Periodontal treatment is necessary when various conditions affect the health of your gums and the regions of your jawbone that hold your teeth in place. Retaining your teeth is directly dependent on proper periodontal care and maintenance. Healthy gums enhance the appearance of your teeth, like a frame around a beautiful painting. When your gums become unhealthy, they can either recede or become swollen and red. In later stages, the supporting bone is destroyed and your teeth will shift, loosen, or fall out. These changes not only affect your ability to chew and speak. They also spoil your smile.

Periodontal diseases are ongoing infections of the gums that gradually destroy the support of your natural teeth. Periodontal disease affects one or more of the periodontal tissues: alveolar bone, periodontal ligament, cementum, or gingiva. While there are many diseases which affect the tooth-supporting structures, plaque-induced inflammatory lesions make up the majority of periodontal issues, and are divided into two categories: gingivitis and periodontitis. While gingivitis, the less serious of the diseases, may never progress into periodontitis, it always precedes periodontitis.

Gingivitis

Accumulation of Dental Plaque is the primary cause of gingivitis. The important feature of gingivitis is that there is inflammation, swelling and bleeding of the gums but the underlying bone is not affected. All people have potential to develop gingivitis and interestingly there are up to 70% of people that no matter how much they neglect their teeth will probably only ever get a chronic gingivitis and will never develop the more serious Periodontitis (see below). Plaque is a sticky colorless film, composed primarily of multiple types of bacteria, which adhere to your teeth at and below the gum line. Plaque constantly forms on your teeth, even minutes after cleaning. Bacteria found in plaque produce toxins or poisons that irritate the gums. Some people may have more toxic bacteria in their dental plaque and their gums may become inflamed, red, swollen, and bleed easily. If daily brushing and flossing is neglected, plaque may also harden into a rough, porous substance known as calculus (or tartar). This can occur both above and below the gum line.

Periodontitis

Periodontitis is the destructive form of gum inflammation and is related to the presence of certain bacterial species being present in your plaque. The important feature of periodontitis is that the gums are swollen and inflamed (just like gingivitis) but there is also destruction of the underlying bone occurring. It is estimated that about 30% of the population have a significant background susceptibility to potentially developing periodontitis.

Once you have been diagnosed as having a susceptibility to periodontitis, treatment and optimised preventive care will allow you to stabilise the condition and prevent it from causing bone loss and tissue damage. This is the same as many other medical conditions such as diabetes, high blood pressure and cardiac disease where we know some patients have increased susceptibility to these diseases due to their genetic predisposition however if appropriate treatment and preventive strategies are put in place then the problem can be controlled long term and damage to the body minimised. This is important to understand as this means you will need to follow a professional maintenance program and optimise your home dental care to ideally manage your periodontitis. If untreated there is progressive loss of the soft tissue and bone at a rate of up to 2mm per year, which if allowed to progress may result to loosening and subsequent loss of teeth.

Periodontitis may be present in up to 80% of the population at some time in their life. However we see the more problematic form of the disease in ~20% of the population. Aggressive Periodontitis, which does not respond well to most treatments is usually seen in 1-2% of the population and these patients not only appear to have the more toxic bacteria but also appear to be more genetically susceptible to the infection leading to more rapid and severe bone and tooth loss.

Research has recently proven what dentists have long suspected: that there is a strong connection between periodontal disease and other chronic systemic disease conditions such as diabetes, heart disease, arthritis and osteoporosis.

Periodontal disease is characterized by inflammation of the gum tissue, presence of disease-causing bacteria, and infection below the gum line. Infections and bacteria in the mouth can spread throughout the body and lead to a host of problematic health issues. Therefore, maintaining excellent oral hygiene and reducing the progression of periodontal disease through treatment will have benefits beyond preventing gum disease and bone loss. It can also save you from the chance of developing another serious condition.

Periodontal Disease and Diabetes

Diabetes is a serious metabolic disease that is characterized by too much glucose, or sugar, in the blood. Type II diabetes occurs when the body is unable to regulate insulin levels, meaning too much glucose stays in the blood. Type I diabetics cannot produce any insulin at all. Diabetes affects many people and increases with age. It can lead to a variety of health issues, such as heart disease and stroke.

