Dr. Aarthi Raghavan, DMD

A Slow but Destructive Disease – Periodontitis

Periodontitis is an irreversible bacterial disease of the structures surrounding the teeth, namely the gingiva (the gums), periodontal ligament, and bone. It is a bacterial driven disease, caused by inadequate home care, in- office care and sometimes also involves genetic factors, vitamin D levels and habits like smoking that predispose a person to this disease.

Most of the bacteria causing severe form of the disease fall into the red complex and have the following scientific names

  1. Porphyromonas gingivalis
  2. Tannerella forsythia
  3. Treponema denticola

The disease is easily treatable and relapse can be prevented when identified and managed early. Patient education and compliance play a key role.

As doctors, dentists also have a public health responsibility in educating patients about this disease so patients are able to maintain a healthy dentition for good oral health, nutrition and well being.

Periodontitis treatment involves two phases:

  1. The disease control phase during which the calculus ( tartar) is removed from teeth, gums and underneath the gum line ( a process sometimes mis-named deep cleaning), antibacterial therapy ( localized using rinses, systemic using medications, like capsules and pills), Laser therapy for complete elimination of bacteria and cell regeneration to promote healing, bone formation and prevention of relapse.

Advanced periodontal disease may need prompt surgical therapy after completion of scaling and root planing.

  1. Maintenance phase during which a patient comes in for routine maintenance as well as good home care habits to prevent recurrence or relapse.

It is an irreversible disease because once it sets in it can always come back again, the bone loss caused by periodontitis is nearly impossible to reverse. So the goal is to prevent further bone loss, which can lead to tooth mobility, bony defects  and loss of teeth together with pain and deterioration of quality of life

Periodontitis also has a direct effect on blood sugar and has been shown to worsen diabetes control.

It has also been cumulatively shown in several scientific studies to be an independent factor causing heart disease. Dr. Bradley Bale, a cardiologist from Cleveland Clinic has several videos where he talks about this connection.

It has also been shown that periodontal bacteria are found in the brains of Alzheimer’s patients.

It’s a slow destructive or chronic disease.

This is why we cannot ignore the diagnosis and do preventative maintenance or prophylaxis on a patient who has periodontitis (gum disease). Many patients frequently seek answers to why a “regular cleaning” cannot be done.

In my sincere opinion, “regular cleaning” and “deep cleaning” are two of the worst misnomers to misguide a patient.

A healthy patient receives routine preventative therapy, a patient with periodontal disease must be educated and treated and maintained in a timely manner to prevent progression of disease and re-establish health.

©Dr.Aarthi Raghavan, BDS, DMD, D.ABDSM

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