PUBLIC

HEALTH

PREVENTION OF
PERIODONTAL DISEASES


SITI FATIMAH MOHD KAMAL

PERIODONTAL DISEASES

Periodontal diseases : results of infections and inflammation of the gums and bone that
surround and support the teeth. In its early stage, called gingivitis, the gums can become
swollen and red, and they may bleed. In its more serious form, called periodontitis, the gums
can pull away from the tooth, bone can be lost, and the teeth may loosen or even fall out.
Periodontal disease is mostly seen in adults. Periodontal disease and tooth decay are the two
biggest threats to dental health.

WHO GETS GUM DISEASE?
People usually dont show signs of gum disease until they are in their 30s or 40s. Men are more
likely to have gum disease than women. Although teenagers rarely develop periodontitis, they
can develop gingivitis, the milder form of gum disease. Most commonly, gum disease develops
when plaque is allowed to build up along and under the gum line.

WARNING SIGNS
The following are warning signs of periodontal disease:
Bad breath or bad taste that won't go away
Receding gums
Red or swollen gums
Tender or bleeding gums
Painful chewing
Loose teeth
Sensitive teeth
Gums that have pulled away from your teeth
Any change in the way your teeth fit together when you bite
Any change in the fit of partial dentures






CAUSES
1) Smoking.
Need another reason to quit smoking? Smoking is one of the most significant risk factors
associated with the development of gum disease. Additionally, smoking can lower the
chances for successful treatment.

2) Hormonal changes in girls/women as with pregnancy or the use of oral contraceptives.
These changes can make gums more sensitive and make it easier for gingivitis to
develop.

3) Diabetes.
People with diabetes are at higher risk for developing infections, including gum disease.

4) Underlying immune-deficiencies.
Diseases like cancer or AIDS and their treatments can also negatively affect the health of
gums.

5) Medications.
There are hundreds of prescription and over the counter medications that can reduce
the flow of saliva, which has a protective effect on the mouth. Without enough saliva,
the mouth is vulnerable to infections such as gum disease. And some medicines can
cause abnormal overgrowth of the gum tissue; this can make it difficult to keep teeth
and gums clean.

6) Poor oral hygiene
Bacteria in the mouth infect tissue surrounding the tooth, causing inflammation around
the tooth leading to periodontal disease. When bacteria stay on the teeth long enough,
they form a film called plaque, which eventually hardens to tartar, also called calculus.
Tartar build-up can spread below the gum line, which makes the teeth harder to clean.
Then, only a dental health professional can remove the tartar and stop the periodontal
disease process.

7) Genetic susceptibility
Some people are more prone to severe gum disease than others.

8) Crooked teeth or fillings that have become defective
9) Bridges that no longer fit properly
10) Coronary heart disease
11) Stroke
12) Stress
13) Low birth weight
HOW DOES PERIODONTAL DISEASE DEVELOP?



Healthy Gums

Healthy gums, periodontal ligament, and bone
hold teeth firmly in place.



Gingivitis

Gingivitis is an inflammation of the gums
caused by plaque. It is characterized by
redness, swelling, and bleeding of gum tissue.
Thorough personal oral hygiene measures,
such as daily brushing and flossing, will
prevent or reverse gingivitis. Chronic gingivitis
can lead to a more serious condition called
periodontitis.




Periodontitis

Periodontitis is an infection of the gums and
supporting structures of the teeth caused by
bacterial toxins in plaque. It is characterized
by bad breath, bleeding, and pain. Loss of
supporting bone can result in tooth mobility
and eventual tooth loss. If left untreated, it
can progress to advanced periodontitis.




Advanced Periodontitis

Advanced periodontitis is the stage in which
gums and bone have been seriously damaged.
If not treated, healthy teeth may become
loose and need to be removed.



PREVENTIVE MEASURES

PREVENTION
Healthy habits and good oral hygiene are critical in preventing gum disease. Regular and
effective tooth brushing and mouth washing, however, are effective only above and slightly
below the gum line. Once periodontal disease develops, more intensive treatments are needed.

BRUSH YOUR TEETH
Brushing after meals helps remove food debris and plaque trapped between your teeth and
gums. Dont forget to include your tongue, bacteria loves to hide there.
FLOSS
Flossing at least once a day helps remove food particles and plaque between teeth and along
the gum line that your toothbrush cant quite reach.
SWISH WITH MOUTHWASH
Using a mouthwash can help reduce plaque and can remove remaining food particles that
brushing and flossing missed.
KNOW YOUR RISK
Age, smoking, diet and genetics can all increase your risk for periodontal disease. If you are at
increased risk, be sure to talk with your dental professional.
SEE A PERIODONTIST
Get an annual comprehensive periodontal evaluation (CPE)from a dental professional. A CPE
looks at your teeth, plaque level, gums, bite, bone structure and other risk factors for
periodontal disease. Identifying symptoms of gum disease early is key to protecting your teeth
and gums.

DIETARY CHANGES
It is important to reduce both the quantity and, in particular, thefrequency of sugar intake.
Snacks and drinks should be free of sugars (other than natural sugars found in fruits and
vegetables). Sugar-containing foods should be consumed with meals. ideally followed by
brushing. Since fruit juices can also cause tooth erosion in children, milk and water use should
be emphasized.

