More periodontal diseases

The one periodontal disease that seems to be increasing in my practice is Lichen planus. This is an autoimmune disease that can be a minor nuisance, a source of significant discomfort, or even a precursor to oral cancer. Generally, there are red and white areas that can be on the gums, tongue or inside the cheeks that may or may not be painful and sometimes have spontaneous bleeding. One hallmark of the disease are white lines called Wickham's striae, but they are not always present. The disease process is not well understood, but it falls somewhere between an allergy and an overactive immune system, Regardless, anti-inflammatories (generally steroids) are the most effect treatment. Topical steroids are effective for minor forms of the disease, but, in more aggressive cases, system steroids are necessary to get the disease under control. A biopsy is necessary for a definitive diagnosis. There are some studies that show a weak correlation between Lichen planus and oral cancer, and it can be severe enough to cause loss of bone around the teeth and even tooth loss. If you think that you may have Lichen planus, seeing a periodontist for a biopsy is the first step to getting it under control. 

Gum recession

Although not really classified as a disease process, the second most common gum issue is recession of the gums, leading to exposure of tooth roots, sensitivity, decay, and esthetic issues. This isn't generally due to infection, although it can be. Causes of recession are traumatic tooth brushing, tooth clenching and grinding, orthodontic treatment, thin gum tissue, tooth wear, and there may also be a genetic or diet component as well. Of course prevention is best, and all people should use a soft tooth brush and use a circular rather than sawing motion with the brush. Pressing hard with an electric tooth brush is also an issue. Bite guards are the best way to deal with clenching and grinding, and teeth with thin gums should be grafted before orthodontic treatment. After the recession has occurred, there are a variety of procedures for recovering the roots and preventing future problems. These include repositioned flaps, grafts (from the patient, synthetic, or from human tissue banks), and orthodontic treatment to reposition teeth back within the bony housing. If grafts are necessary, we have a variety of techniques for best addressing the particular issue that your condition presents. While you may see one or another grafting technique promoted on dental websites, the truth of the matter is that no one procedure is best to treat all recession issues. Periodontists are trained in many techniques and have the best judgement and experience to recommend the optimum procedure for your particular condition. 

Periodontal Diseases

Today, I'm going to start a series about periodontal diseases, and we'll start with adult periodontitis, the most common form of gum disease. 

Adult periodontal disease is defined as a loss of attachment and support for the teeth as a result of inflammation caused by certain oral bacteria. These bacteria are normally found in the mouth, but, in some people, and under some conditions, they cause inflammation in the area surrounding the teeth that leads to bone loss and, eventually, tooth loss. This is a complex process that involves many different bacteria, but the caveat is that the bacteria themselves do not directly cause the bone loss. It is an over-response by the body's own immune system that causes the damage. This is why there is tremendous variability in the amount of dental plaque (100% bacteria by weight) that is necessary to cause problems. You may know people who seldom brush, floss, or have regular dental cleanings that don't have gum issues. They have more resistance to the inflammation caused by plaque. Other people do a good job of keeping their teeth clean, but still have bone loss. Of course, the best way to prevent gum disease is to keep your teeth as clean as possible and have regular dental cleaning, regardless of your susceptibility to gum disease. If you have gum problems, see a dentist or periodontist, so you can minimize the damage and get back to a healthy mouth that will benefit you throughout life.