Deep Cleaning (Scaling and Root Planing)

The dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease.

Medications

Medications may be used with treatment that includes scaling and root planing, but they cannot always take the place of surgery. Depending on the severity of gum disease, the dentist or periodontist may still suggest surgical treatment. Long-term studies will be needed to determine whether using medications reduces the need for surgery and whether they are effective over a long period of time. Here are some medications that are currently used:

Surgery

Flap Surgery. Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications. A periodontist may perform flap surgery to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the patient, dentist, and hygienist to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again.

Bone and Tissue Grafts. In addition to flap surgery, your periodontist may suggest bone or tissue grafts. Grafting is a way to replace or encourage new growth of bone or gum tissue destroyed by periodontitis. A technique that can be used with bone grafting is called guided tissue regeneration, in which a small piece of mesh-like fabric is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow.

Since each case is different, it is not possible to predict with certainty which grafts will be successful over the long-term. Treatment results depend on many things, including severity of the disease, ability to maintain oral hygiene at home, and certain risk factors, such as smoking, which may lower the chances of success. Ask your periodontist what the level of success might be in your particular case.

Getting a Second Opinion

When considering any extensive dental or medical treatment options, you should think about getting a second opinion. To find a dentist or periodontist for a second opinion, call your local dental society. They can provide you with names of practitioners in your area. Additionally, dental schools may sometimes be able to offer a second opinion. Call the dental school in your area to find out whether it offers this service.

National Institutes of Health
Bethesda, MD 20892-2190
301-496-4261

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Ann Talks With Maria

"What are you doing?" asked Ann. Ann and her friend, Maria, were watching Maria's children play. "I'm cleaning my baby's teeth," said Maria.

"But your baby hardly has any teeth!" said Ann. "Yes, but my dentist said there are things I can do to keep my baby from getting tooth decay," said Maria.

"But don't baby teeth just fall out?" asked Ann. "Yes, but tooth decay can cause pain for the baby. And baby teeth hold space for adult teeth," said Maria.

"What else did the dentist say?" asked Ann. "She told me how fluoride protects teeth. She also said to feed my baby healthy foods and not to put my baby to bed with a bottle," said Maria.

"When do you have to start taking care of a baby's teeth?" asked Ann. "As soon as they come in. Teeth can decay as soon as they appear in the mouth," said Maria.

"I'll have to start thinking of those things soon!" laughed Ann.

Tips for Maintaining Good Oral Health for Your Baby
There are simple things you can do to protect your baby's teeth!

Protect Your Baby's Teeth with Fluoride
Fluoride (pronounced "floor-eyed") protects teeth from tooth decay and helps heal early decay. Fluoride is in the drinking water of many towns and cities. Ask your dentist or doctor if your water has fluoride in it. If it doesn't, talk to your dentist or physician about giving you a prescription for fluoride drops for your baby.

Check your baby's teeth
Healthy teeth should be all one color. If you see spots or stains on the teeth, take your baby to your dentist.

Clean your baby's teeth
Clean your baby's gums as soon as they come in with a clean, soft cloth or a baby's toothbrush. Clean the teeth at least once a day. It's best to clean them right before bedtime. At about age 2, most of your child's teeth will be in. Now you can start brushing them with a small drop of fluoride toothpaste. Use a drop of toothpaste about as big as a pea. Young children cannot get their teeth clean by themselves. Until they are 7 or 8 years old, you will need to help them brush. Try brushing their teeth first and then letting them finish. And be sure that you put the toothpaste on the brush -- use only a pea-sized amount of toothpaste.

Feed your baby healthy food
Choose foods that do not have a lot of sugar in them. Give your child fruits and vegetables instead of candy and cookies.

Prevent baby bottle tooth decay
Do not put your baby to bed with a bottle at night or at nap time. If you put your baby to bed with a bottle, fill it only with water. Milk, formula, juices, and other sweet drinks such as soda all have sugar in them. Sucking on a bottle filled with liquids that have sugar in them can cause tooth decay. Decayed teeth can cause pain and can cost a lot to fill.

During the day, do not give your baby a bottle filled with sweet drinks to use like a pacifier. If your baby uses a pacifier, do not dip it in anything sweet like sugar or honey. Near his or her first birthday, you should teach your child to drink from a cup instead of a bottle.

Take your child to the dentist
Ask your dentist when to bring your child in for his first visit. Usually, the dentist will want to see a child by his first birthday. At this first visit, your dentist can quickly check your child's teeth.

Source

www.nidcr.nih.gov

People who have diabetes know the disease can harm the eyes, nerves, kidneys, heart and other important systems in the body. Did you know diabetes can also cause problems in your mouth?

Tooth and gum problems can happen to anyone, but risk for these problems is increased when you have diabetes. A sticky film of bacteria, called plaque, builds up on your teeth and can lead to gum disease and other oral health complications. High blood glucose helps this bacteria grow.

