What is Periodontal Disease ?
At every new patient exam, one of the first questions I ask is, “Do you know what Periodontal Disease is?” AND “Do you know what Perio Pockets are?” Nine times out of ten, the answer is, “Isn’t when your gums go up higher on the tooth?”
This is not it at all. In fact, its the opposite.
In my opinion, next to oral cancer, Periodontal Disease is THE MOST IMPORTANT AND MOST PREVALENT DENTAL CONDITION among the population. It is so interesting to me because it also seems to be the ONE condition that patients seem to know the LEAST about!
I think that the reason that Periodontal Disease is so unknown is that:
1. Its difficult to explain. Dentists/Hygienists may not have the time or patience to show pictures/ models, etc.
2. Its invisible... meaning, its not immediately apparent to the naked eye, as would be a big black cavity or obvious chipped tooth. Its the “see no evil, hear no evil” syndrome.
3. Its often symptomless. I always compare Periodontal Disease to the condition of having high blood pressure. If gone unchecked (and, MANY dentists and hygienists out there DO NOT CHECK or DON”T CHECK THOROUGHLY ON A CONTINUAL BASIS), you can have it for years and years and not know it. With high blood pressure, the first sign of a problem may be a stroke. The first sign of periodontal disease may be a severely mobile tooth (or MULTIPLE TEETH) that must be extracted. Not to mention, many other linked diseases.
4. Lastly, people have selective hearing. Many people may have been told they have some degree of Periodontal Disease at some point in their life, but since it doesn’t SEEM to pose an immediate problem and treatment is often difficult, cumbersome, and expensive; people choose to ignore it. Its human nature.
For ALL patients at initial exam, I personally go through a detailed explanation of the condition of Periodontal Disease. Bear with me. Its kind of boring, but it’s SO IMPORTANT. Once you understand this condition, you will understand every hygiene visit you ever have in your life. And, you will be a healthier person.
The following is an expanded version of exactly what I say:
“You know that white stuff that gets on your teeth? Well, that’s called plaque and it’s the stuff that can be taken off with a toothbrush. But, even when people brush three times a day, a little plaque can get under the gum line and into hard to reach nooks and crannies in and around the teeth and remain there for days to weeks to months. When plaque is given a location and time to remain, it begins to “calcify”. The calcification process is very similar to that white stuff that forms on your pool tiles at home. And, as you know how hard that is to remove from pool tiles, that’s how hard it is to remove from your teeth. In dentistry, we call this material “tartar” or “calculus” or, as I like to call it “Barnacles” . And, this is the reason why even the best of us need to see a hygienist every 6 months. This stuff is really hard to remove by yourself. I’m a dentist and I can’t even do it on myself in a mirror. I’ve tried! Hygienists have special instruments to scrape off the tartar manually and something called an ultrasonic cleaner (or the Star Trek name is: “cavitron”) to vibrate the barnacles off the teeth.”
[Ok, are you all still with me out there? Take a breath. There’s more... ]
“But, when people, go months to years to decades (to centuries!!!) without seeing a dentist or hygienist, then the barnacles remain under the gum line, sheltered from the tooth brush, and cause the body to have an immune response.”
[This is when i show the picture below and point to the left side of the tooth just under the gum line.]
This barnacle is like a foreign body invader that they body wants out of its space. Its like when you have a splinter in your finger. The tissue around the splinter gets red and puffy because it wants that thing out! Well, the gums get red and puffy around the barnacle. This is called “gingivits.” Its just a fancy way of describing your body’s first attempt at attacking and getting the barnacle out of the body. The problem is that the barnacle is a barnacle!!! And, its not going anywhere... just like pool tiles.”
“So, the body’s next reaction to the foreign body is to run away from it.”
[Point to the bone to the left side of the tooth on the picture]
“Bone begins to kind of “self destruct” or “erode away” from this invader. As bone is lost, a gap or “pocket” begins to form between the gum and the tooth. The top of the tissue stays at the top of the tooth (even higher if its puffy) but it’s “attachment” to the tooth is lost because bone is lost. Tissue attachment to teeth tend to follow very closely to bone height, if that makes any sense??? (Look at the picture again.) So, the result is what we call a “Periodontal Pocket” around the tooth. I think of it like alligators hiding under rocks in a moat around a castle. The pocket is the hidden space (the moat) that harbors tartar (the rocks) which becomes a living space for bacteria (the invading alligators). As the pocket gets bigger, this results in more plaque deposition, which again calcifies to tartar, which ultimately results in more bone loss which results in a bigger pocket. Its a vicious cycle and downward spiral of bone loss to loosing teeth.”
“And, as I said earlier, Periodontal Disease is NOT the gums moving lower or higher on the tooth as people believe. The gum height stays the same. Its the BONE that’s moving and ultimately being lost. And, once bone is lost, its VERY difficult to get back. So, Periodontal Disease is the process of BONE loss due to the above process of plaque deposition/calcification to tartar/bacteria harbor and resulting immune response, etc.”
[At this point, I hold up a “periodontal probe” and show the millimeter markings on the tip, see photo below]
“Now the best way we have as Dentists and Hygienists to evaluate these pockets is by measuring them with a periodontal probe. See, these last three notches on the probe represents 3 millimeters. You can see as I hold the probe up to the picture (just below the height of the gum line). 3mm or less is a good healthy pocket. 4mm is a borderline number. 6-7mm is about halfway down the root. And, 10mm is about the entire root. You can think of it like a golf score. The lower the better.”
“I’m going to VERY GENTLY tuck the probe in the pockets around your teeth until light resistance. I’m going to check 6 sites on every tooth. 3 on the inside and 3 on the outside. I will be VERY GENTLE and IT WILL NOT HURT. If the tissue is sensitive at all, I will be happy to use topical gel anesthetic. But, from my experience, very few people need to be numbed to do probings. The only people where it may be uncomfortable are people with multiple 8’s, 9’s, and 10’s. And, with those people, we usually probe at the time of cleaning with full anethesia.”
“So, now that you know what the numbers mean, then we can be on the same team. You will understand location and severity of the problem areas as I call them out. We will document the location of all pockets greater than 3 and sites that bleed on probing. Furthermore, these sites will be subsequently tracked at every hygiene appointment you have from here into the future. A typical hygiene appointment involves me coming in, checking the teeth for problems, but, more importantly, its a checkup of progression and hopeful improvement of pocket depths. I’ll say, “How’s the 5mm? Any better? Looks like this 4 became a 3, etc.” “
“When my hygienist cleans teeth, she will have that “Perio Chart” out EVERY TIME. That chart is like a blueprint for cleaning teeth. I figure that people can clean their own teeth with a tooth brush, but is my job and the job of the hygienist to MAINTAIN, TRACK, and ELIMINATE periodontal disease and remove tartar from the mouth. So, lets get started!”
OK! So....... Perio means AROUND. And, Dontal means TOOTH. So, Periodontal Disease is disease of everything immediately around the tooth. And, the reason this disease is so important in the world of dentistry is that everything around the tooth is the structure and foundation upon which the teeth are secured. I would never build a skyscraper on a foundation that’s only 3 feet thick. Its the same concept with teeth. When you have a super tall tooth (including crown and root) sitting on bone only around half the root or less, then its going to become mobile and eventually rock out. And, I don’t mean “ROCK OUT” as in Van Halen or Black Sabbath!! I mean extraction, go directly to jail, don’t collect $200, you wear a denture.
So, now that you understand a little better who the enemy is, the next obvious question is: HOW DO YOU TREAT IT??????
The next section in the website will go through in detail my methods of treating periodontal disease.