Research has shown people with diabetes are more likely to develop periodontal disease than non-diabetics. Diabetics with insufficient blood sugar control also develop periodontal disease more frequently and severely than those who have good management over their diabetes.

The connection between diabetes and periodontal disease results from a variety of factors. Diabetes sufferers are more susceptible to all types of infections, including periodontal infections, due to changes in blood flow, altered bacterial killing activity of white blood cells and alteration in the body’s overall resistance to infection. However controlling ones blood sugar levels may prevent many of these issues.

The systemic inflammation induced by moderate to severe periodontal disease may increase blood sugar levels in the body further exaggerating the need to control diabetes. So treatment of periodontitis has a positive benefit for Diabetic patients.

Smoking and tobacco use is detrimental to anyone’s oral and overall health, but it is particularly harmful to diabetics. Diabetic smokers 45 and older are in fact 20 times more likely to develop periodontal disease than those who do no smoke.

If you are a diabetic it is very important to control your blood sugars, to brush and loss your teeth effectively, visit the dentist regularly, and to have your periodontitis treated.

Periodontal Disease, Heart Disease and Stroke

Coronary heart disease occurs when fatty proteins and a substance called atheroma plaque build up on the walls of your arteries. This causes the arteries to narrow, constricting blood flow. Oxygen is restricted from traveling to the heart which results in shortness of breath, chest pain, and even heart attack.

The link between periodontal disease and heart disease is so apparent that patients with oral conditions are nearly twice as likely to suffer from coronary artery disease than those with healthy mouths. Periodontal disease has also been shown to exacerbate existing heart conditions. Additionally, patients with periodontal disease have been known to be more susceptible to fatal strokes. A stroke occurs when the blood flow to the brain is suddenly stopped. This may occur, for example, when a blood clot prevents blood from reaching the brain.

One of the causes of the connection between periodontal disease and heart disease is oral bacteria entering the bloodstream. There are many strands of periodontal bacteria. Some strands enter the bloodstream and attach to the fatty plaques in the coronary arteries. This attachment leads to clot formation and increased risk to a variety of issues including heart attack.

Inflammation caused by periodontal disease also creates an increase in white blood cells and proteins called “Acute Phase Proteins” such as C-reactive proteins (CRP). CRP is a protein that has long-been associated with heart disease. When levels are increased in the body, it indicates an increase in the body’s natural inflammatory response. Bacteria from periodontal disease may enter the bloodstream, or may induce inflammatory changes that causing the liver to produce extra CRP, which may lead to altered inflammatory responses and possibly blood clots which can predispose to clots blocking arteries.

Coronary heart disease is the leading cause of death in the Western world for both men and women. Enacting positive oral hygiene practices and obtaining treatment for periodontal problems may help to reduce the risk of developing this unfortunate condition.

Periodontal Disease and Pregnancy

Pregnant women with periodontal disease expose their unborn children to a variety of risks and possible complications. Pregnancy causes many hormonal changes in women, which may be associated with increased growth in some of the bacteria in the plaque which are associated with increased gingivitis, or gum inflammation. These oral problems have been linked to preeclampsia, or low birth weight of the baby, as well as premature birth. Some evidence exists that treating periodontal disease may reduce these risks.

There is evidence that alteration in inflammation found in periodontal diseases may influence the pregnancy in some genetically susceptible patients. Inflammation may influence the onset of labour leading to premature and low birth weights of the child, or the development of preeclampsia.

If you are pregnant, it is important to practice effective home care for preventing gum disease. can help assess your level of oral health and develop preventive measures and treatment plans to best protect you and your baby.

Periodontal Disease and Respiratory Disease

Respiratory disease occurs when fine droplets are inhaled from the mouth and throat into the lungs. These droplets contain germs that can spread and multiply within the lungs to impair breathing. Recent research has shown that oral bacteria can be drawn into the lower respiratory tract and cause infection or worsen existing lung conditions, such as pneumonia, bronchitis and emphysema. Chronic obstructive pulmonary disease (COPD), a respiratory condition characterized by blockage of the airways, and caused mostly by smoking, has also been shown to worsen if the patient also has periodontal disease.

Periodontal Disease and Osteoporosis

Osteoporosis is a condition common in older patients, and particularly women, that is characterized by the thinning of bone tissue and loss of bone density over time. Studies have found that women with periodontal disease were more likely to have periodontal bone loss in the jaws, more likely to develop periodontitis and that osteoporosis patients could significantly reduce tooth loss by controlling periodontal disease. It appears that inflammation derived from periodontal disease may be involved in this process.

