Gum Disease Q & A

All About Gum Disease

Institute Founder and Director Dr. Gene Sambataro answers your commonly asked questions about the dental terminology and treatments.

Q. What is plaque?

Plaque is a sticky material made up of food particles, saliva, germs and bacteria that attaches to the tooth at and below the gum line that is removed by brushing and flossing.

Q. Why is plaque so hard to remove?

Because of where it lives! Plaque usually builds up and becomes a problem in the areas we fail to clean properly. We tend to neglect hard-to-reach places; areas at and below the gum line, in between the teeth and in all the little nooks of the teeth. Plaque which is built up, attaching itself to older layers of plaque is the most difficult to remove.

Q. What is calculus (commonly called tartar)?

It is hardened plaque. Well, it is not that simple. All plaque does not form calculus. However, when combined with other ingredients and factors, mineralized or calcified plaque is described as calculus. Calculus is usually more difficult to remove than plaque and it can begin to form in as little as eight hours.

Q. What is a periodontist?

A periodontist is a specialist with advanced training in the prevention, diagnosis and treatment of diseases affecting the gums and supporting the structures of the teeth.

Q. What is periodontal disease?

Almost half of American adults have some form of periodontal disease but don’t know they have it. Periodontal disease (also known as gingivitis or gum disease depending on its severity) is a bacterial infection of the gums, bone and periodontal ligament, which supports the teeth and holds them in the jaw.

Periodontal disease begins with the bacterial build up in the mouth commonly known as plaque or calculus, which is present in everyone’s mouth. As bacteria make themselves at home on your gums and teeth, your gums become inflamed. Your body then attempts to destroy the bacteria using its natural defense mechanism to send infection fighting white blood cells to the site of inflammation. These white blood cells release enzymes and in some people, they are overproduced. This overproduction of enzymes causes the destruction of the tissues that surround and support the teeth, gums and bone, leading to advanced stages of periodontal disease.

Q. Am I at risk of developing periodontal disease?

A number of factors can increase your chances of developing periodontal disease. The good news is that you may be able to reduce your risk simply by changing your behavior. Smoking, poor oral hygiene, infrequent dental visits, poor nutrition, stress, diabetes and osteoporosis can all negatively impact your oral health and promote gum disease.

Q. Does periodontal disease “run” in families?

Unfortunately, periodontal disease is not “fair” and can invade the mouth of even the most devout user of toothbrush and floss. In some cases, this may be attributed to genetic makeup.

Studies show that genes passed along to you by your parents, may make you more susceptible to some forms of periodontitis. In addition, certain disease, such as diabetes or osteoporosis, can increase your risk for periodontal disease.

If you are predisposed to periodontal disease because it runs in your family or if you have diabetes, don’t give up your fight to save your teeth. While good oral hygiene, regular professional care and a healthy lifestyles may not prevent all periodontal disease, they can help you to keep it under control.

Q. I’ve read that periodontal disease can affect all my major organs, is that true?

Yes. Periodontal disease is a bacterial infection. Periodontal bacteria can enter the blood stream and travel to major organs beginning new infections. The Heart is one of the most susceptible organs along with the Brain, but all major organs in the body can be impaired or damaged by the constant bacterial load caused by periodontal disease.

Q. Does periodontal disease increase my risk for heart disease and stroke?

Researchers have found that people with periodontal disease are one and a half times more likely to suffer a fatal heart attack, twice as likely to suffer from coronary artery disease and nearly three times more likely to suffer a stroke as those without periodontal disease.

Several theories exist to explain the link between periodontal disease and heart disease. One theory is that oral bacteria affect the heart by entering the bloodstream. Once in the bloodstream they attach to the fatty plaques lining the coronary arteries (heart blood vessels) and contributing to clot formation.

Coronary artery disease is characterized by a thickening of the walls of the coronary arteries due to buildup of fatty proteins. Blood clots can obstruct normal blood flow, restricting the amount of nutrients and oxygen required for the heart to function properly, increasing the risk of heart disease.

Heart (or cardiovascular) disease affects more than 60 million Americans and is the leading cause of death for both men and women in the United States. The good news is that many types of heart disease may be prevented. Taking care of your periodontal health can be one important component, along with controlling other well-known risk factors for heart disease.

