Periodontal Disease
Thursday March 1, 2007 

Dear Dr. Mady: : I have been using osteoporosis medication for the past fifteen years. I need some teeth removed and implants placed and my dentist is referring me to an oral surgeon because he said I am at risk for bone infection that could eat my jaws. What condition exactly is he talking about and why is it dangerous? —Eleanor in North Palm Beach, Florida


Dear Anna: It is no doubt, that if you have periodontal disease and leave it untreated, you will not maintain your teeth for life. Periodontal (Gum) disease, previously known as “pyorrhea” is a destructive bacterial disease that will destroy the fibers of the supporting structures of your teeth.

            Periodontal disease is caused by many factors including genetic, oral hygiene and systemic diseases. It is true that more than half of all adults between the age of 30 and 90 have some sort of periodontal disease. Many don’t even know that they have it and many don’t care. The key to diagnosing and treating periodontal disease is regular visits to your dentist or periodontist. Periodontal disease has now been linked to heart disease and a number of other health problems.

            It has been said that only 60 to 65 percent of individuals over the age of 12 visit the dentist. Also only about 50 percent of the population visit their dentist once or more every 6 months. 9 to 10 percent of Canadians over the age of 15 have no natural teeth. 70 percent of the people floss their teeth but only half of those people do it daily. In 2004, expenditures on health services in Canada cost $130.3 Billion and only 7 percent of that was for dental services. I think that people don’t realize that the mouth is where nutrition and digestion begin for the entire body and that is why oral health is so important.  These previous statistics were obtained from Canadian Dental Association public health surveys.

            Periodontal disease begins as gingivitis which is actually an inflammation in your gums. They usually appear red, puffy and bleed easy. When not addressed, this goes from gingivitis to mild, moderate, and severe periodontitis and then tooth loss. One thing all these stages of gum disease have in common is pockets. As this destructive situation advances, pockets deepen between the gums and the teeth. They are normally 1 to 3 millimeters deep, but periodontal disease can make them 4 millimeters and deeper. Once your pocket depths reach greater than 2 or 3 millimeters, it is not possible for you to debride or clean them properly at home. Flossing and brushing daily will not do the trick at that point. It is the bacteria that remain at the bottom of those pockets that eats bone support for your teeth and causes the pockets to increase in depth.

            Common methods used to treat gum disease include scaling and root planning. This is basically a manual debridement with hand instruments by your dentist or hygienist. Plaque and tartar (calculus) above and below the gum line are removed by these procedures. Even though this is the best and most common method of treating this disease, some bacteria may still be left in the pocket which will promote the disease to strengthen again. Occasionally patients are referred to a gum specialist or periodontist to have their pocket depths reduced surgically.

            There is a new procedure being used in dental clinics recently after scaling and root planing although I have not used it or seen the results. It involves using a topical disinfectant that utilizes low-intensity lasers and wavelength-specific, light activated compounds to kill bacteria that is left behind by scaling and root planing.
 The process is known as photodynamic disinfection. It has apparently been used for approximately one year in Canada and is a two-stage process that uses a photosensitizing solution and low-intensity, non-thermal diode laser light to kill the harmful bacteria and inactivate enzymes that cause gum disease. As an adjunctive treatment, they say it achieves better results than scaling and root planing alone. The solution is a short-acting topical disinfectant, not antibiotic that can lead to bacterial resistance.

            This solution is topically placed between the teeth and gums and then a heatless, low-intensity laser light is placed at the site for about 60 seconds. Supposedly there is little or no discomfort involved with the process.

            The desired end result with any periodontal disease treatment modality is shallower pockets, better attachment of the gums to the roots of the teeth and reduced gingival inflammation and bleeding. It sounds like your dentist has an excellent treatment plan for you! If you have any other questions about this topic or any other dental treatment, e-mail me directly at

This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5



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