CATEGORY 64 AUSTRALASIAN DENTIST CLINICAL Periodontal (gum) disease affects millions of people all over the world. It is the number one cause of adult tooth loss and has been linked to a host of other ailments like diabetes, heart disease and problems in pregnancy. Nearly half of adults age 30 and older have some degree of gum disease, and the percentage increases with age. However, because the symptoms can be very subtle, many don’t realize they have gum disease until it starts to take a serious toll. Healthy gums are vital to a beautiful smile and to overall oral health – yet, when gums are not healthy, they not only look less appealing, but can also lose their tight attachment to the teeth. One of the chief signs of gum disease is the presence of periodontal (“peri” – around; “odont” – tooth) pockets – that is, spaces around the teeth, below the gum line, that have become infected. Pockets provide an ideal environment for bacteria to grow and may spread infection to the structures that keep teeth anchored in the mouth. Although periodontal pockets are invisible to the eye, they can be detected during an oral exam, when the space between the gums and teeth is measured. During a comprehensive examination, your dentist or hygienist may probe your gums and read off numbers like “three-two-three… four-three-three…” These numbers indicate whether periodontal pockets are present, and how deep they are. Taken together, they can give your dentist an accurate picture of the health of your gums. How gum disease progresses The early stage of gum disease is called gingivitis, or “inflammation of the gums.” Here, plaque builds up around the gum line, the gums become inflamed, and they may begin to swell. There is no bone loss with gingivitis – and fortunately, this common form of gum disease can almost always be reversed with good oral hygiene and regular professional cleanings. Left untreated, gingivitis can progress to a more serious stage of gum disease called periodontitis. Periodontitis causes damage to the tissues surrounding the teeth, including bone, periodontal ligaments and the gum tissues. While many think teeth are directly supported by bones in the jaw, the true anatomy is more complex. Teeth are actually held in place by thousands of tiny fibers that connect the root of the tooth to the bone. These fibers can be damaged or destroyed by bacterial infections that stem from untreated periodontal disease. In a case of periodontitis, pockets allow infection to spread, resulting in bone loss underneath the gums. These are the kind of “deep pockets” that no one wants, so it’s important to diagnose and treat them before they threaten the integrity of the structures that support the teeth – or even cause tooth loss. What’s in a number? To monitor the health of your gums, your dentist uses a special tool called a periodontal probe, a small hand-held instrument that measures the gap where the tooth meets the gum. During the periodontal examination, the dentist gently inserts the probe between the tooth and gum and then measures from the top of the gum to the bottom of the sulcus or pocket. Six measurements, in Understanding periodontal pockets By Dr Mario A. Vilardi A healthy connection between gums and teeth can help you keep your natural smile for life Stages of periodontal disease The anatomy of a periodontal pocket Even in healthy gums, the top of the gum tissue does not attach directly to the tooth. Instead, there is a small space between the tooth and gum called a sulcus. Bacteria and food particles may collect in the sulcus, but for the most part they are removed by brushing and flossing. However, a toothbrush generally does not reach more than 2-3 millimeters (about one tenth of an inch) below the gum line. If the sulcus is deeper, bacteria and food debris can build up below the gums, causing inflammation and swelling. When gum tissue begins to separate or pull away from the teeth, it leaves a larger space between the tooth and gums where harmful bacteria can thrive. At this point the space is called a “pocket.” Inflammation is present, and the once healthy sulcus has become deeper because it is diseased. If bacteria in the pocket remain undisturbed, they will continue to accumulate there, causing further loss of bone and gum tissue attachment beneath the gum line, and eventually eroding the structures that hold the teeth in place.
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