Online Dental Education Library
Our team of dental specialists and staff strive to improve the overall health of our patients by focusing on preventing, diagnosing and treating conditions associated with your teeth and gums. Please use our dental library to learn more about dental problems and treatments available. If you have questions or need to schedule an appointment, contact us.
Periodontal Disease
When to See a Periodontist
Periodontal treatment may be sought in several ways. Your general dentist or a hygienist may recommend a consultation with a periodontist if they find signs of periodontal disease through the course of a checkup or other dental care appointment. You may also decide to see a periodontist on your own, as a referral is not necessary to be seen at our office.
In fact, if you experience any of these symptoms, we encourage you to schedule an appointment at our office without delay:
- Unexplained bleeding while performing regular cleaning or consuming food is the most common sign of a periodontal infection.
- Ongoing halitosis (bad breath), which continues despite rigorous oral cleaning, can point to periodontitis, gingivitis or the beginnings of a gum infection.
- Longer-looking and loose-feeling teeth can indicate recession of the gums and/or bone loss as a result of periodontal disease.
Patients with heart disease, diabetes, osteopenia or osteoporosis are often diagnosed with correlating periodontal infections. The bacterial infection can spread through the blood stream, affecting other areas of the body.
- Bleeding while brushing or eating normal foods
- Bad breath
- Loose teeth and gum recession
- Related health concerns
What is Periodontal Disease?
Periodontal disease is a chronic infection of the periodontal or gum tissue. This infection is caused by the presence of a bacterial film, which is called dental plaque, that forms on the teeth surfaces. Bacteria that found in dental plaque produce toxins which irritate the gums. They may cause them to turn red, swell and bleed easily. If this irritation is prolonged, the gums separate from the teeth, causing pockets (spaces) to form. Plaque can also harden into a rough, porous substance known as calculus (or tartar). This can occur both above and below the gum line.
As periodontal diseases progress, the supporting gum tissue and bone that holds teeth in place deteriorate. If left untreated, this leads to tooth loss. With periodontal disease, bleeding, redness and swelling do not have to be present. Further, pain is usually not associated with periodontal disease. This disease damages the teeth, gum and jawbone of more than 80% of Americans by age 45. Each case is looked at individually, because in addition to plaque there are co-factors such as genetics, smoking, and overall health, which contribute to disease severity. Once periodontal disease is detected, our goal as therapists is to provide information and treatment necessary to control/ or arrest the active infection, and help keep the disease in an inactive or controlled state.
However, don’t be fooled!
With periodontal disease, bleeding, redness and swelling do not have to be present. The periodontal disease symptoms of inflammation may only be evident with sub gingival probing. Further, pain is usually not associated with periodontal disease.
Antibiotics are widely prescribed to control bacterial infections. Sometimes they are given before a medical or dental procedure, to prevent a possible infection from occurring; this practice is called "antibiotic prophylaxis." In the recent past, physicians and dentists advised that people with certain medical conditions - including a number of heart problems and several types of bone or joint replacements - should always take antibiotics before many routine dental procedures. Today, their advice may be different.
A growing body of evidence now indicates that far fewer patients need to take this preventive step than was previously thought. As a result, the guidelines for prescribing antibiotic prophylaxis have recently changed - and they may do so again in the future. Why are the recommendations changing - and what do you need to know about taking antibiotics before coming to the dental office?
The Risk of Infection
We all know that bacteria - both helpful and harmful types - thrive in many parts of the body, including the mouth. Whenever circumstances make it possible for these microorganisms to enter the bloodstream, there's a slight risk that a bacterial infection may develop. This could occur in many dental procedures - and it could also occur during routine activities like chewing, brushing and flossing. In most cases, the risk is so small that the chance of a having bad reaction to antibiotics (while rare) is far greater than the chance of developing an infection; therefore, antibiotics aren't routinely used.
Some people, however, need to take extra precautions before having dental procedures. If you have been treated for some types of heart disease, or have had certain orthopedic procedures (including total joint replacement), we may advise taking antibiotics to protect against even a remote chance of infection. Recommendations are made on an individual basis, taking into account your medical history and a clinician's healthcare experience.
Guidelines for Antibiotic Premedication
Prophylactic antibiotics might be recommended before dental procedures if you have one or more of the following heart conditions:
- A heart transplant
- Artificial heart valves
- A history of infective endocarditis
- Some types of congenital heart problems - particularly if they haven't been completely repaired, or if their treatment involves prosthetic material
If you have undergone a joint replacement procedure, prophylactic antibiotics might be recommended if you also have one or more of the following risk factors:
- A systemic inflammatory disease such as rheumatoid arthritis or lupus erythematosis
- A weakened immune system resulting from HIV, cancer, radiation or chemotherapy, or another cause
- Insulin-dependent (type I) diabetes or hemophilia
- A history of previous infection in a prosthetic joint
- Undernourishment or malnourishment
There are other circumstances where taking prophylactic antibiotics would be a prudent step; there are also a number of situations where these medications might have been recommended in the past, but aren't currently required in all cases. For example, the presence of a benign heart murmur, a pacemaker or defibrillator, and certain heart diseases or congenital defects don't automatically mean that antibiotic prophylaxis will be needed.
In recent years, reports of drug-resistant bacteria and harmful side effects from some medications have increased public awareness of the consequences of overusing antibiotics. Fortunately, new scientific research is helping healthcare professionals make better, evidence-based treatment decisions on antibiotic use. If you have questions about whether you should take antibiotics before dental procedure, don't hesitate to ask.
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Premedication for Dental Treatment If you have had a total joint replacement in the past, you may be advised to take antibiotics before have dental work. That's because certain preexisting health conditions may make you more susceptible to infection during a dental procedure. Find out what the risk factors are... Read Article