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It is a progressive disease

Periodontal diseases are serious bacterial infections that destroy attachment fibers and supporting bone that hold teeth in the mouth.  Approximately 15 % of adults between 21-50 and 30% of adults over 50 have this disease

Gum and bone disease is a disease of neglect.

 Untreated periodontal disease in effect "seeds" the bloodstream with disease-causing bacteria.

Some causes of periodontal disease are:

bulletPlaque is a mostly invisible  bacterial loaded film that clings to teeth and gums. Plaque is the soft, sticky layer of bacteria, which is constantly forming on the  teeth. Usually it is invisible to the naked eye, but when a person is not brushing adequately, it can build up to where it appears to be a thick whitish coating on the teeth at the gum line. This bacterial causes irritation of the tissues that support your teeth.  This irritation can lead to inflammations and infection that can destroy your gum and bone tissue.  When plaque is not completely removed it may harden or calcify into a rough deposit called tarter or calculus.  The only way to limit the damage caused by the tartar to your gum tissue is to have your teeth cleaned regularly at the dental office.
bulletWhat foods are best avoided to maintain good periodontal health? The top culprit chosen by periodontists was popcorn, because the husks can get caught in between the teeth and gums and cause abscesses.
bulletOral-disease-causing microbes like:  porphyromonas gingivalis bacterium are associated with chronic and severe adult periodontitis. The problem with calculus is that it harbors plaque. Bacterial plaque, or reaction to it, is what the problem is that causes gum disease.
bulletImpacted food, alcohol, improper use of toothpicks and tobacco products may irritate gum tissue.
bulletThe results suggest that persistent alcohol abuse increases periodontitis , gum disease, development by heightening the loss of attachment through recession of gingival margins. J Periodontol 2003;74(4):485-493
bulletBadly aligned teeth, defective fillings, poorly fitting bridges or partial dentures and harmful habits such as grinding you teeth can cause problems.
bulletPoor diet that causes nutritional deficiency and reduces the body's ability to fight off infection.
bulletThere is increasing evidence that decay and periodontal disease are both contagious diseases. The causative bacteria can be passed from parent to child or from lover to lover by kissing. People who never had a cavity may suddenly have several (or more) because of the person’s new relationships! Practical advice---if your kids or your lover have active decay or gum and bone disease, you BOTH may need treatment, including the use of antibacterial rinses, for the disease to be controlled. This is a major paradigm shift in the treatment of dental disease.
bulletHormone fluctuations during pregnancy can cause pregnancy gingivitis.
bulletOral contraceptive, steroid, cancer therapy drugs and anti-epilepsy drugs will affect gum tissue.
bulletSuch conditions as diabetes, leukemia, AIDS/HIV..
bulletPeriodontal Disease can be spread through family members
bulletMedications that can cause gum disease
bulletPoor oral hygiene habits cause periodontitis. All the body needs is 0.05mm of calculus to allow for the formation of bacterial antigens that cause gum disease.
bulletLow calcium intake is a risk factor for gum disease.  Women aged 20-39 with the lowest calcium intake had a risk of 54% for  periodontal diseases.  Women who took moderate calcium supplements lowered their risk by 27%.^
bullet Smoking-causes calculus, deep pockets, bone loss, infection and chronic gum disease.  It damages the natural processes that the body uses to fight against gum disease, it reduces saliva levels, restricts blood flow, and damages your immune system.  The nicotine causes significant changes in the blood vessels and the tissue of the mouth are getting attacked by the heat and smoke itself.
bullet Anger...see anger and gum disease.
bulletStage and ages in life.  Hormonally triggered life stages like puberty, pregnancy and menopause, where estrogen and progesterone levels climb, causing gums to react differently to the bacteria found in plaque.
bulletDry mouth.
bulletIt only takes 0.05mm of bacteria plaque to allow for bacterial antigen formation which is a pretty thin layer and EASY to accumulate in hard to get at areas. Dental plaque as a biofilm, just like in your arteries. Plaque is NOT chemically causative in the PD process, CALCULUS is.
bulletHalf of the population may be genetically predisposed to periodontal disease.
bulletIt is believed that gum disease may caused by a gene that causes a defect in the Il-1antibody. Periodontal. disease is now proving to be an autoimmune type disease, with bacterial toxins as the trigger. PD, Arthritis, Cardiovascular Disease, Cerebral Vascular Disease, Diabetes, and a host of many more are all linked by the fact that they are immune disorders dressed up as "other issues" PD was almost totally controlled by 2 genes that controlled inflammation.  It is almost 100% a genetic disease that can be made much worse by smoking. It demonstrates itself in the mouth and  is nothing more then an Immune System Gone Awry. It needs a trigger to start but once started it only takes minimal forces to keep it going. U of Wash, Dr.Roy Page, stated that perio is a genetic disease. If you have the two bad genes that adversely effect the way your body responds to irritation with an exaggerated inflammatory response and smoke you will loose teeth early.
 IDF 5/05 People with PD have a defective immune response to the antigens that the perio pathogens produce. Thus PD as an immune disease that is caused initially by poor home care and bacterial antigens but is propagated by a systemic defect that some have and some don't. It is a bacterially induced immune response.  IDF 11/05
bulletStress-Smokers under stress have deeper pockets than non-anxious smokers Bacterial biofilm triggers periodontal infection, and stress can aggravate the situation. Past studies have demonstrated that people with psychiatric disorders have more periodontal  disease. High stress levels combined
with  smoking may lead to more periodontal infection. High-stress levels combined with smoking may lead to more periodontal

Anxiety, Gingival Inflammation and    Periodontal Disease Johannsen, A., Asberg, M., Söder, P., Söder, B.: Anxiety, Gingival Inflammation and    Periodontal Disease in Non-Smokers and Smokers - An Epidemiological Study. J Clin Perio 32: 488-491, 2005. Cited Dental Hygienetown, PerioReports
bulletIt is caused by mixed infection of bacterial + host response to bacterial infection= gum disease. It is the interaction of the host or your immune response with pathogenic bacterial that determines whether gum disease is initiated or whether disease progresses. It is important to recognize certain risk factors make certain people more susceptible to gum disease.**

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. 


