Gum problems fall into two broad categories--gingivitis and periodontal disease.

Gingivitis is an inflammation of the gum immediately surrounding the teeth. Gingivitis is characterized by puffy, swollen gums that bleed easily when touched. Gingivitis, like decay, is almost always caused by plaque. It is usually easy to resolve gingivitis with proper home care and a thorough professional cleaning. We often prescribe short-term mouth rinses and antibiotics to help the gums return to health. Gingivitis is often present when periodontal disease is active. Periodontal disease is much more serious because the bone that supports the teeth is usually being lost.

Periodontal disease (commonly known as pyorrhea) is the most common cause of teeth loss in adults. The word "periodontal" means "around the tooth." "Periodontal disease" refers to a deterioration of the soft tissue (gums) and bone around the teeth. Periodontal disease begins when plaque accumulates on your teeth. Your saliva will calcify the plaque if it is not removed by proper home care. This calcified plaque is called tartar or calculus. Tartar generally accumulates at the gum line. The inflammation caused by plaque and tartar may first reveal itself as a mild gum irritation with bleeding during brushing. However, the real damage is occurring in the underlying bone The bone which supports the tooth is being dissolved away. In the advanced stage of periodontal disease (periodontitis), the tooth may become infected and require removal. Periodontal disease is common because you cannot actually see the underlying bone destruction taking place.

Treating periodontal disease usually begins with the collection of good baseline measurements. We generally perform a thorough x-ray analysis of the teeth and a measurement of the level of remaining bone (Figure 13) using a periodontal probe (similar to a ruler). Following diagnosis, the next step in treatment involves a thorough deep cleaning (also called scaling and root smoothing). This procedure is usually performed while your gums and teeth are numb and involves cleaning the calculus (tartar) and contaminants from the crowns and root surfaces of the teeth. The object is to make the roots and crowns of the teeth smooth and polished. Several weeks after deep cleaning, your mouth is re-examined to determine if further treatment is necessary. Occasionally, surgical intervention is necessary to prevent progress of the disease. Most surgical procedures involve replacing the lost bone (regenerative therapy) or the removal of small amounts of gum tissue to reestablish normal anatomy of the tooth, gum and bone. Decay of the exposed root surfaces can readily occur if excellent home care is not maintained. The kind of treatment appropriate for each mouth can vary depending on the extent of the damage and the health of the teeth.

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