this new analysis of previously published studies suggest that the long-term effect of chronic periodontitis, such as extended bacterial exposure, may be what ultimately leads to cardiovascular disease."
Researchers at Howard University identified 11 studies that had previously examined clinically-diagnosed periodontal disease and cardiovascular disease. The team then analyzed the participants' level of systemic bacterial exposure, specifically looking for the presence of the bacteria associated with periodontal disease, as well as measuring various biological indicators of bacterial exposure. They found that individuals with periodontal disease whose biomarkers showed increased bacterial exposure were more likely to develop coronary heart disease or atherogenesis (plaque formation in the arteries).
"While more research is needed to better understand the connection between periodontal disease and cardiovascular disease, this study suggests the importance of taking of your teeth and gums and how that can help you take care of your heart," said Susan Karabin, DDS, President of the AAP. "With the number of people with heart disease continuing to increase, it is important to understand that simple activities like brushing and flossing twice a day, and regular visits to your dental professional can help lower your risk of other health conditions."
Periodontal Therapy Helps Patients With Type 2 Diabetes
Researchers find oxidative stress levels reduced to those of non diabetic patients
CHICAGO - October 31, 2006 - When patients with Type 2 diabetes and periodontal disease receive periodontal therapy, they often experience a reduction in their levels of oxidative stress, a condition in which antioxidant levels are lower than normal. Patients' stress levels after periodontal therapy were similar to those of nondiabetic patients, according to a new study that appeared in the November issue of the Journal of Periodontology (JOP).
Researchers from Kyushu Dental College in Kitakyushu, Japan investigated the impact of periodontal therapy on patients with Type 2 diabetes, as compared to non diabetic patients. They found that periodontal therapy decreased lipid peroxide (LPO), an oxidative stress index, in diabetic patients.
"Our research emphasized one of the benefits of having periodontal therapy for patients with diabetes," said Dr. Kazuo Sonoki, M.D. PhD at Kyushu Dental College, one of the study authors. "However, this was just a preliminary study and more research should be conducted to evaluate how periodontal disease affects both people with and without diabetes."
It has been found that diabetes and periodontal disease can lead to atherosclerosis, which occurs when deposits of fatty substances, cholesterol, and other substances build up in the inner lining of an artery. This buildup is called plaque. It has been thought that oxidative stress is linked to heart disease because oxidation of LDL (low-density lipoprotein) in the endothelium is a precursor to plaque formation. Recently, oxidative stress has emerged as an important factor for atherosclerosis in patients with diabetes.
"We hear every day about how more and more people are being diagnosed with diabetes," said Preston D. Miller, DDS and AAP president. "This research confirms that patients with diabetes should be especially conscious of their periodontal health. While more research needs to be done to evaluate the relationship between periodontal disease and diabetes, we do know that treating periodontal diseases can save teeth, and can promote overall health."
Is there a link between Rheumatoid Arthritis and Periodontal Disease?
CHICAGO – June 21, 2001 – Swollen joints and missing teeth often go hand in hand, according to a new study in the Journal of Periodontology. In the Australian study of 130 people, the 65 people who had rheumatoid arthritis were more than twice as likely to have periodontal disease with moderate to severe jawbone loss as the control subjects. In addition, they averaged 11.6 missing teeth, compared to 6.7 in the control group.
"Periodontal disease and rheumatoid arthritis have very similar pathologies," said Robert Genco, D.D.S., Ph.D., editor of the Journal of Periodontology. "Damage caused by the immune system and chronic inflammation are central to both diseases. A better understanding of the biological processes common to these diseases may help us find new ways to treat them with medications that modify the body's response to inflammation."
At this point, researchers are not saying the relationship between the two diseases is causal. However, some scientists think a bacterial infection may trigger the disease process in some of the estimated 2.1 million people with rheumatoid arthritis.
Some dental professionals had speculated that people with arthritis have more periodontal disease because limited dexterity decreases oral hygiene. However, researchers in this study found no difference in plaque deposits between the group with rheumatoid arthritis and the control group, indicating that the progression of periodontal disease in the arthritis group was due to factors other than a difference in oral hygiene.
"People with rheumatoid arthritis should take note of this connection," said Michael McGuire, D.D.S., president of the American Academy of Periodontology (AAP). "They should be on a close lookout for signs of periodontal disease, such as red, swollen gums that bleed easily. The earlier you detect periodontal disease and treat it, the better off you are."
New Evidence Finds an Association Between Periodontal Disease and Stroke
Researchers from Boston University investigate the relationship between periodontal disease and ischemic stroke
CHICAGO – October 10, 2006 – People missing some or all of their teeth or who have significant loss of bone and tissue surrounding their teeth may be at an increased risk for having a stroke, according to a new study that appeared in the October issue of the Journal of Periodontology (JOP).
Researchers from Boston University investigated the relationship between periodontal disease and history of stroke in patients 60 years of age and older by examining the data of the Third National Health and Nutrition Examination Survey (NHANES III).
"We found that patients 60 years and older who were edentulous, partially edentulous and/or had significant clinical attachment loss were more likely to have a history of stroke compared to dentate adults without significant clinical attachment loss," said Dr. Martha E. Nunn, Goldman School of Dental Medicine, Boston University. "However, based on the results of this study, it is unclear whether periodontal disease is an independent risk factor for stroke or simply a risk marker that reflects negative effects of risk factors common to both periodontal disease and stroke."
Age, tobacco use, hypertension, diabetes, serum glucose, C-Reactive protein (CRP) and alcohol intake were also included as additional risk factors in this study. These confounders are independent risk factors for cardiovascular disease and if left untreated, periodontitis has been shown to have harmful effects on the control of diabetes, serum glucose levels and increases CRP levels.
Evidence continues to accumulate associating severe periodontitis with an increased risk of forming atherosclerotic plaques, which are responsible for myocardial infarction and ischemic stroke. According to past JOP studies, this relationship could be due to elevated CRP levels in patients with chronic periodontal disease.
Further investigation is needed to support periodontal treatment intervention as a means of controlling systemic inflammation. Based on findings from another study in the same issue of the Journal, CRP levels may now be reduced by periodontal treatment such as scaling and root planing in patients with severe periodontal disease.
"Studies evaluating additional treatment methods such as repeated scaling and root planing or surgical treatment are needed to conclusively demonstrate that CRP can be improved by periodontal treatment," said Preston D. Miller, DDS and AAP president. "Until science presents a definitive direction, the periodontists ultimate goal is to lead patients to the right side of health. What we do know is that eliminating periodontal infection saves teeth."