Dr. Pietrini writes
a monthly column for Fra Noi, an Italian
newspaper. Articles related to the topic of Gum
Disease are featured below. Click
here to view this month's article
Several years ago in the movie "Summer Rental",
the late John Candy bought an old boat called
the "Barnacle." The mineral deposits
found on the bottom of boats are known as "barnacles."
They are similar to the deposits found on the
teeth, which we refer to as calculus or tartar.
Calculus can be found throughout the mouth, but
it is usually found in heavier amounts on the
cheek side of the upper molars and behind the
lower front teeth where the deposits flow out
of the salivary ducts. The amount of buildup varies
from patient to patient.
of a comprehensive oral examination, the dental
team will use various tests and criteria to determine
the patient's periodontal condition. Visual examination
and x-rays will give an indication of the location
and the extent of the calculus buildup as well
as evidence of gum recession and bone loss. Initially
the dentist or hygienist may perform a "periodontal
screening and recording" (PSR). As hard deposits
and dental plaque accumulate on the teeth, the
gingival tissues (gums) will become red and swollen
and will start to separate from the underlying
bone around the teeth creating periodontal pocketing.
If the PSR indicates that significant pocketing
is occurring, then a full mouth probing and charting
might be necessary. This will aid the dental team
in diagnosing if there has been any "loss
of attachment" of the periodontal tissues.
A zone of healthy tissue must be present around
the teeth and bone, which is capable of withstanding
the abrasion caused by foods, brushing and flossing.
The patient's health history is reviewed to determine
if there are any underlying factors or medications,
which might affect the periodontal condition and
could contribute gum recession and bone loss.
earliest stage of periodontal disease is called
gingivitis. It is usually characterized by red,
swollen gums accompanied by a moderate to heavy
buildup of calculus with minimal gum recession
or bone loss present. Brushing and flossing or
gentle probing of the tissues will cause bleeding
to occur. Generally the patient will not experience
any discomfort at this stage of the disease process.
At this time, the dental staff will recommend
a treatment plan, which usually begins with thorough
scaling and root planing of the teeth using ultrasonic
scaling devices and hand instruments. At times,
nitrous oxide and/or local anesthetic may be utilized
to minimize discomfort. Oral hygiene instructions
are reviewed and occasionally antibiotics and/or
antimicrobial mouth rinses are prescribed.
patients are generally seen at three-month intervals
for re-evaluation and treatment. Studies indicate
that after thorough scaling and root planing or
following surgery, plaque and bacteria begin to
aggressively organize during the next ninety-day
period. With the patient's assistance in maintaining
good oral hygiene on a daily basis and with thorough
follow-up scaling and polishing, periodontal health
can be stabilized.
months article, I will discuss more advanced periodontal
problems and the variety of treatments available.
To all of our readers-BUON NATALE!
Very Sticky Situation by
Several years ago, a patient ran into my
office in a state of panic. She had planned to
repair a broken vase with Crazy Glue. Unwisely;
she made the mistake of attempting to remove the
cap with her teeth. As she pulled the cap off,
she accidentally squeezed the tube and squirted
glue all over her teeth and gums. It took some
effort on my part to get her out of this "very
sticky situation." Normally the dental team
spends its time cleaning tartar and plaque from
the teeth and gums, although several years ago
there was a dental product that was impregnated
with tetracycline inserted between the tooth and
gum and sealed with a glue to hold it in place
for several days.
I stated last month, periodontal (gum) disease
is the number one cause of tooth loss for adults.
Periodontal disease starts when bacteria become
trapped in plaque and calculus (tartar) attached
to the tooth surface. Eventually it causes the
gums to become red and swollen (inflamed), causing
the gum tissue to be separated from the tooth
and bone, forming pockets. The body tries to fight
off insult to the gums by sending infection-fighting
white blood cells to the inflamed sites, which
release enzymes that breakdown the bone and gum
tissue surrounding the teeth. The earliest form
of this disease is known as gingivitis. Untreated,
this may eventually lead to an advanced stage
of disease known as periodontitis. Once gum recession
and bone loss have occurred, it is often irreversible
and requires treatment to slow down the progress
of the disease.
on the severity of the disease, the most common
periodontal treatment starts with a soft tissue
management program. Your dental office may choose
to provide this treatment or they may refer you
to a periodontitis, who specializes in treating
gum disease. Usually the dentist or hygienist
will perform scaling and root planing, which removes
the plaque and calculus from the surfaces of the
teeth-above and below the gumline. This is often
accomplished with the use of hand instruments
and ultrasonic cleaners. Today, many offices use
lasers to increase the effectiveness of the treatment.