Smokers, diabetics and those taking steroids, oral contraceptives and certain cancer drugs are a higher risk for developing periodontitis.


Alcohol is a drying agent and causes sloughing to occur so as it does the remnant cells are "food sources" for the antigen.   Decay requires a carbohydrate rich environment while PD needs protein. So if we have a diet high in protein and we are not exquisitely diligent on home care the remnant of the protein feeds the antigen reaction. IDF 11/21/05


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, floss, sticks, oral irrigation, and automatic flossers.  remember this disease needs to be treated both in the office and at home.++



Gum disease is caused from an immune system that has gone off track and is linked
to the causes of heart disease, cancer and diabetes via the immune system pathway.


Stress can cause Periodontal Disease- stress is bad for your teeth.
Psychological stress can lead to elevated plaque levels, while physical stress is linked to gingivitis (gum disease). What’s more, caregivers helping people under these physical and emotional stresses are also at increased risk for gum disease.Experts believe chronic stress may lead to a malfunction of some biological functions. Also, those who are struggling with stress and those who care for them often become depressed and slide on oral hygiene, if not giving up on themselves altogether.

Gum disease leads to more than bleeding gums. It can affect the integrity of your teeth and the bone that supports them. If unchecked, gingivitis can lead to loose and missing teeth. When this happens, teeth can often shift. It can be uncomfortable and painful for your bite (not to mention your smile). Brushing at least twice a day and flossing each night are the first step toward protecting yourself from gum disease. Regular dental check-ups and cleanings are also crucial. While these steps can help reduce the risk of stress-related periodontal disease, they don’t resolve the key problem – stress! Exercising and eating right can help, and developing a hobby can be a fantastic release. Talking about it can help as well.
Journal of Periodontology

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Cigarette Smoking and the Periodontal Patient 

Adult smokers are approximately three times as likely as non-smokers to have periodontitis. The association between smoking and attachment loss is even stronger when the definition of periodontitis is restricted to the most severely affected subjects. Smokers have a diminished response to periodontal therapy and show approximately half as much improvement in probing depths and clinical attachment levels following non- surgical and various surgical modalities of therapy. Implant failures in smokers are twice those of non-smokers, with a higher failure rate in the maxillary arch . Tobacco-induced alterations in microbial and host factors contribute to these deleterious effects of smoking on the periodontium. In longitudinal studies, the rate of periodontal disease progression is increased in smokers, but decreases to that of a non-smoker following tobacco cessation. Likewise, recent non- smokers respond to periodontal therapy in a manner similar to patients who have never smoked.  Use the five A's: ask – identify tobacco users; advise – advise them to quit; assess – evaluate the patient's readiness to quit; assist – offer assistance in cessation; and arrange – follow up on cessation efforts. The addition of pharmacotherapy to behavioral therapy, including nicotine replacement therapy and bupropion, can increase cessation rates. The most popular form of nicotine replacement therapy is the patch, and its use has been shown to double cessation rates compared to behavioral therapy alone. Use of bupropion in combination with nicotine replacement therapy may be particularly helpful for heavy smokers or smokers who have experienced multiple failed attempts at cessation. [J Periodontol 2004;75:196-209.]Georgia K. Johnson and Margaret Hill [J Periodontology Feb 2004] 

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Anger may be a risk factor of gum disease!

Stress is associated with poor oral hygiene, increased glucocorticoid secretion that can depress immune function, increased insulin resistance and potentially increased risk of periodontitis. Methods. The authors examined the association between social support, anger expression and periodontitis in 42,523 male.   Subjects who reported having at least one close friend had a 30 percent lower risk of developing periodontitis. Men who participated in religious meetings or services had a 27 percent lower risk of developing periodontitis. Men who reported being angry on a daily basis had a 43 percent higher risk of developing periodontitis compared with men who reported being angry seldom. 
Prospective Study of Social Support, Anger Expression and Risk of Periodontitis in Men Merchant A.T. et al., December 2003 JADA 

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Transmission of Porphyromonas gingivalis and FimA Type in Spouse Relationship Recent findings suggest that the genotype of the fimbriae is one of the important factors in infection by P. gingivalis. The objectives of the present study were to investigate the transmission of P. gingivalis between spouses.  Intrafamilial transmission of infectious bacteria was significantly higher in couples. Conclusion: This study suggests that fimA type II,, may be an important factor in the transmission of P. gingivalis between spouses. [ J Periodontol 2003;74:1355-1360.]

Clinical studies prove

Untreated Periodontal Disease - A follow-up on 30 cases. Randall J. Harris, Journal of Periodontology, May 2003

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Harvard Medical School researchers studied longevity and found one of the most important contributing factors was daily flossing. Because it removes bacteria from the teeth and gums, flossing helps to prevent periodontal disease and gingivitis. Another study found that men with periodontitis had a whopping 72% greater risk of developing coronary disease. Gingivitis was associated with a 42% increased risk for men. Nov 02

Source: Dr. W.B.Willams
^ Dental Abstracts Jan/Feb 2001.

This is an EXCELLENT article on Periodontal Disease.

Plaque: What it is and how to get rid of it

** Etiology Fast Forwarded: The Host Bacterial Interaction Theory and the Risk Continuum Hein.  Contemporary Dental Assisting pg 18-27 Sept 05.

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February 27, 2007

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