• Periodontal (gum) disease - People with diabetes are at special risk for mouth infections, especially periodontal (gum) disease, an infection of the gum and bone that hold the teeth in place. Periodontal disease can lead to painful chewing difficulties and even tooth loss. Periodontal disease may also make it hard to control your blood glucose (blood sugar). Red, sore, and bleeding gums are the first sign of gum disease. These problems can lead to periodontitis. Periodontitis is an infection in the gums and the bone that holds the teeth in place. If the infection gets worse, your gums may pull away from your teeth, making your teeth look long.
• Dry Mouth & Thrush - Often a symptom of undetected diabetes, dry mouth can cause soreness, ulcers, infections, and tooth decay. Dry mouth happens when you do not have enough saliva - the fluid that keeps your mouth wet. Diabetes may also cause the glucose level in your saliva to increase. Together, these problems may lead to  a fungal infection called thrush, which causes painful white patches in your mouth.

Smoking makes these problems worse.

How do I know if I have damage to my teeth and gums?

If you have one or more of these problems, you may have tooth and gum damage from diabetes:

• red, sore, swollen gums
• bleeding gums
• gums pulling away from your teeth so your teeth look long
• loose or sensitive teeth
• bad breath
• a bite that feels different
• dentures (false teeth) that do not fit well

Diabetes can cause serious problems in your mouth.
You can do something about it.

People with poor blood glucose control get gum disease more often and more severely than people whose diabetes is well controlled. Daily brushing and flossing, regular dental check-ups and good blood glucose control are the best defense against the oral complications of diabetes.

• Take time to check your mouth regularly for any problems. Sometimes people notice that their gums bleed when they brush and floss, others notice dryness, soreness, white patches, or a bad taste in the mouth. All of these are reasons to visit your dentist.
• Use dental floss at least once a day. Flossing helps prevent the buildup of plaque on your teeth. Plaque can harden and grow under your gums and cause problems. Using a sawing motion, gently bring the floss between the teeth, scraping from bottom to top several times.
• Brush your teeth after each meal and snack. Use a soft toothbrush. Turn the bristles against the gum line and brush gently. Use small, circular motions. Brush the front, back, and top of each tooth.
• If you wear false teeth, keep them clean. Tell your dentist if your dentures (false teeth) do not fit properly.
• Communicate with your dentist. Call your dentist right away if you notice problems with your teeth and gums: if you have red, sore, or bleeding gums; gums that are pulling away from your teeth; a sore tooth that could be infected; or soreness from your denture, or some other problem. Be sure your dentist knows that you have diabetes.
• Get your teeth cleaned and your gums checked by your dentist twice a year.
• Listen to your dentist. If your dentist tells you about a problem, take care of it right away.
• Don't smoke. If you smoke, talk with your doctor about ways to quit smoking.

How can my dentist help take care of my teeth and gums?
Work together to maintain your oral health!

It's important to have good communication with your dentist, and to follow-up with regular visits. To help take care of your teeth and gums, your dentist can:

• clean and check your teeth and gums twice a year
• teach you the best way to brush and floss your teeth
• tell you if there are problems with your teeth or gums and what to do about them
• make sure false teeth fit well

Plan Ahead for Dental Work
Those with diabetes may need to take special precautions before and after a visit to the dentist.

You may be taking a diabetes medicine that can cause low blood glucose, also called hypoglycemia. Talk with your doctor and dentist before a visit about the best way to take care of your blood glucose during the dental work. You may need to bring some diabetes medicine and food with you to the dentist's office.

If your mouth is sore after the dental work, you might not be able to eat or chew for several hours or days. For guidance on how to adjust your normal routine while your mouth is healing, ask your doctor:

• what foods and drinks you should while healing after dental work
• if and how you should change your diabetes medicines
• how often you should check your blood glucose

What should I do each day to stay healthy with diabetes?

For More Information

Diabetes Teachers (nurses, dietitians, pharmacists, and other health professionals)
To find a diabetes teacher near you, call the American Association of Diabetes Educators toll-free at 1-800-TEAMUP4 (832-6874), or look on the Internet at www.diabeteseducator.org and click on "Find a Diabetes Educator."

Dietitians
To find a dietitian near you, call the American Dietetic Association toll-free at 1-800-877-1600, or look on the Internet at www.eatright.org and click on "Find a Nutrition Professional."

Government
The National Institute of Dental and Craniofacial Research (NIDCR) is part of the National Institutes of Health. To learn more about tooth and gum problems, write or call the NIDCR's information clearinghouse, the National Oral Health Information Clearinghouse (NOHIC), at 1 NOHIC Way, Bethesda, MD 20892-3500, 301-402-7364; or see www.nidcr.nih.gov/OralHealth/OralHealthInformation.

To learn more about diabetes and oral health, please see: http://diabetes.niddk.nih.gov/dm/pubs/complications_teeth/teeth.pdf

If you have been told you have periodontal (gum) disease, you're not alone. An estimated 80 percent of American adults currently have some form of the disease. Periodontal diseases range from simple gum inflammation to serious disease that results in major damage to the soft tissue and bone that support the teeth. In the worst cases, teeth are lost. In all cases, gum disease is a threat to your oral health. Research is also pointing to possible health effects of periodontal diseases that go well beyond your mouth. Whether it is stopped, slowed, or gets worse depends a great deal on how well you care for your teeth and gums every day, from this point forward.

