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18/Jul/2013

Periodontal-Health-&-Treatm

Sequela of gum disease
Sequela of gum disease

Gingivitis
Gingivitis

Gingivitis is the inflammation of the gingiva due to bacterial infection that can occur at any age but most frequently arises during adolescence. It is a disease that requires the presence and maturation of bacterial plaque Gingivitis is diagnosed by bleeding and by changes in the colour, contour and consistency of the gingiva. Features include red swollen marginal gingiva; loss of stippling; red-purple, bulbous interdental papillae; and the increased fluid flow from the gingival crevice. Gingival bleeding and pain are induced by tooth-brushing and slight probing. Treatment of gingivitis consists of frequent and regular removal of plaque through dental scaling and root planing. If gingivitis is left untreated for a long period of time, it will lead periodontitis which will result in loosing teeth.


Dr. Janice Ng
16/Jul/2013

Periodontal-Health-&-Treatm

After the age of 35, gum disease or periodontitis is the major cause of tooth loss in adults, far more so than tooth decay. In fact, about 80% of tooth loss can be ascribed to periodontal disease in this age group. A lot of time and money could be saved by early detection and treatment of the disease and many more people would keep their teeth if they were aware of this fact.

Sequela of gum disease
Sequela of gum disease

Periodontal disease affects the support structures of the teeth: the bone, gums and ligament (Click here for Dental Anatomy). It is long-term and slow-moving disease: painless in its initial stages, but later presenting as a chronic inflammation that damages both the gums and bone holding the teeth in place. Bacterial plaque is the main culprit here, and only fastidious daily brushing and flossing can effectively remove it.
The most common form of periodontitis is adult periodontitis. It can be localized or generalized and appears to progress episodically. During periods of exacerbationthere is advancing loss of epithelial attachment, increase periodontal pocket depth, increased gingival crevicular fluid, loss of alveolar bone and connective tissue attachment and gingival bleeding.
The predominant species associated with adult periodontitis ace Actinobaccillus actinomycetemcomitans (25-30%), Actinomyces naeslundii, Bacteriods forsythus, Campylobacter rectus, Eikenella corrodens, Eubacterium species, Fusobacterium nucleatum, Peptostreptococcus micros, Prevotella intermedia, Prophyromonas gingivalis, Selenomonas sputigena, Streptococcus intermedius and Treponema species

Types of periodontitis

Adult periodontitis can be devided into  3 types base on severity:

i) Mild (Early) Adult Periodontitis

Mild periodontitis. From Colour Atlas of Common Oral Disease
Mild periodontitis. From Colour Atlas of Common Oral Disease

Clinical features:

  • 3mm epithelial attachment loss or less (gum recession)
  • periodontal pocket depths of 3-5mm (determine by using a periodontal probe)
  • class I furcation involvement
  • alveolar bone loss of 2mm or less (Alveolar bone loss is determined by vertical periapical bitewing radiograph)

ii) Moderate Adult Periodontitis

Moderate periodontitis. From Colour Atlas of Common Oral Disease
Moderate periodontitis. From Colour Atlas of Common Oral Disease

Clinical features:

  • 4-5mm epithelial attachment loss
  • periodontal pocket depths of 4-6mm
  • alveolar l bone loss of 3-5mm
  • gingival exudate and bleeding
  • horizontal, vertical  bone loss and osseous defects
  • mobile teeth and class II furcation involvement

iii) Advanced Adult Periodontitis

Advanced periodontitis. From Colour Atlas of Common Oral Disease
Advanced periodontitis. From Colour Atlas of Common Oral Disease

Clinical features:

  • At least 6mm epithelial attachment loss
  • periodontal pocket depths exceed 6mm
  • alveolar crestal bone loss is more than 5mm
  • gingival recession
  • significant tooth mobility and class III furcation involvement (A through-and-through bony defect)