Periodontal Disease and Arthritis

Recent evidence has shown a link between arthritis and periodontitis. Once against this appears to be associated with an increase in the inflammatory response induced by the bacteria in the oral cavity. It has been shown that treatment of periodontal disease can reduce the signs and symptoms associated with arthritis.

Periodontal Disease and Smoking

Smoking has been linked to the worsening of periodontal disease. Patients who smoke have greater levels of periodontal tissue loss than and age sex matched patients with periodontitis. Factors induced by smoking appear to alter the immune response and this in turn seems to result in an increase in tissue destruction in smokers with periodontitis. The periodontal disease treatment outcomes for patients who smoke are not as good as those for patients who do not.

When people with periodontitis stop smoking they frequently will report more gum bleeding and swelling. This appears to be related to the improvement in the inflammatory response. The Periodontists will give you information about smoking and they will also encourage you to QUIT.

Adults over the age of 35 lose more teeth to gum diseases than from cavities. At least three out of four adults are affected at some time in their life. The best way to prevent cavities and periodontal diseases is by daily thorough tooth brushing, interproximal (between teeth) cleaning techniques and regular professional examinations and cleanings. Unfortunately, even with the most diligent home dental care, people can still develop some form of periodontal disease. Once this disease starts, professional intervention is necessary to prevent its progression.

Other important factors that can negatively affect the health of your gums include: tobacco usage, uncontrolled diabetes, obesity, and poor nutrition.

Tooth decay and Periodontal disease are caused by quite different bacterial species which grow under different environmental conditions. Tooth decay causing bacteria grow well when there is an increase in refined sugars in the oral environment so brushing ones teeth after consuming these items is the recommended timing for cleaning. Periodontal disease causing bacteria grow well when there is an increase in blood products in the mouth. The frequency of brushing required to eliminate gingival inflammation is less and a twice a day routine gives optimum clinical outcomes.

Hand Held Brushing: While brushing the outside surfaces of your teeth, position the brush at a 45-degree angle where your gums and teeth meet. Gently move the brush in a circular motion several times using small, gentle strokes. Use some pressure while putting the bristles between the teeth, but not so much pressure that you feel any discomfort. When you are done cleaning the outside surfaces of all your teeth, follow the same directions while cleaning the inside of the back teeth.

To clean the inside surfaces of the upper and lower front teeth, hold the brush vertically. Make several gentle back-and-forth strokes over each tooth. Don’t forget to gently brush the surrounding gum tissue.

Next you will clean the biting surfaces of your teeth. To do this, use short, gentle strokes. Change the position of the brush as often as necessary to reach and clean all surfaces. Try to watch yourself in the mirror to make sure you clean each surface. After you are done, rinse vigorously to remove any plaque you might have loosened while brushing.

Electric toothbrushes: Power assisted brushing with a round headed brush has recently been shown to be more efficient per unit of time spent cleaning than hand held brushing. Many power assisted brushes are available but the Braun/Oral B range of brushes available in Australia seem to provide a good basic unit to use. Place the edge of the brush against the tooth with the bristles at the gum line on the outer aspect of the last back tooth. Then move the brush along your teeth keeping the bristles at the gum margin. Do this methodically so that you do not miss any areas. The brush is doing all the work all you have to do is hold it in the area for long enough to clean the area. Most power assisted brushes have 2 minute timers which indicate to you that you have spent enough time cleaning.

If you have any pain while brushing or have any questions about how to brush properly, please be sure to consult us.

Interproximal Cleaning

Periodontal disease usually appears between the teeth where your toothbrush cannot reach. In Australia, most people brush their teeth well but do not clean in between their teeth as well as they could.

Interproximal brushing with any of the available brushes is the most efficient method of interproximal cleaning. These brushes come in multiple different sizes and most people will need more than one size to clean between their teeth. The appropriate size to use is one that feels slightly snug going through the gap but does not hurt. If in doubt, check with us. Several brushing strokes between each tooth should be sufficient to remove the plaque. Dr Hinckfuss has recently designed his own range of interdental brushes for the convenience of our patients and you will be supplied with these free of charge when you attend our practice. Further information about interdental brushes is available on www.oralis360.com.au. TePe interdental brushes and Pikster interdental brushes are other commonly available brands. Some patients have a preference for a particular style so you may want to try them all and see what feels best for you.

