The Basics Of Avoiding Gum Disease

Gum Disease has historically been a major cause of premature tooth loss. The incidence of this infection is very high worldwide, and is considered to afflict more than seventy-five percent of Americans to some extent. The good news is that gum disease, or periodontitis, is a preventable problem. Like dental decay, it is caused by bacteria which produce acid as a byproduct of the carbohydrates that they ingest. This acid irritates the gums and erodes the bone holding the teeth. So, in the simplest terms, if the bacteria are eliminated, no gum disease can develop. At the end of this article, you will learn how simple it is to diagnose this condition, and exactly what to do about it.

There are three basic stages of periodontal disease. The initial stage is called Gingivitis which simply means inflammation of the gums. This inflammation is easily recognizable because you will see or taste blood after brushing or flossing. In addition, the gums usually look a bit red and swollen in effected areas. Such inflammation is easily reversed with a visit to the hygienist and proper home care. What the hygienist does is inspect the gums for signs of inflammation and the build-up of tartar (called calculus, which is simply calcified plaque). She then thoroughly cleans the effected areas and polishes the teeth. Usually, this procedure will eliminate the bleeding and redness until the bacteria reorganize and recreate their inflammatory products. Patients who have regular professional cleanings in conjunction with proper brushing and flossing rarely develop more serious stages of this disease. Our job as dental professionals is to help you, our patient, avoid progressing beyond this initial stage of gum inflammation.

If the gum disease were permitted to progress to stage two, it would be more accurate, then, to call it “bone disease.” At this stage, the bacteria have progressed past the gums and are now into the bone. Most patients still experience no discomfort at this stage, but the attachment of the teeth is certainly compromised now. The loss of bone is now visible on the x-rays, and inflammmed gum pockets are deeper than three millimeters. A patient may notice that his or her gums are receding or pulling away from the teeth. And, you may consider that since the gums are attached to the teeth and to bone, then for recession to have occurred, the bone must have receded first. At this stage, more aggressive gum therapy is necessary to stop the further progression of periodontal disease. Usually deep cleanings and personalized home care plans are utilized.

In stage three of Periodontal Disease, the teeth have lost more than half of their attachment to the gums and bone. Patients at this stage of gum disease will experience more obvious inflammation (swelling and bleeding) as well as the loosening of the teeth. In more severe cases, the loss of teeth has or will occur. We have actually seen patients who have lost teeth during normal chewing as a result of this advanced bone infection. Such patients will require the help of a gum specialist, or periodontist, if they wish to save their teeth.

Now let us get to the heart of the matter – the inside secret, the bottom line. During your regular examination and cleaning appointments, we will measure the depth of the gum pockets around your teeth. If any are greater than three millimeters AND they are bleeding they must be treated. End of story. Untreated pockets WILL get worse, and the deeper the pocket, the more virulent are the bacteria which live there. As with nearly all oral conditions, prevention is the key.

Fortunately, today we have many modalities for treating this disease. We use ultrasonic scalers to comfortably remove the toxic deposits around the teeth. We use a wonderful product called Arrestin to deliver antibiotic directly into infected pockets. We even have a laser which can be used to remove infected tissue and sterilize pockets. And, finally, there are various adjuncts like fluoride, ClosysII toothpaste and rinse, and special cleaning aids which all assist in keeping gum tissues healthy.

If you have any questions or concerns about your periodontal health, please feel free to call our office at 908.359.6655 for answers. Or, you may send email to info@DesignsForDentalHealth.com.

Mercury Amalgam Fillings Banned

Last week the American Dental Association, (ADA), announced that as of this year the use of mercury-silver, or amalgam, dental fillings has been banned in Sweden, Denmark and Norway. There has been much discussion about the health and environmental risks of mercury fillings in the United States as well as Europe for some time. This new broader ban was instituted because mercury is considered in those countries to be a dangerous environmental toxin as well as a potential health risk.

However, in the USA the use of mercury in dental fillings is still approved by the government and the ADA. It is only in recent years that most American insurance companies have approved payment for alternatives to mercury-silver fillings. It is considered unethical for a dentist to advise a patient to have mercury fillings removed for health reasons. However, any patient may choose to have their existing amalgams replaced with an alternative material if they so desire.

From a dental point of view, amalgam fillings are inferior to their alternatives for various reasons. Just like a mercury thermometer, as they are exposed to heat, amalgam fillings expand. And with cold, they contract. The problem is that they expand and contract at a slightly greater rate than the tooth structure which surrounds them. After years of hot and cold cycling, small cracks develop in the teeth. Eventually, these cracks propagate and the teeth fracture. Then, a larger and more complicated restoration is required to repair the damage. In addition, unlike the alternative materials used to repair teeth which are bonded into place, amalgams do nothing to hold the remaining tooth together. And, from a cosmetic point of view, silver fillings cause the teeth to appear grayish. Such discoloration often increases over time. Although ethically, I am not permitted to recommend removal of amalgams for strictly health issues, I decided over fifteen years ago to stop using mercury-containing fillings. My patients’ experience with the alternative materials has been excellent in terms of longevity of service, comfort, and appearance.

There are two main amalgam alternatives. For fillings which are less than one-third the width of the tooth, composite restorations are wonderful. They are relatively inexpensive, bonded into the tooth for strength, and match the tooth color. Larger restorations are best replaced with porcelain inlays or onlays. These, too, are bonded to the surrounding tooth structure and match in color. They are very strong and can be used to conservatively restore teeth which, in the past, required crowns or caps.

If you have any concerns or questions about such filings, please feel free to call our office at 908.359.6655 for more information. Or, you may send email to info@DesignsForDentalHealth.com.