 Other types of periodontitis

  • Early-onset periodontitis which can be prepubertal periodontitis and juvenile periodontitis
  • Rapidly progressing periodontitis
  • Necrotizing ulcerative periodontitis (HIV periodontitis)
  • Responsiveness to therapy (refactory periodontitis)

Treatment

Treatment depends on the causal factors but generally involves:

Dental Scaling
Dental Scaling

  • the removal of plaque, calculus and diseased cementum by scaling, curettage and root planing
  • Topical antibiotics, short-course therapy with systemic antibiotics (tetracycline and metronidazole)
  • periodontal surgery

 

More info

 

Treatments of gum disease:

 


Dr. Tham
02/Nov/2011

Why it is important?

  • Improper oral hygiene leads to plaque build-up
  • Plaque formation can lead to gingivitis, an early form of gum disease
  • If left untreated, gingivitis can progress to periodontitis, a more severe form of gum disease
  • Recent evidence indicates that periodontitis is associated with certain medical conditions

That is why it is important for your overall health to understand the importance of good oral hygiene.

Plaque

Plaque

What is plaque?

  • A colourless film of harmful bacteria that sticks to your teeth
  • It is constantly form on the tooth surface.
  • Combination of saliva, food and fluids produce these deposits that collected on teeth and where teeth and gums meet.

Why prevent it?

  • Plaque build-up can lead to gum irritation, gingivitis, periodontal disease, cavities, and even lead to tooth loss
  • Plaque build-up may also harden into tartar

Tartar

  • Tartar trapped between the teeth and gum

    Tartar or calculus is a crusty deposite that can trap stains on the teeth and cause discolouration.

  • It creates a strong bond to the tooth surface, making it difficult to be remove by using dental floss or brushing
  • Tartar formation may also make it more difficult to remove new plaque and bacteria
  • Tartar can only be removed with dental scaling by a dental professional

Tartar attach on the extracted teeth

Plaque and Tartar will lead to dental problem such as:


Gingivitis

Periodontitis and tooth loss

Dental Caries

Poor Oral Health Could Mean Poor Overall Health

Oral health is integral to general health – from the Surgeon General’s Report on Oral Health, 2000

What is the association?

  • The mouth is directly connected to the body by the bloodstream and the digestive system
  • Left untreated, plaque and inflammation can lead to gingivitis
  • Untreated gingivitis may progress to periodontitis
  • Recent evidence suggests that periodontitis is associated with systemic diseases such as heart disease (eg. heart attack, stroke) and diabeties.

Prevention is better than cure

Daily Oral Care: Cleaning In Between

1. Dental Floss

Step 1

Step One:
Take about 18 inches (50cm) of floss and loosely wrap most of it around each middle finger (wrapping more around one finger then the other) leaving 2 inches (5cm) of floss in between

Step 2

Step Two:
With your tumb and index fingers holding the floss taut, gently slide it down between your teeth, while being careful not to snap it down on your gums.

Step 3

Step Three:
Curve the floss around each tooth in a “C” shape and gently move it up and down the sides of each tooth, including under the gumline

How to floss your teeth – source Mouth Healthy (ADA)

2. Interdental Brushes and Threading Floss

Threading Floss

For people with widely spaced teeth, braces, bridges or implants, they may benefit from an interdental toothbrush.

Interdental Brush

Daily Oral Care: Brushing Teeth

Video: How to brush your teeth – source Health Education England (NHS)

Twice yearly: To visit a dentist for dental check-up & dental scaling

Consultation01 [1600x1200]

More info

 

Treatments of gum disease:

 


Dr. Eddy Loo
31/Oct/2011

Periodontal-Health-&-Treatm

Diabetic patients are more likely to develop periodontal disease, which in turn can increase blood sugar and diabetic complications.

