• Dr Shirman

Gum disease Questions and Answers from the perspective of practicing clinician

Updated: Apr 19

I see a great deal of confusion amongst new patients that come to my practice regarding gum disease. No one likes to give bad news. There is nothing worst that telling a client that I just met that he or she has gum disease eating away jaw bone and gums... and they just had an exam and cleaning 6 months ago at another dental office! As doctors we are trained to tell patients clinical truth without sugarcoating it. So... lets start from the beginning in language everyone can understand, even a 5 year old.

Gum disease, periodontitis, is caused by bacteria growing in the mouth. There are well over 1000 species of bacteria that’s directly associated with gum disease. Don’t fall asleep just yet. These bacteria release toxins or poisons into the patient’s blood stream and if not diagnosed early, the toxins will cause jaw bone and gum loss that hold teeth attached to jaws. Studies have also linked association of gum disease and heart problems. There are 4 stages or gum disease and fortunately or unfortunately the disease runs its course completely painless. Only during later stages, patients generally start feeling discomfort.

Question: Why can’t you just give me antibiotic?

Answer: Antibiotics don’t work well on gum disease related bacteria and generally wipe out good and bad bacteria. We do use antibiotics, however, as an adjunct to the gum disease therapy in order to make the main therapy more effective.

Question: What’s gum disease therapy?

Answer: In order to treat gum disease, the infection must be approached from different angles. Periodontal disease therapy almost always starts with "scaling and root planing". Some people call it "deep cleaning". I personally don't like this term because it improperly describes what's being provided. Cleaning isn't therapeutic and doesn't treat disease. Therapy, or treatment is what makes things better. The procedure involves mechanical removal of bacteria, toxins, and infected tissues from root surfaces of teeth below the gum line. We then use antibiotics in slow release microspheres deposited into gums to continue target deeply embedded bacteria in gums. Lasers and gum surgery can also be used to treat this disease.

Question: I had “deep cleaning” done 3 years ago. Why do I need it again?

Answer: I see this question come up all the time. Patient has had gum therapy years ago then after substantial gap between dental visits we find evidence of active gum disease still present. Periodontal therapy removed bacteria, toxins, and infected tissue as discussed earlier. After about only 3 months gum disease bacteria reattach to roots of teeth and the process starts all over again. To be brutally honest, we cannot cure gum disease, yet we can only stop it from progressing. That required constant, life long treatment. So, without proper on-going therapy, gum disease simply returns.

Question: So what can I do to prevent gum disease from damaging my gums? I don’t wanna loose my teeth.

Answer: Once the initial periodontal therapy is completed, patients are placed on periodontal maintenance. It is a fancy word for “supped up” cleaning that removes bacteria bellow roots. Patient’s gums are also measured on order to measure the efficacy of the initial therapy. That is the only way to tell if gum therapy is working. If we still see evidence of active gum disease such as bleeding gums, we start looking into other treatment options. 90% of patients respond very well to the initial therapy as long as they follow the 3 month periodontal maintenance protocol and practice oral hygiene. Special instruments and ultrasonic scalers are used to clean roots of teeth healthy and free from bacterial growth and buildup. Some medical conditions such as uncontrolled diabetes require more aggressive approach to gum therapy.

Question: I just had cleaning and exam 6 months ago and they never told me I have gum disease.

Answer: There are several scenarios here that might apply. Either the condition just started within 6 months. Which is why it is very important to see a dentist on routine visits (emergency extraction is not a routine visit) in order to catch problems early before things go out of control. Or the disease has not been diagnosed. Depending on the country of origin or dental training, some places in the world don’t practice “whole mouth” approach and concentrate on “fixing” immediate problems as they arrise. This type of approach does not help a patient to minimize risk of future problems. For example, patients with latest stage of uncontrolled periodontal disease generally loose some or even all of their teeth. At this stage, not much can be done other than removal of teeth and replacing teeth with plastic dentures. Had this condition been appropriately managed, the patient wouldn’t end up in the position of loosing all teeth.

Question: I know I have gum disease but I just want my regular cleaning.

Answer: Regular cleaning is intended for patients without presence of gum disease. In addition, regular cleaning involves removal of deposits such as stain, plaque and tartar above gums. Therefore, it does nothing for patients with gum disease and gives them false perception of something being done. In reality, the disease still progresses until patients start noticing loose teeth or gum related abscesses. Once patients are diagnosed with gum disease or periodontitis, they remain in this category and should be treated accordingly for best outcome. The analogy I can give you is asking for a car wash when there is engine malfunction. The wash won’t fix the engine issue and is simply wrong approach.

In conclusion, I would like to say that I believe in providing patients with knowledge about their condition. Knowledge is the tool that can be used successfully in order to make best educated decision regarding one’s health.

Written by Sergei Shirman, DMD

Dental Wellness of Charlotte

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