. Sunday, November 23, 2008
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For people overage 35, gum disease outranks boxing, car accidents, ice hockey, hard candy and saltwater taffy as the leading cause of tooth loss. Three out of four adults Americans will have either the mild form of gum disease––gingivitis––or the severe form––periodontitis, or periodontal disease––at some point in their lives.

Despite such statistics, nine out of ten cases of gum disease could be prevented with simple, regular care, says William Clark, D.D.S., professor of oral biology and director of the Periodontal Disease Research Center at the University of Florida College of Dentistry.

We’ll tell you exactly what proper care of your gum entails, but first, a brief explanation of how gum disease does its dirty work.

The Plaque Attack

Gum disease starts with plaque. Plaque is a particularly loathsome, sticky concoction of mucus, food particles and bacteria that forms in the tiny spaces between your teeth and the gum line. Left to sit long enough, plaque can harden into a rock-hard substance called calculus.

In gingivitis, the plaque or calculus irritates and infects the gums. Your body’s natural defenses against infection make the gums swollen and shiny, and they bleed easily when you brush or floss. As the gums swell, pockets form between the teeth and gums, providing a cozy home for even more plaque.

Gingivitis may lead to periodontitis, a severe form of gum disease caused by bacteria. In good health, the tiny culprits inhabit your mouth in very low numbers. However, poor oral hygiene gives them the green light to multiply, says Dr. Clark. They move into the pockets caused by gingivitis, and your mouth becomes a battleground. The bacteria try to gain a foothold, releasing toxins and enzymes to battle the fighter cells created by your own immune system.

The ongoing war eats away at your bones, gums and connective tissue, and over the years, your teeth loosen in their sockets. Cementum, the sensitive tissue enveloping the roots, becomes exposed, and you feel pain when you eat hot or cold foods. Occasionally an abscess will form in the pocket, and the infection will destroy yet more bone.

In both forms of gum disease, one telltale sign is bad breath. Periodontitis also brings a bad taste in the mouth.

Preventing Gum Disease

Ask anyone with dentures: Real, healthy teeth are better than false ones. Prevent gum disease, and you should keep your teeth forever. It’s not so hard to do.

Brush daily. Let’s see, when did you first hear this one? Brushing gently after every meal is best, Dr. Clark says, “But you probably don’t need to take your toothbrush to work.” (Still, it’s a good idea, so at that important meeting you’re not caught with broccoli between your teeth.)

Is brushing best done with a plain old toothbrush, with an electric one or with a more expensive gadget that shoots water into gums? It really doesn’t matter. “Electric toothbrushes are no better for most people, but they may help if you have trouble with dexterity,” says Dr. Clark. An electric toothbrush may be more entertaining to use, so you may find yourself brushing more often––which is good. Thinking about the money you shelled out may also encourage you to brush more often!

Floss frequently. “At least three or four times a week is usually enough for most people, although flossing every day is best,” says Dr. Clark. Floss cleans between teeth, where bristles often can’t go.

Get regular professional cleanings. Even with good brushing and flossing, plaque can still form below the gum line. A visit to your dentist once every six months should be enough to keep the plaque at bay. “If your gums bleed when you brush, or if they’re puffy looking, you may need cleaning more than twice a year,” says Dr. Clark.

Try a mouthwash. This is purely an extra for your arsenal. Mouthwash can kill bacteria, but it’s no substitute for brushing, flossing and cleaning.

Use a toothpick. Especially handy when you can’t brush or floss, a toothpick can get rid of the big hunks of food and stimulate your gums. Be very gentle, though, to avoid stabbing your gums.

Stop smoking. One study says smoking doubles your risk of gum disease. While there’s no proof smoking actually causes gum disease, there’s plenty of evidence that it suppresses the immune system,” and that makes it harder for your body to fight the infection and makes the infection more resistant to treatment,” says Dr. Clark.

Treating Periodontitis

Periodontal disease is irreversible, at least for now. “But if you have it, you can keep it from getting worse,” says Dr. Clark. With the kind of treatment outlined below, you may be able to stop your pain––sand save your teeth.

Pocket probing, which can measure the space between gum and tooth, shows your dentist how deep your pockets are (perioontitis-wise, not money-wise). But the traditional manual probe is slow and imprecise. You may benefit from the newer computerized probe in which a slender wire is inserted into the pocket and withdrawn in one-tenth of a second. The computer-aided probe is quicker and able to make more accurate measurements than the old-fashioned manual kind.

Planning and scaling––a very thorough cleaning of plaque and calculus from tooth and root––is the first line of attack in halting existing gum disease. One form of the procedure woks best on front teeth, using anesthesia to go deeper than usual. This method can take 10 minutes per tooth but usually causes less gum shrinkage than surgery. For planning and scaling to have a chance to work, you have to follow up with your own commitment to faithful brushing and flossing.

Fiber-optic probes can be used instead of surgery for moderate periodontitis. Entering an incision so tiny that it doesn’t need stitches, the probe pushes gum tissue aside and shines a light on the root surface, enabling the dentist to scrape off calculus. You might call this “Scraping-edge” technology.

Antibiotics are often used in conjunction with cleaning or surgery, says Dr. Clark. Oral tetracycline is the most commonly used antibiotics, and more severe cases often call for amoxicillin. One new form or tetracycline comes in plastic fibers that are placed under the gum line, slowly releasing the medication over ten days, killing bacteria while reducing pockets.

Surgery may be needed in more advanced cases of gum disease. The octor makes tiny incisions around the neck of the tooth to expose the root and bone, enabling a more thorough cleaning, removal of diseased tissue and a possible reshaping and even grafting of damaged bone and gums.


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