Periodontal Disease

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Scaling Calculus

Periodontal Disease (gum disease) is an ongoing bacterial infection of the gums and bone surrounding a tooth.  When plaque bacterial growth is not controlled by Brushing, Flossing and Routine Preventive Cleanings, it begins to harden on the tooth creating a shell of Tartar or Calculus.  As this layer grows, it expands under the gingiva becoming an irritation to the gums and bone surrounding the tooth.  The gingiva becomes red and inflamed.  This beginning stage of the disease process is called Gingivitis.  Eventually, it progresses to where the gums bleed easily and begin to pull away from the tooth.  This causes the natural pocket around the tooth to become deeper, creating an area for bacteria to hide.  When the bone becomes irritated by bacteria, it retreats, receding down the root.  Again, this creates a deeper pocket in which the bacteria can hide.  This cycle of Periodontal Disease, if not treated, can destroy the gum and bone around the teeth, causing the tooth to become loose.  Then a tooth, which may be healthy, is lost due to Periodontal Disease.

Approximately 55% of adult tooth loss in the United States is due to Periodontal Disease.

Symptoms of Periodontal Disease

Periodontal Disease

Periodontal infection is usually painless until it reaches the advanced stages.  There are, however, some warning signs which can indicate the presence of a gingival problem.  These include but are not limited to:

  • Red, swollen gums
  • Bleeding when brushing, flossing or eating
  • Aching, itchy gums
  • Receding gum line
  • Halitosis (Bad Breath)
  • Fluid oozing from between teeth when pressure is applied
  • Changes in bite
  • Changes in the fit of a Partial Denture 
  • Loose Teeth
  • Spaces appearing between teeth

If you notice any of the above warning signs of Periodontal Disease, please contact our office to schedule a Periodontal Evaluation with one of our Dentists or our highly skilled Hygiene Staff.

Factors which contribute to Periodontal Disease

Some people with Periodontal Disease have low resistance to oral bacteria. This creates an ongoing battle in attempt to keep the plaque growth under control.  Increased oral Home Care and more frequent Dental Cleanings are some ways a patient can battle gum disease.  However, in some cases, patients have other forces which create a negative impact on their fight against Periodontal Disease.  Some factors are:

  • Poor oral hygiene
  • High dental plaque growth rate 
  • Smoking
  • Genetic factors
  • Stress or tension
  • Grinding 
  • Diet - poor diets have a negative impact on gingival health, but patients who are on low carbohydrate diets tend to have an increase in hard tartar build-up 
  • Age
  • Dry Mouth
  • Sickness 


Without removing the cause of the infection, a person's immune system is unable to conquer the bacteria on its own.  Periodontal Disease is a growing infection of the gum and bone caused by the increased bacterial growth in the gingival pocketing surrounding the tooth.  Without the removal of the plaque bacteria, the human body can not rid itself of the infection, and the swelling and redness will worsen.  Periodontal Care is the first and main step in stopping this disease.

Beginning Stages of Periodontal Disease

A beginning case of Periodontal Disease can be Gingivitis or the patient may have developed several increased pockets throughout the mouth.  In this stage, a Routine Preventive Hygiene appointment may be enough to clean out the hard tartar beginning to form at or below the gingival level.  After the appointment, increasing home care by Brushing and Flossing will allow the gums to heal to a healthy pink state.  Listerine is recommended to help prevent bacteria growth.

Moderate Periodontal Disease

With Moderate cases of Periodontal Disease, the patient will have numerous deep pockets throughout the mouth.  The gums will be red in color and bleed easily on probing.  Bone loss has already begun.  Depending on the amount of bacteria and the patient's tolerance, the case may be treated by a Gross and Fine Scale.  During the Gross Scale, the Doctor or the Hygienist uses an UltraSonic instrument to remove as much of the hard tartar above and below the gumline as possible.  This can be uncomfortable for the patient.  The patient is given Home Care instructions and returns several weeks later for a Fine Scale appointment.  The Fine Scale is more like a Routine Preventive Cleaning.  The Doctor or Hygienist goes under the gum to remove any areas of plaque left behind from the first appointment and polishes the patient's teeth.  The gum pockets are measured so it can be determined if additional treatment is necessary.  If a pocket measures greater than 5 mm, a medicated powder called Arestin is placed to aid in healing.  The patient is placed on a Periodontal Maintenance Recall until they are able to keep their gingiva healthy.  If the patient is unable to tolerate the Gross Scaling, Quadrant Scaling can be performed under local anesthesia as described below.

Severe Periodontal Disease

With Severe Periodontal Disease, the patient will have many deep pockets throughout the mouth.  Some pockets may be greater that 6 mm.  The gum tissue is usually a dark red to purple color and bleeds easily.  Often the patient's breath has a bad odor because of the infection, and a greater amount of bone loss can be seen on x-ray.  When treating a Severe Periodontal case, Quadrant Scaling is recommended.  In four separate appointments, the patient is given local anesthesia for their comfort, and one section of the mouth is Deep Scaled.  The gum pockets are measured so it can be determined if additional treatment is necessary.  If a pocket measures greater than 5 mm, a medicated powder called Arestin is placed to aid in healing.  After the Quadrant Scalings are complete, the patient is placed on a Periodontal Maintenance Recall until they are able to keep their gingiva healthy.

In some Severe Periodontal cases, the patient has allowed their gingival condition to go beyond the care we can provide at our office.  When the Doctor or the Hygiene staff feel it necessary, a patient with Severe Periodontal Disease will be sent to the Periodontist (gum specialist) for treatment.

Important Note: Your gums can look and feel quite normal and yet deep pockets of periodontal infection can still be present. To be certain about any periodontal disease, ask our Dentist or Hygiene Staff to examine your gums for signs of infection.

Systemic Links to Periodontal Disease

Research has now linked Periodontal Disease to several serious health problems.  These including heart disease, diabetes, lung infections, strokes and pre-mature child birth.  The mouth is an essential entrance point for the digestive tract.  When a person chews, teeth and saliva mix the bacteria found in the mouth into the foods we eat.  The higher the bacterial content in a person's mouth, the more bacteria is swallowed throughout the day.  This bacteria is absorbed into our system, causing additional health problems throughout the body.   As ongoing research continues to define how Periodontal Disease is associated with these and other health problems, oral health maintenance is essential.  Some Insurance Companies are beginning to recognize the connection between Periodontal Health and the body.  To aid in lessening claims concerning serious health problems, some insurance companies are beginning to cover additional cleanings for patients who have issues which can be affected by their periodontal conditions, such as diabetes and pregnancy.   Periodontal health is a key component to a healthy body.


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