The laser help to remove the diseased lining from
within the wall of the periodontal pocket and
has been shown to reduce certain types of harmful
bacteria. Lasers can be used to remove and recontour
gum tissue when necessary-they also help to reduce
the amount of post-operative pain, swelling and
bleeding. In more advanced cases, other surgical
procedures might be advisable, such as gum or
bone grafts or dental implants to replace teeth
that cannot be saved.
dentist may choose to prescribe medications such
as antibiotics or antimicrobials to help eliminate
bacteria. Your dentist or hygienist may choose
to rinse the treated sites with chlorohexidine,
which can also be dispensed as a mouth rinse.
Dissolvable antimicrobial chips can be placed
into the gum pocket. Recently, the Food and Drug
Administration (FDA) approved the use of PeriostatTM
a form of the antibiotic doxycycline. When this
medication is used in conjunction with periodontal
therapy, it helps to prevent the enzymes produced
by bacteria from destroying gum and bone tissue.
with your dental team about which treatment or
medications are most appropriate for your specific
needs. Remember that all these treatments and
medications will not be effective unless you help
yourself with proper brushing and flossing and
continue with necessary follow up dental care.
A Leg by
Before going on stage, actors are often
told to "break a leg," a somewhat unusual
way to wish someone good luck. I would like to
relate to you a different twist (pun intended)
to breaking a leg. A few years ago a patient and
family friend, Nancy Jo was walking towards me
with a cast on her leg. When I asked her what
had happened, she told me that while on vacation,
she decided that before going to bed that she
wanted to floss her teeth. On her way down a flight
of stairs, she fell and twisted her ankle. Undeterred,
she limped into the bathroom brushed and flossed
her teeth and then crawled up the stairs to bed.
It wasn't until the next day that she realized
that she had broken her ankle. Now that's what
I call a conscientious dental patient.
often ask me if they have to floss all of their
teeth. My response is, "only floss the teeth
you want to keep." In the best selling book,
Real Age, the author makes the bold statement
that flossing your teeth can add more than six
years to your life. Periodontal (gum} disease
is the number one cause of tooth lose for adults.
In the U.S., one in every three adults suffers
from periodontitis, the most serious form of gum
disease. Recent studies have shown the relationship
between periodontal diseases and several serious
heath problems such as diabetes, stroke, heart
disease and babies born prematurely with low birth
weight. Researchers have discovered that moderate
to advanced gum disease makes it more difficult
for people with diabetes to maintain proper blood
sugar levels. Other studies show that people with
gum problems are twice as likely to have a fatal
heart attack and nearly three times more likely
to suffer a stroke. The risk is seven times greater
that pregnant women with periodontal disease will
give birth to a low-weight or pre-term baby.
are some interesting facts obtained from a recent
Two-thirds of adults did not know that gum disease
is associated with serious medical conditions.
· 80% did not know it is the leading cause
of tooth loss in adults.
· 60% of adults are not familiar with periodontal
· 40% of adults do not visit a dentist
on a regular basis.
are often unaware of their symptoms or experience
little pain until the disease has reached a more
advanced stage. Symptoms can include swollen or
tender gums that bleed when you floss or brush,
receding gums, bad breath, loose or shifting teeth
and formation of deep pockets between teeth and
gums. The earliest stage of disease is called
gingivitis and can be easily treated. If left
untreated deep pocketing and bone loss make the
treatment more complicated and can lead to tooth
loss. A number of factors can increase your chances
of developing periodontal disease and related
serious health problems. While you cannot control
your family history, by changing your behavior,
you may be able to reduce your risks by:
Brushing your teeth well at least twice a day.
· Floss and clean between your teeth daily.
· Eat a well balanced diet.
· If you are a smoker, attempt to quit-people
who smoke can have a seven-fold increased risk
of suffering from periodontal disease.
· See your dentist on a regular basis for
treatment and maintenance.
month I will discuss treatment options and medications
available to help patients control and prevent