QUITTING SMOKING
Smoking may play a significant role in over half the cases of chronic periodontal disease,
according to research published in 2000. For smokers, quitting is one of the most important
steps toward regaining periodontal health.
FLUORIDE TREATMENTS
Fluoride treatment in children has helped to account for the decline in periodontal disease in
adults. Because fluoride prevents decay, back molars, which keep the teeth in place, are spared,
and are thus less vulnerable to bacteria. Even before teeth first erupt, babies'' gums should be
wiped clean with a bit of gauze bearing a dab of fluoride toothpaste. Supplementation with
fluoride tablets or drops may be recommended for children 6 months or older who drink
unfluoridated water or who are at risk for dental problems. A prescription from the child''s
pediatrician or dentist is required.
Some dentists recommend a fluoride gel for adult patients who are still at risk for tooth decay
or sensitivity, but extra fluoride is generally not necessary for adults who use fluoride
toothpaste.

DENTAL EXAMINATIONS
Periodontitis is a silent disease. People with the disease rarely experience pain and may not be
aware of the problem. A periodontal examination by a general dentist once or twice a year
should reveal any incipient or progressive problems. A full mouth series of x-rays is advised
every 2 - 3 years. This will alert the dentist to early bone loss and other disorders of the oral
cavity.
Dentists now often perform Periodontal Screening and Recording (PSR) using a probe to
measure gum pockets. This procedure used to be performed only by periodontists but is now
encouraged as part of a regular dental examination. The dentist will identify any areas where
deep pocketing has occurred, where the health of the gingiva appears compromised, and
where there is undue mobility of teeth. It is the general dentist''s responsibility to identify
periodontal disease and inform the patient. If the condition is severe, the dentist may want to
refer the patient to a periodontist.

DEEP CLEANING (SCALING AND ROOT PLANING)
The dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning
method called scaling and root planing. Scaling means scraping off the tartar from above and
below the gum line. Root planing gets rid of rough spots on the tooth root where the germs
gather, and helps remove bacteria that contribute to the disease. In some cases a laser may be
used to remove plaque and tartar. This procedure can result in less bleeding, swelling, and
discomfort compared to traditional deep cleaning methods.




MOUTHWASHES.
The value of many mouthwashes is highly controversial. Many have only temporary
antibacterial value. Some can even harm the mucus membrane, and they can be dangerous to
children who drink them. Those that are considered plaque fighters are chlorhexidine
(prescription) and Listerine, which is available over the counter.

PRODUCING SALIVA AND DRINKING WATER.
Saliva is important for diluting the toxins created by plaque. Drinking at least 7 glasses of water
a day helps reduce inflammation in the mouth by producing more saliva. Increasing water
intake is particularly important as one ages, when less saliva is produced.

MEDICATIONS
Medications may be used with treatment that includes scaling and root planning, but they
cannot always take the place of surgery. Depending on how far the disease has progressed, the
dentist or periodontist may still suggest surgical treatment. Long-term studies are needed to
find out if using medications reduces the need for surgery and whether they are effective over
a long period of time. Listed on the next page are some medications that are currently used.
Medications What is it? Why is it used? How is it used?
Prescription
antimicrobial
mouthrinse
A prescription
mouthrinse
containing an
antimicrobial called
chlorhexidine
To control bacteria
when treating gingivitis
and after gum surgery
Its used like a regular
mouthwash.
Antiseptic chip A tiny piece of gelatin
filled with the
medicine
chlorhexidine
To control bacteria and
reduce the size of
periodontal pockets
After root planing, its placed
in the pockets where the
medicine is slowly released
over time.
Antibiotic gel A gel that contains
the antibiotic
doxycycline
To control bacteria and
reduce the size of
periodontal pockets
The periodontist puts it in
the pockets after scaling and
root planing. The antibiotic is
released slowly over a period
of about seven days.
Antibiotic
microspheres
Tiny, round particles
that contain the
antibiotic minocycline
To control bacteria and
reduce the size of
periodontal pockets
The periodontist puts the
microspheres into the
pockets after scaling and root
planing. The particles release
minocycline slowly over time.
Enzyme
suppressant
A low dose of the
medication
doxycycline that
keeps destructive
enzymes in check
To hold back the bodys
enzyme response If
not controlled, certain
enzymes can break
down gum tissue
This medication is in tablet
form. It is used in
combination with scaling and
root planing.
Oral antibiotics Antibiotic tablets or
capsules
For the short term
treatment of an acute
or locally persistent
periodontal infection
These come as tablets or
capsules and are taken by
mouth.

SURGICAL TREATMENTS
Flap Surgery. Surgery might be necessary if inflammation and deep pockets remain following
treatment with deep cleaning and medications. A dentist or periodontist may perform flap
surgery to remove tartar deposits in deep pockets or to reduce the periodontal pocket and
make it easier for the patient, dentist, and hygienist to keep the area clean. This common
surgery involves lifting back the gums and removing the tartar. The gums are then sutured back
in place so that the tissue fits snugly around the tooth again. After surgery the gums will heal
and fit more tightly around the tooth. This sometimes results in the teeth appearing longer.

Bone and Tissue Grafts. In addition to flap surgery, your periodontist or dentist may suggest
procedures to help regenerate any bone or gum tissue lost to periodontitis. Bone grafting, in
which natural or synthetic bone is placed in the area of bone loss, can help promote bone
growth. A technique that can be used with bone grafting is called guided tissue regeneration. In
this procedure, a small piece of mesh-like material is inserted between the bone and gum tissue.
This keeps the gum tissue from growing into the area where the bone should be, allowing the
bone and connective tissue to regrow. Growth factors proteins that can help your body
naturally regrow bone may also be used. In cases where gum tissue has been lost, your
dentist or periodontist may suggest a soft tissue graft, in which synthetic material or tissue
taken from another area of your mouth is used to cover exposed tooth roots.
Since each case is different, it is not possible to predict with certainty which grafts will be
successful over the long-term. Treatment results depend on many things, including how far the
disease has progressed, how well the patient keeps up with oral care at home, and certain risk
factors, such as smoking, which may lower the chances of success. Ask your periodontist what
the level of success might be in your particular case.