Depending on the extent of the gum disease, treatments can range from professional deep cleaning and medications to surgery. While periodontal disease can be treated, more importantly, it can be prevented. Daily brushing and flossing, regular dental check-ups, and quitting tobacco use are the best defense against periodontal disease. Learn more about Peridontal Disease Treatment Options »

What causes periodontal disease?

Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless "plaque" on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form bacteria-harboring "tartar" that brushing does not clean. Only a professional cleaning by a dentist or dental hygienist can remove tartar.

Gingivitis - The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums called "gingivitis." In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that usually can be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.

Periodontitis - When gingivitis is not treated, it can advance to "periodontitis" (which means "inflammation around the tooth.") In periodontitis, gums pull away from the teeth and form "pockets" that are infected. The body's immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body's enzymes fighting the infection actually start to break down the bone and connective tissue that hold teeth in place. Bones, gums, and connective tissue that support the teeth can be destroyed If not treated, and the teeth may eventually become loose and have to be removed.

Risk Factors

There are a number of risk factors for gum disease, but smoking is the most significant. In fact, smoking can even jeopardize the success of treatment.

• Smoking. Need another reason to quit smoking? Smoking is one of the most significant risk factors associated with the development of periodontitis. Additionally, smoking can lower the chances of success of some treatments.
• Hormonal changes in girls/women. These changes can make gums more sensitive and make it easier for gingivitis to develop.
• Diabetes. People with diabetes are at higher risk for developing infections, including periodontal disease.
• Stress. Research shows that stress can make it more difficult for our bodies to fight infection, including periodontal disease.
• Medications. Some drugs, such as antidepressants and some heart medicines, can affect oral health because they lessen the flow of saliva. (Saliva has a protective effect on teeth and gums.)
• Illnesses. Diseases like cancer or AIDS and their treatments can also affect the health of gums.
• Genetic susceptibility. Some people are more prone to severe periodontal disease than others.

Who gets periodontal disease?

People usually do not show signs of gum disease until they are in their 30s or 40s. Men are more likely than women to have periodontal disease. Although teenagers rarely develop periodontitis, they can develop gingivitis, the milder form of gum disease. Gum disease develops most commonly, when plaque build s up along and under the gum line.

How Do I Know if I Have Periodontal Disease?

Symptoms are often not noticeable until the disease is advanced. They include:

• Bad breath that won't go away
• Red or swollen gums
• Tender or bleeding gums
• Painful chewing
• Loose teeth
• Sensitive teeth

Any of these symptoms may signal a serious problem and should be checked by a dentist.

Dental Examination:

• The dentist will ask about your medical history to identify underlying conditions or risk factors (such as smoking) that may contribute to periodontal disease.
• The dentist or hygienist will examine your gums and note any signs of inflammation.
• The dentist or hygienist will use a tiny ruler called a 'probe' to check for periodontal pockets and to measure any pockets. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimeters. 
• The dentist or hygienist may take an x-ray to see whether there is any bone loss. 
• The dentist may refer you to a periodontist, a specialist who treats gum diseases.

What Can I Do to Prevent Periodontal Disease?
While Gum Disease can be treated, more importantly, it can be prevented.

Here are some simple things you can do to prevent periodontal diseases:

• Brush your teeth twice a day (with a fluoride toothpaste)
• Floss every day 
• Visit the dentist routinely for a check-up and professional cleaning 
• Eat a well balanced diet 
• Don't use tobacco 

Can Periodontal Disease Cause Other Health Problems?

Maybe. But so far the research is inconclusive. Studies are ongoing to try to determine whether there is a cause-and-effect relationship between periodontal disease and:

• an increased risk of heart attack or stroke,
• an increased risk of delivering preterm, low birth weight babies,
• difficulty controlling blood sugar levels in people with diabetes.

In the meantime, it's a fact that controlling periodontal disease can save your teeth -- a very good reason to take care of your teeth and gums.

For Additional Information

To learn more about periodontal disease, please see:  http://www.nidcr.nih.gov/NR/rdonlyres/7B7D24C2-02E5-47C8-B076-27CB580FAF82/0/PeriodontalGum_Eng.pdf

Causes
Dry mouth occurs when the salivary glands that make saliva don't work properly.  Many over-the-counter and prescription medicines, as well as diseases such as diabetes, Parkinson's disease and Sjogren's syndrome, can affect the salivary glands.  Other causes of dry mouth include certain cancer treatments and damage to the glands' nerve system.  It's important to see your dentist or physician to find out why your mouth is dry.

To learn more about Dry mouth, please see:  http://www.nidcr.nih.gov/NR/rdonlyres/A22079A5-8C4C-4E6D-80C1-D6A1D2EB07F8/0/DryMouth.pdf

Severity of periodontal (gum) disease increases with age. About 23 percent of 65- to 74-year-olds have severe disease, which is measured by 6mm loss of attachment of the tooth to the adjacent gum tissue. At all ages men are more likely than women to have more severe disease. At all ages, people at the lowest socioeconomic level have the most severe periodontal disease.