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More on Periodontal Disease

What causes Periodontal diseases?

More than half of the adults over age 18 have some form of periodontal disease. There are many factors that can contribute to gum disease, some are smoking, home care, genetics, medical conditions. Often plaque is the major cause.  Plaque is a colorless, sticky film that forms on the teeth and on the tissues in your mouth and reforms every 24 hours.   Plaque gives a home to bacteria that produce harmful toxins.  If teeth are not cleaned properly from all tooth surfaces above and below the gum line, and especially in between the teeth, it accumulates, eventually hardens to form tarter (we call it calculus) and spreads down under the gum line.  This causes the gums to pull away from the teeth, forming pockets.  These pockets provide a home for more bacteria.  If the infected pockets are not treated, the disease can get worse.  A dangerous aspect of periodontal disease is the fact that it is often painless and without symptoms.  The diagnosis often comes as a surprise to the patient.

How will I be diagnosed?

Dr. Gotterer and the hygienist will review your complete medical and dental history with you.  We will discuss any medications or existing conditions that apply to you that might affect your periodontal health.  To accurately evaluate your gums a thorough comprehensive periodontal examination called periodontal probing will be done . A periodontal probe is a small measuring instrument and is placed in between your teeth and gums to determine the depth in millimeters of the periodontal pocket.  A periodontal pocket of up to 3mm is considered healthy.  Beyond 3mm may be a sign of gum disease.

How is periodontal disease treated?

Dr. Gotterer may recommend a treatment called scaling and root planning. In this treatment the plaque and tartar are carefully removed down to the bottom of each periodontal pocket.  This treatment may be done in several visits, depending on your needs.  The tooth’s root surfaces are then smoothed to allow the gum tissue to heal and reattach to the tooth.  It is a very meticulous cleaning.  This procedure is usually done with a local anesthetic and very little discomfort accompanies this procedure.

The dentist may also prescribe antibiotics or other medications.  Sometimes these medications can be placed directly in the periodontal pocket.

Our hygienists are specially trained to perform certain services vital to your periodontal treatment.  Included are oral hygiene instruction and supervision, special periodontal cleanings, and periodontal maintenance after treatment has been completed.  In addition, they perform health status updates, nutritional evaluations and help to maintain and monitor periodontal conditions with accurate record keeping on a regular basis.  Our hygienists attend continuing education seminars and we take pride in their special abilities and skills.  They work closely with each patient to design personalized plaque control program, the cornerstone to successful periodontal therapy.  They provide the cleaning that will start the healing process, and they are also heavily involved in the maintenance of the teeth in health at the completion of treatment.  They are, therefore, a most valuable and integral part of our team.

Success of treatment

You will, in a sense, become part of our team, and a very important part, for as you will learn, much of the long term success of your treatment will be in your own hands.  A sincere commitment to good plaque control at home is an essential element to success.  We look forward to meeting you and to have  you join us in this mutual effort to treat your periodontal needs so that you may keep and enjoy your teeth in health and comfort for a lifetime!


How can I avoid getting periodontal disease?

Brush your teeth at least twice a day, for at least two minutes each time.

Clean between your teeth once a day with floss or another interdental cleaner.

Eat a balanced diet for good general and oral health

Avoid tobacco in any form

Visit the dental office regularly for professional cleaning.  With regular dental visits, your dentist can detect periodontal disease in the early stages.



Gum Health Helps Prevent Heart Disease

Gum Health Helps Prevent Heart Disease
Tue, 11/05/13 – 09:09

A new study has found that improved gum health significantly parallels slow progression of atherosclerosis, a major risk factor for heart disease, stroke, and death.

According to lead study author Moïse Desvarieux, MD, PhD, Principal Investigator of the National Institutes of Health (NIH)–funded Oral Infections and Vascular Disease Epidemiology Study (INVEST) cohort, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, this study is significant in that “it provides a potential mechanism for the purported relationship between periodontal status and cardiovascular disease and importantly provides a timeline, with the results having been observed over a median time of 3 years.”

In addition, “because the results were observed in a population setting, they certainly support the importance of primary prevention as a potential preventive measure, even for periodontal status that are not yet ‘diseased.’”

He added that their results also provide a target for future clinical trials. Researchers followed 420 individuals from INVEST for their analysis. Participants were examined for periodontal infection over a median follow-up period of 3 years. Overall, 5008 subgingival samples (an average of 7 samples per patient) were collected beneath the gum and analyzed for 11 periodontal bacterial species linked to periodontal disease and seven control bacteria.

The authors also took samples of fluid from around the gums to assess for levels of interleukin-1β, which is a marker of inflammation. High-resolution ultrasound was used to measure intima‐medial thickness (IMT) in both carotid arteries.

Desvarieux and colleagues found that improvement in both clinical and microbial periodontal status correlates with a decreased rate of carotid artery IMT progression. Results were adjusted for the following potential confounders: age, sex, race/ethnicity, diabetes, smoking status, education, body mass index, systolic blood pressure, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol.

“These are the first results to show that improvement in periodontal status—both clinical improvement and improvement in the microbacterial profile in the mouth—is associated with slower progression in carotid atherosclerosis in a population where patients have been followed for years,” said Desvarieux.

In addition, “This improvement is related only to the presence of specific bacteria thought to be linked to periodontal disease, and not to the set of other bacteria that are also in the mouth and that we used as controls.”

He explained that this is important “because otherwise, we could have thought that people with higher levels of any bacteria simply take less care of themselves and have overall less healthy lifestyle. This is not the case, since the relationship only holds for the specific bacteria linked to periodontal status.” Previous studies have linked an increase in carotid IMT of 0.033 mm per year to a 2.3-fold increased risk of heart attack and stroke.

Desvarieux and colleagues found a 0.1 mm difference in IMT change over 3 years of follow-up among those whose periodontal health worsened compared with the patients whose periodontal health improved.

“We were surprised by the magnitude of the difference in IMT progression that we saw, while measuring carotid atherosclerosis,” he said. “The magnitude of difference in IMT thickness we report is equivalent to about a 2.3-fold increase in coronary events, based on previous studies by other investigators.”

Some potential limitations of the study are that “we still need longer follow-up to address the issue of lag time between periodontal status and subclinical vascular disease and we do not yet have the relationship with clinical events (myocardioal infarction and strokes),” said Desvarieux.

In terms of their future research, Desvarieux noted that their next steps are twofold: to continue to follow these patients to quantify the relationship on longer follow-up and the translation to clinical events, and “to potentially intervene on a subset of the population to see if modification of the periodontal status and of the gum microbial profile can modify the curve of atherosclerosis progression,” he said. This study is available in the Journal of the American Heart Association.

This study is available in the Journal of the American Heart Association. Funding was provided by the NIH, National Institute for Dental and Craniofacial Research, the National Institute of Neurological Disorders and Stroke, and the Institut National de la Santé et de la Recherche Medicale (INSERM), among others.

-Meredith Edwards White


Desvarieux M, Demmer RT, Jacobs DR, Papapanou PN, Sacco RL, Rundek T. Changes in clinical and microbiological periodontal profiles relate to progression of carotid intima-media thickness: the oral infections and vascular disease epidemiology study. J Am Heart Assoc. 2013 Oct 28;2(6):e000254. doi: 10.1161/JAHA.113.000254.