Moderate and Advanced Gum Disease

Signs of moderate gum disease:

Moderate gum disease occurs when gum disease worsens and spreads into the bone around the teeth. Healthy gums are pink and appear to hug the teeth and they do not bleed. The gums of moderate gum disease will be loose and swollen around the teeth and will bleed.

This is a ‘probe’ used to measure bone lost from gum disease. Note the loose gums (called a pocket). (Advanced Dent. Care)

Measuring the loss of bone

The dentist is able to see in the office just how deep the gum infection is and how much bone is gone. This measurement is made with an instrument called a ‘perio probe’ (see image). Little by little more and more of the roots of the teeth will begin to show. In the early stages of root showing it is possible to repair through cosmetic grafting. This can be done by taking a piece of gum from the palate and placing it around the exposed root. In other cases the gums from the adjacent teeth can be cut and moved over to cover the exposed root. Either way, this is a simple in office procedure.

Don’t pout….

Moderate gum disease means early bone loss has just begun and the roots of the teeth are just beginning to show. A root cleaning called ‘ or a cleaning of the swollen gum known as ‘curettage’ might be all that is required. If the bone loss is severe then gum or bone grafting can restore your smile.

Regrowing lost bone

Proteins:

Proteins are now being used to regrow bone for cases with minimal bone loss. This technique has proven effective also to stimulate gum growth. Recent studies find that it may be possible to use proteins for teeth with greater amounts of bone loss. Proteins used for this purpose are called ‘growth factors’ and are made either from artificial products, or, are made directly from teeth (a product known as

Emdogain). Less commonly, these products are made from one type of blood cell (called platelets).

Minerals:

Also effective, particularly for replacing bone lost in gum disease cases and also to replace bone in and around teeth that were extracted (taken out), is a mineral called hydroxyapatite. This is the same mineral that teeth are composed of. The hydroxyapatite is mixed with proteins prior to use.

Replacing lost bone through grafting:

• Bone taken from the patient’s own mouth:

  Once collected, this bone is then transplanted wherever needed. Often the bone is collected from your chin or behind the back molars in the jaw. This is called an autogenous graft. The procedure carries with it the risk of infection, but, there is no negative immune reaction and there are always many bone cells that promise healthy growing bone.

• Bone from deceased human beings:

  This is known as an allogenic transplant or graft. There are no bone forming cells and therefore the bone will not blend into your own bone. This procedure, however, is generally successful. Allogenic bone grafting is not for everyone due to religious and ethical concerns.

• Bone taken from animal (usually a cow), known as a xenograph, is also proven successful although this technique also has shown limited ability to stimulate further bone growth.

• Bone grafting is accomplished under local

  anesthesia (with a shot). Here are the

  steps:

  After anesthesia, the gums are gently teased away from the teeth to reveal the areas where bone is needed. Next, the roots of the teeth are cleaned and the new bone material is placed around the roots. The bone is covered with a protective material to ensure proper healing. The gums are then placed back in proper position and sutures (stitches) are tied for one or more weeks.

Advanced gum disease:

First: get a cleaning:

An advanced case of gum disease requires you making choices. First, make sure that your teeth are clean. Use your toothbrush, floss, Waterpik irrigation, fluoride mouth wash, and then schedule your routine dental cleanings. Once your mouth is clean then it is time for you and your dentist to do an evaluation as to which teeth will need extraction (removal), and which can be saved. Severe bone loss, either uniformly throughout the mouth, or in various areas means trouble.

With significant bone loss there is little in the way of esthetic improvement. Implants might be an option or a removable denture. If you want to keep the teeth, simple, frequent cleanings are in order.

The most important thought for a tooth with gum disease is, how much does the tooth move. If there is bone loss but the teeth are solid and strong, then you might still keep those teeth for years. When there is bone loss and the teeth are loose, then it is time to consider removing those teeth. A loose tooth cannot hold a bridge or a denture and is of little value for eating.

Be sensible when deciding which teeth to remove:

Don’t stubbornly hold on to a tooth unless it serves an important purpose such as for eating or for holding bridges and dentures. Also, do not hold onto a tooth that contains significant infection, or cannot be kept properly clean because it is tucked into the back of the mouth. Most importantly, do not hold onto a tooth that will not last.

There comes a point where bone loss around a tooth is so bad, the tooth is simply not savable. With implants and the many other types of removable and permanent replacements available, you can once again have a great smile. We will talk about this in the prosthetics (denture and bridge) section.