People with diabetes are more likely to have periodontal disease than people without diabetes, probably because diabetics are more susceptible to contracting infections. In fact, periodontal disease is often considered the sixth complication of diabetes. Those people who don’t have their diabetes under control are especially at risk.
A study in the Journal of Periodontology found that poorly controlledtype 2 diabetic patients are more likely to develop periodontal disease than well-controlled diabetics are.
Research has emerged that suggests that the relationship between periodontal disease and diabetes goes both ways – periodontal disease may make it more difficult for people who have diabetes to control their blood sugar.
Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. This puts diabetics at increased risk for diabetic complications. Thus, diabetics who have periodontal disease should be treated to eliminate the periodontal infection.
This recommendation is supported by a study reported in the Journal of Periodontology in 1997 involving 113 Pima Indians with both diabetes and periodontal disease. The study found that when their periodontal infections were treated, the management of their diabetes markedly improved.
-Source: perio.org-

More info

 

Treatments of gum disease:

 


Dr. Janice Ng
31/Oct/2011

Periodontal-Health-&-Treatm

Researchers have found that people with gum disease are almost twice as likely to suffer from coronary artery disease. – American Academy of Periodontology

Heart Disease

Several theories exist to explain the link between periodontal disease and heart disease. One theory is that oral bacteria can affect the heart when they enter the blood stream, attaching to fatty plaques in 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 the 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. This may lead to heart attacks.
Another possibility is that the inflammation caused by periodontal disease increases plaque build up, which may contribute to swelling of the arteries.
Researchers have found that people with periodontal disease are almost twice as likely to suffer from coronary artery disease as those without periodontal disease.
Periodontal disease can also exacerbate existing heart conditions. Patients at risk for infective endocarditis may require antibiotics prior to dental procedures. Your periodontist and cardiologist will be able to determine if your heart condition requires use of antibiotics prior to dental procedures.

Stroke

Additional studies have pointed to a relationship between periodontal disease and stroke. In one study that looked at the causal relationship of oral infection as a risk factor for stroke, people diagnosed with acute cerebrovascular ischemia were found more likely to have an oral infection when compared to those in the control group.
-Source: perio.org-

When you have heart disease, maintaning goor oral health is important. Remember:

  • Make sure your dentist and hygienist know you have a heart problem
  • Have regular dental checkups
  • Maintain good oral health by brushing and flossing twice a day
  • Eat healthily, exercise, and if you smoke, quit

 

More info

 

Treatments of gum disease:

 


Dr. Eddy Loo
22/Jan/2011

Periodontal-Health-&-Treatm

Pregnancy Gingivitis

Topics

  • What is Gingivitis?
  • What is Pregnancy Gingivitis?
  • Causes of Gum Disease in Pregnancy
  • Symptoms of Pregnancy Gingivitis
  • Complications of Pregnancy Gingivitis
  • Treating Gingivitis in Pregnancy
  • Prevention



Some ladies may feel that their gums are uncomfortable than usual during pregnancy. Their gums are sore or tender, or if they bleed when brushing or flossing, they may have a condition called pregnancy gingivitis. Pregnancy gingivitis is a very common occurrence during pregnancy however; if it is not treated it can lead to complications with their pregnancy. If you are pregnant and notice any of the symptoms of pregnancy gingivitis it is important that you visit with your dentist in order to get appropriate treatment.
Pregnancy gingivitis is an hyperplastic reaction to microbial plaque. Elevated estrogen or progesterone levels resulting from hormonal shifts enhance tissue vascularity, which permits an exaggerated inflammatory reaction to plaque.

What is Gingivitis?

Gingivitis is more commonly referred to as gum disease, and it will affect over 90% of Americans at some point in their lives. Caused by the sticky plaque that accumulates on our teeth and gums, it can leave your gums swollen and tender, and even cause them to bleed. Gingivitis can also make brushing and flossing extremely painful. Gingivitis is one of the earliest stages of a more severe type of gum disease, called periodontal disease. Untreated gum diseases will progress into periodontal disease, which can cause irreversible damage to your gums and teeth. (More info on gingivitis)

What is Pregnancy Gingivitis?