Q. What precautions should heart patients take before dental treatments?

Periodontal disease can affect some existing heart conditions by increasing the risk for infective endocarditis which is characterized by inflammation of the lining of the heart. Those patients with existing heart conditions or a history of rheumatic fever, mitral valve prolapse or heart murmur may require antibiotics before receiving treatment for periodontal disease. Your periodontist and Cardiologist will be able to determine if your heart condition requires the use of antibiotics before dental appointments.

The American Heart Association has established guidelines to help protect those patients most at risk for infective endocarditis and prone to heart problems following a dental procedure. If you are at risk for infective endocarditis, your dentist and/or periodontist can take steps to limit the entry of bacteria into the blood streams during the dental procedures including:

  • Treatment of any existing periodontal infection
  • Prescribing antibiotics prior to the procedure
  • Asking you to make more regular maintenance visits to reduce the build-up of bacteria in the mouth
  • Proper home care techniques for your teeth

Good periodontal health is essential for you to maintain your heart health. If you know you have heart disease or if you are currently receiving treatment for a cardiovascular complication, see your periodontist for a periodontal evaluation.

Q. What other health conditions have been linked to periodontal disease?

Periodontal disease has also been linked to other significant health problems including:

  • Stroke
  • Respiratory disease
  • Osteoporosis
  • Premature and underweight births
  • Diabetes

Advanced periodontal disease in diabetics has been linked to an increased difficulty in the maintenance of blood sugar levels a well as reducing the bodies ability to fight off infection and heal wounds.

It is very important that you always provide your periodontist with a complete and accurate medical history, including any heart problems you are aware of. Your periodontist and physician can work together to help your gums and your overall health. As former surgeon general C. Everett Koop said, “A person is not healthy without good oral health.”

Q. What are the symptoms of periodontal disease?

Periodontal disease is usually painless and silent, until it’s advanced stages. If left untreated, symptoms can include:

  • Persistent bad breath
  • Gums that bleed when you brush your teeth and floss
  • Red, swollen and tender gums
  • Gums that have pulled away from the teeth (receded)
  • Loose, shifting or separating teeth
  • Pus between the gum and tooth
  • A change in the way your teeth fit together

Periodontal disease can be diagnosed and treated by your dentist and/or periodontist.

Q. How can I reduce the risk of developing periodontal disease?

You may be able to reduce your chances of periodontal disease just by changing your behavior.

  • If you smoke, quit. Smoking increases your risk of periodontal disease between two-to-seven fold
  • Brush your teeth thoroughly at least twice a day
  • Floss/clean between your teeth daily
  • Eat a balanced diet
  • Visit your dentist regularly for professional care to reduce the build up of bacteria-harboring plaque and tartar

Q. What can my dentist and periodontist do to battle periodontal disease?

Once a dental professional has diagnosed you with adult periodontitis, or any form of progressive periodontal disease, you should seek out appropriate treatment as soon as possible to control or prevent further destruction of tooth-supporting tissues.

Periodontitis has two components: bacterial infection and tissue-destroying enzymes (which are produced by your immune systems attempts to fight the infection). Scientists have now determined that the best way to control periodontal disease is to use a two-step process to treat both components.

  1. Reduce the amount of bacteria in the gum pockets, the spaces formed between the tooth and gum by periodontal disease
  2. Block or suppress the action of the tissue-destroying enzymes released by the immune system into the gum tissues

The most common procedure used to eliminate bacteria is an intensive professional cleaning method called scaling and root planning (SRP), which removes soft (plaque) and hard (calculus) deposits from the tooth surface above and below the gum line. This procedure also includes shaving off a layer of the root surface, which encourages the gum tissue to re-attach to the tooth.

The use of prescription drugs and anti-microbial agents are also methods that your dentist may use to eliminate bacteria. Prescription drugs and anti-microbial agents can be administered in a pill-form, as a mouth rinse or implanted directly in your gum as an antibiotic-laden thread, gel or an anti-microbial chip. Most of these treatments are given in conjunction with or following SRP.

Once bacteria has been reduced in the mouth, another important treatment step is to prevent further loss of gum and bone tissue by halting the tissue-destroying enzymes produced by the bodies own immune system. A prescription medicine designed to halt the production of these enzymes called Periostat, has been approved by the U.S. Food and Drug Administration and is now widely available.