Flossing is not as effective as interproximal brushes but is the best alternative when cleaning interproximal spaces which are small. It is best to use inter proximal brushes in the spaces that you can fit them and then use floss in all other areas. You may find monofilament waxed floss such as Colgate Total waxed floss the most user friendly.

Superfloss and similar flosses: These flosses have inbuilt brushes which can be used by pulling the thin non-brush part though the interproximal contact and then pulling the brush part though between the teeth. This acts in a similar manner to that of an interproximal brush.

Thin floss: It is important to develop the proper technique. The following instructions will help you, but remember it takes time and practice.

Start with a piece of floss (waxed is easier) about 18″ long. Lightly wrap most of the floss around the middle finger of one hand. Wrap the rest of the floss around the middle finger of the other hand.

To clean the upper teeth, hold the floss tightly between the thumb and forefinger of each hand. Gently insert the floss tightly between the teeth using a back-and-forth motion. Do not force the floss or try to snap it in to place. Bring the floss to the gum line then curve it into a C-shape against one tooth. Slide it into the space between the gum and the tooth until you feel light resistance. Move the floss up and down on the side of one tooth. Remember there are two tooth surfaces that need to be cleaned in each space. Continue to floss each side of all the upper teeth. Be careful not to cut the gum tissue between the teeth. As the floss becomes soiled, turn from one finger to the other to get a fresh section.

To clean between the bottom teeth, guide the floss using the forefinger of both hands. Do not forget the back side of the last tooth on both sides, upper and lower.

When you are done, rinse vigorously with water to remove plaque and food particles. Do not be alarmed if during the first week of flossing your gums bleed or are a little sore. If your gums hurt while flossing you could be doing it too hard or pinching the gum. As you floss daily and remove the plaque your gums will heal and the bleeding should stop.

Caring For Sensitive Teeth

Sometimes after dental treatment, teeth are sensitive to hot and cold. If the mouth is kept clean, this sensation should not last long. However, if the mouth is not kept clean, , the sensitivity will remain and could become more severe. If your teeth are especially sensitive, consult with Drs. Hinckfuss, McGregor, Mitchell, Chin. A medicated toothpaste or mouth rinse made especially for sensitive teeth may be recommended.

Choosing Oral Hygiene Products

There are so many products on the market that choosing the right one can be difficult. Here are some suggestions for selecting dental care products that will work for most patients:

• Automatic and “high-tech” power assisted toothbrushes are safe and effective for the majority of users. Oral irrigators (water spraying devices) will rinse your mouth thoroughly, but will not remove plaque effectively. You need to brush and floss in conjunction with the irrigator. The WaterPik is an excellent irrigator and mandatory for all patients that have had full mouth implant rehabilitation.

• Electric toothbrushes are excellent and if you like their feel go for it! If you don’t like them, don’t worry as the normal old fashioned toothbrush works very well if used appropriately and for at least two minutes.

• If used in conjunction with brushing, interproximal brushing and flossing, fluoride toothpastes and mouth rinses can reduce tooth decay by as much as 40 percent. For children, consult your dentist or a specialist Paediatric dentist for the optimal fluoride preventive program as it will depend on your child’s age and decay risk profile.

• Mouthwashes and rinses are not a substitute for physical cleaning between your teeth with inter proximal brushes or floss. If you feel you need to use a mouthwash, avoid ones that contain alcohol. Curasept 0.05% mouthwash is a good mouthwash for periodontal patients.

Drs. Hinckfuss, McGregor, Mitchell, Chin are the best people to help you select the right products that are best for you.

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 check up or other dental care appointment. You may also decide to see a periodontist on your own as a referral is not necessary. The earlier Periodontitis is diagnosed the better your chances are of avoiding unnecessary problems that could otherwise lead to tooth loss, and subsequent complicated dental needs.

In fact, if you experience any of these symptoms, we encourage you to schedule an appointment at our office without delay:

• Bleeding while brushing or eating normal foods. Unexplained bleeding while performing regular cleaning or consuming food is the most common sign of a periodontal infection.