Pregnancy gingivitis is simply gingivitis that occurs during pregnancy. More than 50% of all pregnant women experience some form of pregnancy gingivitis. Though gingivitis disease is annoying, it is usually harmless, unless it is left untreated. Pregnancy gingivitis is an hyperplastic reaction to microbial plaque. Elevated estrogen or progesterone levels resulting from hormonal shifts enhance tissue vascularity, which permits an exaggerated inflammatory reaction to plaque.  Pregnancy gingivitis produces fiery red, swollen and tender marginal gingiva and compressible and swollen interdental papilla. If pregnancy gingivitis progresses to periodontal disease, it can increase your risk of going into preterm labor.

Causes of Gum Disease in Pregnancy

There are a number of causes of gum disease in pregnancy. One such reason is increased blood flow. During pregnancy, your blood flow actually increases by between 30% and 50%. This is to ensure that your baby is provided with the appropriate nutrients to grow and develop. Unfortunately, this increased blood flow can also cause you gums to swell and become very tender. It may even cause your gums to bleed, leaving them at increased risk for gingivitis.
The rise in your hormones can also play a role in you developing pregnancy gingivitis. These higher levels of hormones leave your gums and teeth more sensitive to the bacteria that hide in plaque. This is one reason why gingivitis is so common in pregnancy.
Morning sickness may also play a small role in contributing to pregnancy gingivitis. Many women find that they can no longer stand the smell or taste of toothpaste, making it difficult to maintain good oral hygiene. Increased vomiting during pregnancy can also take its toll on your gums. Vomit contains stomach acid which can eat away at your gums and teeth, making your mouth very sensitive.

Symptoms of Pregnancy Gingivitis

There are a few symptoms of gum disease to keep an eye out for. If you notice any of these symptoms, it is important to seek treatment as soon as possible.

  • tender, swollen gums
  • red or purple-red gums
  • gums that look shiny
  • bleeding gums after brushing or flossing
  • persistent bad breath
  • a bad taste in the mouth that won’t go away
  • mouth sores

Complications of Pregnancy Gingivitis

Generally speaking, pregnancy gingivitis is nothing to worry about. However, if your gingivitis is left untreated it could cause potential health problems for both you and your baby.
Sometimes, gum disease can cause sores to form on your gums. These sores are often called pregnancy tumors. These tumors can grow up to three-quarters of an inch in size and may cause discomfort or even pain. If ruptured, pregnancy tumors can become infected. Most tumors can be easily removed though, before they cause any complications.
It is important to take pregnancy gingivitis seriously because, if untreated, it will lead to periodontal disease. Periodontal gum disease is an advanced form of gingivitis that attacks the bones and tissues supporting the teeth. This disease can cause permanent damage to your mouth, and can cause you to lose both your gums and teeth. Periodontal disease has also been linked to a higher risk of premature birth – in fact, women with periodontal disease are seven times more likely to give birth prematurely.

Treating Gingivitis in Pregnancy

There are no cures for gum disease although its damage can sometimes be reversed or halted. All pregnant women should receive at least two thorough dental cleanings during pregnancy. This should help to reduce your chances of developing pregnancy gingivitis or periodontal disease.
If you already have gingivitis, the best gum disease treatment is to have a complete cleaning at your dentist’s office. Your dentist will scale your teeth using a variety of instruments. This will remove excess plaque from your teeth and around your gum line. Serious gingivitis may also require root planning, a process during which the roots of your teeth are cleaned of plaque completely.

Prevention

As always, the best treatment for gingivitis is prevention. Maintaining a good oral hygiene routine will ensure that you have healthy gums and teeth for a long time to come. Try following these tips:

  • brush twice a day for at least five minutes
  • use a soft bristle brush – this will prevent you from irritating your gums
  • floss once a day or use an anti-bacterial mouthwash to get rid of plaque from between your teeth
  • avoid eating large amounts of refined sugar – this will cut down on plaque and tartar buildup
  • visit your dentist regularly

More info

Treatments of gum disease:






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