What is periodontal disease?
Periodontal disease is the destruction of bone around teeth due to bacterial infection
Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) causes the gums to become inflamed. In the mildest form of the disease, gingivitis, the gums redden, swell and bleed easily. There is usually little or no discomfort. Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with professional treatment and good oral home care. Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed
Gingivitis: In this stage bone is still intact although this gum tissue is inflamed.
Periodontitis: This stage begins when bone starts to disintegrate around the tooth.
Advanced Periodontitis: At this stage a majority of the bone around the tooth has been lost and the chances of saving this tooth are greatly minimized.
Some factors increase the risk of developing periodontal disease:
- Tobacco smoking or chewing
- Systemic diseases such as diabetes
- Some types of medication such as steroids, some types of anti-epilepsy drugs, cancer therapy drugs, some calcium channel blockers and oral contraceptives
- Genetic susceptibility
- Hormonal changes
- Fillings that have become defective
- Poor oral hygiene
Health concerns linked to periodontal disease:
What is the treatment for periodontal disease?:
Although periodontal disease is treatable, it is not curable. Our goal is to arrest the disease at its current status and maintain oral health so that it does not progress. In order to achieve health we must remove all bacteria and deposits from the teeth and tissues around the teeth. This will require additional appointments and medications that cannot be provided during a routine dental appointment. Depending on your specific situation a treatment plan will be designed specifically for you. Following your initial treatment it is recommended that your cleanings take place on a more frequent schedule, 3 or 4 months in order to maintain health. It is also extremely important the you are taking excellent care of oral hygiene at home- brushing, flossing and using other aides recommended by your dental professional
There are certain medical conditions which require the patient to take a dose of antibiotics prior to their dental appointment. This is done to help prevent any bacteria introduced from the dental procedure, from causing an infection in another part of the body, such as the heart lining, called bacterial endocarditis.
This subject is of great debate, because there is conflicting evidence whether antibiotic premedication is needed at all, and the over prescription of antibiotics can lead to antibiotic resistant strains of bacteria.
American Heart Association Change in Premed Requirements
The American Heart Association previously recommended that patients with certain heart conditions take antibiotics shortly before dental treatment. This was done with the belief that antibiotics would prevent infective endocarditis. As of April 4, 2007 there is no longer need for short term antibiotics as a preventative measure before dental treatment. The changes in guidelines have also been endorsed by the Infectious Diseases Society of America and by the Pediatric Infectious Diseases Society.
The new guidelines are based on a growing body of scientific evidence that shows the risks of taking preventive antibiotics outweigh the benefits for most patients. These risks include adverse reactions to antibiotics, and the concern that inappropriate use of antibiotics can also lead to the development of drug-resistant bacteria. It is stated that infective endocarditits is much more likely to result from frequent exposure to random bacterimias associated with daily activities (brushing and flossing) than from bacterimias caused by a dental procedure.
The guidelines say patients who have taken prophylactic antibiotics routinely in the past but no longer need them include people with the following conditions:
- mitral valve prolapse
- rheumatic heart disease
- bicuspid valve disease
- calcified aortic stenosis
- congenital heart conditions- (ventricular septal defect, atrial septal defect, hypertrophy cardiomyopathy)
Preventive antibiotics prior to a dental procedure are still advised for patients with the following conditions:
- artificial heart valves
- history of infective endocarditis
- certain specific serious congenital heart conditions (cardiac transplant)
It is necessary for you to continue to premed prior to dental treatment as you have in the past until we receive documentation from your physician.
Preterm low birth weight babies:
Women with periodontitis are eight times more likely to give birth to premature low-birthweight babies. The inflammatory process associated with gum diseases appears to promote pre-term delivery
Bacteria that reproduce in the mouth can also be carried into the airways of throat and lungs, increasing the risks for respiratory diseases and worsening chronic lung conditions, such as emphysema.
Sealants are protective coatings that are applied to the biting surface of teeth, typically the 1st and 2nd molars. These teeth tend to have deep grooves that catch food and bacteria. By placing a thin coating on the teeth we are able to “seal” decay, greatly reducing the likelihood that these teeth will need fillings.
What is sleep apnea? Sleep apnea is a serious sleep disorder that occurs when a person’s breathing is interrupted during sleep. People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times.
There are two types of sleep apnea:
- Obstructive sleep apnea (OSA): The more common of the two forms of apnea, it is caused by a blockage of the airway, usually when the soft tissue in the back of the throat collapses during sleep.
- Central sleep apnea: Unlike OSA, the airway is not blocked but the brain fails to signal the muscles to breathe due to instability in the respiratory control center.
Am I at Risk for Sleep Apnea?
Sleep apnea can affect anyone at any age, even children. However, risk factors for sleep apnea include:
- Having a large neck size (17 inches or greater in men and 16 inches or greater in women)
- Certain shapes of the palate and jaw
- Having larger tonsils
- Having a large tongue
- Narrow airway
- Nasal obstruction
- Having a family history of sleep apnea
- Male gender
- Being overweight
- Over the age of forty
What are the symptoms of Sleep Apnea?
- Excessive daytime sleepiness, including falling asleep at inappropriate times
- Awakening unrefreshed in the morning
- Depression (possibly)
- Poor concentration
- Loud snoring
- Observed episodes of breathing cessation
- Awakening with a dry mouth or sore throat
- Morning headaches
- Difficulty staying asleep
What are the Effects of Sleep Apnea?
If left untreated, sleep apnea can result in a growing number of health problems including:
- Hypertension (High Blood Pressure)
- Heart failure, irregular heart beats, and heart attacks
In addition, untreated sleep apnea may be responsible for poor performance in everyday activities, such as at work and school, motor vehicle crashes, as well as academic underachievement in children and adolescents.