• Bad breath. Ongoing halitosis (bad breath), which continues despite rigorous oral cleaning, can point to periodontitis, gingivitis or the beginnings of a gum infection.

• Loose teeth and gum recession. Longer-looking and loose-feeling teeth can indicate recession of the gums and/or bone loss as a result of periodontal disease.

• Related health concerns. Patients with heart disease, diabetes, osteopenia or osteoporosis are often diagnosed with correlating periodontal infections.

Dental Implants: In recent years it has become apparent that patients with a susceptibility to periodontitis also may be at greater risk of gum problems around dental implants. It is therefore critical that patients with periodontitis only have implants placed if their gums are healthy and well maintained. It is also important that the crowns and/or bridgework placed on the implants are properly shaped to allow optimal cleaning. We can work with your dentist to assist with appropriate delivery of treatment.

If you have been told you may require dental implants and you are concerned about this, we are happy to assess your gums and provide an opinion. If you have pre-existing dental implants and are concerned about bleeding, swelling or pain around them you can also make an appointment to have this assessed. You could have peri-implantitis which is much like periodontal disease around implants.

The following are common signs of peri-implantitis:

• Bleeding or pus coming from around the implant while brushing or eating.

• Swelling, pain or tenderness around your implants.

Please seek advice if you are concerned about these issues.

Throughout a woman’s life, hormonal changes affect tissue throughout the body. Fluctuations in hormonal levels occur during puberty, pregnancy and menopause. At these times, the chance of periodontal disease may increase, requiring special care of your oral region.

Puberty

During puberty, there is increased production of sex hormones. These higher hormone levels may increase the growth of certain bacteria within the plaque which result in the gums becoming swollen, red, and tender.

Menstruation

Similar symptoms occasionally appear several days before menstruation. Bleeding of the gums, bright red swelling between the teeth and gum, or sores on the inside of the cheek may occur. These symptoms generally clear up once the period has started.

Pregnancy

Your gums and teeth are also affected during pregnancy. Between the second and eighth month, gums may also swell, bleed, and become red or tender due to altered bacterial growth in the plaque. Rarely large lumps (Pregnancy granulomas) may appear as a reaction to local irritants. These growths are generally painless and not cancerous. They may require professional removal, but usually disappear sometime after delivery. Periodontal health practices should be part of your prenatal care. Any infections during pregnancy, including periodontal infections, can place a baby’s health at risk or increase the risk of transfer of these bacteria to the child after birth. For more information, see the section of our website labeled “Pregnancy and Periodontal Disease” under the “Mouth-Body Connection” tab.

It is safe to carry out periodontal treatment during pregnancy, particularly within the second trimester.

Oral Contraceptives

Swelling, bleeding, and tenderness of the gums may also occur when you are taking oral contraceptives, which are synthetic hormones.

You should always mention any prescriptions you are taking, including oral contraceptives, prior to medical or dental treatment. This will help eliminate the risk of drug interactions, such as antibiotics with oral contraceptives, which lessens the effectiveness of the contraceptive.

Menopause

Changes in the look and feel of your mouth may occur if you are menopausal or post-menopausal. They include: feeling pain and burning in your gum tissue and salty, peppery, sour tastes, and “dry mouth.” Careful oral hygiene at home and professional cleaning may relieve these symptoms. There are also saliva substitutes to treat the effects of dry mouth.

Dentine Hypersensitivity can occur after a number of different events:

• After periodontal treatment.

• If there is gum recession

• After using whitening toothpastes

Dentine is the root part of the tooth and it has many small tubes within it and these tubes go from the pulp or nerve in the tooth to the outer edge of the dentine. The dentine is usually covered by a fine layer of a material called Cementum. If this cementum is removed off the surface of the dentine than these small tubules become exposed to the mouth.

If we place cold fluids, metal or sweet liquids on the surface of the dentine than the fluid in the tubules will move and this will trigger the nerve inside the tooth and give you pain. To treat dentine hypersensitivity we need to block the tubules and stop the fluid movement.

Treatment of Dentine hypersensitivity can be achieved by a number of different methods:

• Desensitizing toothpastes (Examples being Colgate Pro-relief or any of the Sensodyne toothpastes).

• the dentist painting on the dentine a sealant film.

• If none of the above work than the dentist may place a filling in the tooth.