Bacteria found within plaque and tartar triggers our immune system causing inflammation, which can lead to either gingivitis or periodontitis or both. Tartar is also known as calculus, a mineralized (hardened) form of plaque, which begins to form 3 to 5 days following accumulation of plaque from ineffective brushing and flossing techniques. While gingivitis is a mild form of gum disease and is reversible, it can advance to periodontitis if not treated properly. One periodontitis establishes itself, the bone, gums and tissue undergo destruction via inflammation. Inflammation breaks down collagen – the main building block of all bone and tissue in our body. This process IS the #1 cause of tooth loss. Unfortunately this destructive process is most often painless/asymptomatic. Only with proper treatment can the effects of plaque and calculus can be minimized to preserve oral health. To help treat cases of periodontal disease in Nanaimo, contact Periodontal & Implant Clinic today.
1) Periodontal disease is the number 1 cause of tooth loss.
2) Periodontal disease is largely a painless disease. You may not even know you have it unless someone points it out. The presence of bleeding is NOT a reliable indicator of whether someone has disease or not. It is measured by:
Pocket depths – 5mm or greater is significant since flossing and brushing does not affect plaque bacteria at this depth. A deep pocket changes the environment to foster growth of different, more virulent bacteria, which our immune system is less able to eliminate. Pocketing implies bone loss has occurred.
Bone loss – As seen on a properly taken x-ray (different x-ray views provide different information).
Gum recession – Bone supports your gum. Gum recession is thus preceded by bone loss. Because gum is elastic (i.e. rubbery in consistency), one may not witness gum recession in the presence of deep pockets (and associated bone loss). Inflamed gums are swollen and thus mask gum recession.
3) Periodontal disease is preventable. Brushing and flossing daily effectively keeps plaque under control. Having thorough and effective scaling and root planing on a regular basis (the needed frequency varies depending on how many teeth with pocketing you have and how effective your daily oral hygiene practices are). An electric brush cannot guarantee effectiveness if not used properly. Dr. Petricca and his staff appreciate the importance of reviewing techniques with you.
A dental cleaning is not simply a cleaning. Every hygienist, dental office, and periodontal practice is different such that the quality of scaling and root planing can vary significantly.
4) Plaque is the number 1 cause of periodontal disease. Plaque is a soft yet very sticky biofilm that forms constantly regardless of food intake. Within 3 to 5 days, if plaque is left behind, it mineralizes into tartar/calculus (a hard tenacious deposit that sticks to a surface like cement). Because plaque is sticky it requires an instrument that provides sufficient frictional contact to remove it. A water pick and/or mouthwash may not remove plaque to the degree needed to provide a plaque-free surface. Dr. Petricca considers these a complement rather than a replacement for brushing and flossing.
Our immune system (which is genetically-influenced) is the cause of destruction of bone and tissue in that it recognizes bacteria that live within plaque and mounts an attack. This attack causes inflammation, and inflammation in turn breaks down collagen. Collagen is a building block of both soft tissue (gums) and bone. Over time, inflammation destroys bone from the neck of the tooth towards the apex/tip of the root. At the same time, the natural attachment of our gums to our teeth (combined with natural elasticity of our gums) leads to a deepening of the pocket between the root and the surrounding gum (a healthy pocket is 1 to 3mm versus an unhealthy pocket is generally ≥ 5mm). Studies have shown that root planing is most effective up to 5mm. Meanwhile, anything beyond 5mm may require other forms of periodontal therapy.
5) Common Influencing Factors:
Smoking – While it does not cause gum disease, it makes it worse, and makes outcomes of treatment less favourable than a non-smoker (mainly through its effects on our immune system). Smoking also masks bleeding we might expect to see.
Genetics – Some people's immune system is hyper-responsive to plaque such that they experience more breakdown of bone and tissue than average. Conversely, others' immune systems do not react much towards plaque-bacteria such that despite their less than desirable oral hygiene standards, they don't experience much bone loss and/or pocketing.
Systemic Disease/Illness – A person may have a condition that affects their general immunity (HIV, Leukemia, Chemotherapy, etc.) and thus may influence the "balance in the battle between their immune system and disease-causing plaque-bacteria."
Treatment of Periodontal Disease
Root planing – Some patients ask, "What is the difference between your hygienist and my dentist?” Dr. Petricca’s answer is, "I don't know because I am not in every office to be able to observe and comment." What he does know is that he mentors, gives feedback, teaches and guides his hygienist in attempts to achieve a standard that is acceptable to him. As well, he requests administration of local anesthetic for deeper pockets or extremely sensitive teeth. One may assume that if a hygienist is trying to clean a deep pocket and a patient experiences discomfort then the hygienist might "hold back." Numbing a tooth with local anesthetic allows a hygienist to debride/clean a diseased root surface without hindrance created by pain.
Currettage – This is similar to root planing. When pockets are 7mm or greater, however, and one considers that a pocket is a narrow space to work within, entering such deep pockets inevitably leads to debridement of the soft tissue (gum) lining of the pocket. Currettage is performed by Dr. Petricca, and is chosen over and above root planing when he feels the task of root planing is too great a challenge for his hygienist. Following currettage, if a patient maintains a high standard of daily oral hygiene practices thereafter (brushing, flossing, and often using a proxy brush for the gaps between teeth created by recession from bone loss), his hygienist and that of your general dentist can better be positioned to maintain the improvements achieved from currettage. Some research claims there to be no difference between curettage and root planning. Dr. Petricca differentiates between the two in that that he alone performs the curettage and thus sees added value.