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EARLY PERIODONTAL DISEASE

     Early periodontitis -is when the gums and bone, that support the teeth, are infected and become eroded and damaged

     The difference between gingivitis and periodontal disease is that in gingivitis the infectious disease attacks the connective tissue around the tooth.  Chronic periodontitis is defined as inflammation of the gingiva extending into the adjacent attachment apparatus.* In periodontitis the infectious disease has gone PAST the tissues into the supporting bone of the tooth causing tooth motility leading to permanent tooth loss if not professionally treated by your dentist. 

     Thus in the early periodontitis stage the plaque has build up and harden around and UNDER THE GUMS where a more harmful bacteria attacks the gum and bone tissuesThe bacteria release toxins in the pockets or sulcus which trigger the infection but destruction is caused by the body's own immune system.  Cytokines (chemical machetes) cut their way through healthy tissue and release PMNs like collagenase, prostaglandins and interleukin which destroy healthy connective tissue. The gums pull away from the teeth forming "pockets" of bacterial infection.  These pockets become filled with more plaque, toxins, bacteria and deepen.  These pockets than become impossible for you to clean.  

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     Blood on your toothbrush or dental floss is one of the earliest and most common signs of early periodontal disease. Other signs of early periodontitis are:

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irritated gum tissue                             

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swollen gums due to bacterial infection

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sore gums                                  

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gum tissue that bleeds easily due to toxic substances in the gum tissue which is a good indicator that you have ACTIVE disease

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six or more bleeding points

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gums that are puffy and soft        

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red instead of pink gum tissue

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bad breath                                 

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pocket depths of 4-5mm  because in pockets over 4mm is where 85% of the "Red Zone" bacteria (P.
 gingivalis, B.forsythus, T. denticola) are found.

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possible pus 

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loss of clinical attachment due to destruction of the periodontal ligament

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loss of the adjacent supporting bone

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gingival recession with soft tissue defects or frenum pulls

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amount of attachment loss is defined as the sum of the recession and pocket depth.
a.        Slight- 1-2mm of attachment loss
b.        Moderate- 3-4mm of attachment loss
c.        Severe- 5mm or greater of attachment loss
 

PERIODONTAL DISEASE IS USUALLY A PAINLESS PROGRESSIVE  AND INFECTIOUS DISEASE

Your gums should never bleed while brushing or flossing.  

     You can never completely get rid of all the bacteria in your mouth but brushing and flossing make sure the number of bacteria you do have is in a safe range. A common mistake most people make is to brush but not floss. This allows bacteria to build up to dangerous levels between your teeth where brushing alone cannot reach. When any one group or family of bacteria begin to dominate their levels of toxins increase to a point where they cause an infection.  

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     The good news is that early periodontitis can be:

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Stopped from progressing

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Reattached gum tissue to a spotlessly clean root surface

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It is easier to treat at this stage in a non-surgical manner that allows for natural healing by controlling infection

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Less costly to treat in its early stages

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Treatment

1.  Professional treatments-to remove this harmful bacterial growth from you teeth and gums. You will be placed in the blue program which includes three sessions:

A. Session 1:
 
 1.   Two quadrants of Root Planing 
        and Scaling to remove contamination 
        above and below the gum line
 2.   Irrigation with medications
 3.   Perio bag including home care 
       items
 4.   Oral Hygiene Instructions

B. Session 2: 

     1.   Two quadrants of Root Planing 
        and Scaling to remove contamination 
        above and below the gum line
 2.   Irrigation with medications
 3.   Oral Hygiene Instructions

C. Session 3: 

     1.   Remeasuring and updating 
        perio charting
2.   Cleaning with ultrasonic scaler and medications are placed.

2.  Three month perio maintenance visit to remove the tartar, which harbors and nurtures the growth of undesirable bacteria. You need to be seen every 3-4 months because that's about how long it takes for the biofilm to re-establish causing bacteria infection.

3.  Good brushing for a minimum of twice a day and after meals (if possible) using your soft bristled perio instrument (Rota-dent) for at least two minutes.

4.   Daily flossing Start cleaning BETWEEN your teeth.  Periodontal disease begins between the teeth.  The area between the teeth are more prone to infection than facial or tongue gum tissue surfaces simply by anatomy.  This tissue is not keratinized like tissue found on the facial and tongue surfaces.  Non-keratinized tissue is more susceptible to breakdown.  It is also a very protected area, NOT reached by brushing or rinsing. 

     Since the disease starts between the teeth, it makes sense to start cleaning in between the teeth and than brush.  You can clean this area with interdental brushes, picks, sticks, oral irrigation, and automatic flossers.  remember this disease needs to be treated both in the office and at home.++

5.   Use of Periogard, an antimicrobial medicated mouthrinse.

6.   Daily fluoride treatments.

7.   Do not smoke or use alcoholic beverages while your gums are inflamed.

8.  Good dietary habits.  Cut back on foods and beverages that contain sugar.

9.  On going education about the health of your mouth.

     To insure successful results following periodontal treatments, patient cooperation in maintaining  excellent oral hygiene is essential.

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    Remember: If left untreated, early periodontitis will develop into the next stage of periodontitis which will lead to:

bulletInfection that can affect your overall health
bulletSore bleeding gums
bulletDiscomfort
bulletBone loss
bulletTooth loss
bulletChanges affecting your appearance
bulletPoor nutrition
bulletPossible surgery
bulletCostly treatments

   Delaying treatment is a risky decision because gum disease never goes away on its own. It is an ongoing destructive bacterial infections of gums and bone that can have systemic effects.

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Case Type II Early Periodontitis- Diagnosis Code 4600- Progression of the gingival inflammation in the deeper periodontal structures with evidence of some attachment and bone loss Probing depth is generalized 4mm with isolated 5mm pockets possible.
 

Periodontal News Updates

Coping With Stress: Its Influence on Periodontal Disease

Periodontitis patients with inadequate stress behavior strategies (defensive coping) are at greater risk for severe periodontal disease. J Periodontol 2002;73(11):1343-1351

 

*AAP Parameters of Care

February 06, 2008

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