Diagnosis

During the periodontal exam, your gums are checked for bleeding, swelling, and firmness. The teeth are checked for movement and sensitivity. Your bite is assessed. Full-mouth X-rays can help detect breakdown of bone surrounding your teeth.

Periodontal probing determines how severe your disease is. A probe is like a tiny ruler that is gently inserted into pockets around the teeth. The deeper the pocket, the more severe the disease.

In healthy gums, the pockets measure less than 3 millimeters-about one-eighth of an inch-and no bone loss appears on X-rays. Gums are tight against the teeth and have pink tips. Pockets that measure 3 millimeters to 5 millimeters indicate signs of disease. Tartar may be progressing below the gum line and some bone loss could be evident. Pockets that are 5 millimeters or deeper indicate a serious condition that usually includes receding gums and a greater degree of bone loss.

Following the evaluation, your dentist or periodontist will recommend treatment options. Methods used to treat gum disease vary and are based on the stage of the disease.

Signs and Symptoms

Periodontal disease may progress painlessly, producing few obvious signs, even in the late stages of the disease. Then one day, on a visit to your dentist, you might be told that you have chronic gum disease and that you may be at increased risk of losing your teeth.

Although the symptoms of periodontal disease often are subtle, the condition is not entirely without warning signs. Certain symptoms may point to some form of the disease. They include:

• gums that bleed during and after tooth brushing

• red, swollen or tender gums

• persistent bad breath or bad taste in the mouth

• receding gums

• formation pr deep pockets between teeth and gums

• loose or shifting teeth

• changes in the way teeth fit together on biting, or in the fit of partial dentures.

Proper Oral Hygiene

Brushing your teeth at least twice daily helps prevent tooth decay and gum disease, the major causes of tooth loss. Use a soft-bristle brush remove plaque and food particles. Replace your brush every two to three months.

On outer and inner surfaces, brush at a 45-degree angle in short, half-tooth-wide strokes against the gum line. On chewing surfaces, hold the brush flat and brush bach and forth. On inside surfaces of front teeth, tilt brush vertically and use gentle up and down strokes with toe of brush.

Brush your tongue in a back-to-front sweeping motion to remove food particles and freshen your mouth.

Do introduce your little ones to proper brushing techniques, early. More often than not, tooth decay in children are due to improper brushing which allows food particles to remain between teeth, allowing harmful bacteria to thrive.

Use the wealth of information on this site to take care of the dental health of your family!

Proper Flossing

Flossing daily removes plaque and food particles between teeth and below the gum line. You may experience sore or bleeding gums for the first several days you floss. If bleeding continues after the first week of flossing, call your dentist. If you are having trouble handling your floss, you can ask about the use of a floss holder or other types of inter dental cleaning aids.

Wrap an 18-inch strand around your middle fingers and hold a one-inch section tightly. Ease floss between your teeth. Clean up and down several times while curving around teeth at the gum line. Don't scrub.

Always floss behind the last tooth. Unwind clean floss as you proceed. Floss around the abutment teeth of a bridge and under artificial teeth using a floss threader.

What is Gum Disease?

In the broadest sense, the term gum-disease-or periodontal disease-describes bacterial growth and production of factors that gradually destroy the tissue surrounding and supporting the teeth. "Periodontal" means "around the tooth.

More than 75 percent of Americans over 35 have some form of gum disease. In its earliest stage, your gums might swell and bleed easily. At its worst, you might lost your teeth. The bottom line? If you want to keep your teeth, you must take care of our gums.

The mouth is a busy place, with millions of bacteria constantly on the move. While some bacteria are harmless, others can attack the teeth and gums. Harmful bacteria are contained in colorless sticky film called plaque, the cause of gum disease. If not removed, plaque builds up on the teeth and ultimately irritates the gums and causes bleeding. Left unchecked, bone and connective tissue are destroyed, and teeth often become loose and may have to be removed.

A recent poll of 1,000 people over 35 done by Harris Interactive Inc. found that 60 percent of adults surveyed knew little, if anything, about gum disease, the symptoms, available treatments, and--importantly--the consequences. And 39 percent do not visit a dentist regularly. Yet, gum disease is the leading cause of adult tooth loss. Moreover, a Surgeon General's report issued in May 2000 labeled Americans' bad oral health a "silent epidemic" and called for a national effort to improve oral health among all Americans.

The good news is that in most people gum disease is preventable. Attention to everyday oral hygiene (brushing and flossing), coupled with professional cleanings twice a year, could be all that's needed to prevent gum disease-and actually reverse the early stage-and help you keep your teeth for a lifetime.

In addition, several products have been approved by the Food and Drug Administration specifically to diagnose and treat gum disease, and even regenerate lost bone. These products may help the effectiveness of the professional care you receive.

Healthy Gingiva (Gums) Periodontitis

Periodontal Diseases

Periodontal diseases are infections of the gums, which gradually dest the support of your natural teeth. There are numerous disease entities requiring different treatment approaches. Dental plaque is the primary cause of gum disease in susceptible individuals.

Why is oral hygiene so important? Adults over 35 lose more teeth to gum diseases, (periodontal disease) than from cavities. Three out of four adults are affected at some time in their life. The best way to prevent cavities and periodontal disease is by good tooth brushing an flossing techniques, performed daily.

Periodontal disease and decay are both caused by bacterial plaque. Plaque is a colorless film, which sticks to your teeth at the gum line. Plaque consists of bacteria that produce toxins after they consume the various sugars we eat. Those waste products initiate the destruction of the bone and gum that support our teeth.

Periodontal diseases can be accelerated by a number of different factors (risk factors; genetics, smoking and diabetes.) However, it is mainly caused by the bacteria found in dental plaque. If not carefully removed by daily brushing and flossing, plaque hardens into a rough, porous substance known as calculus (or tartar).

Periodontal Disease

Bacteria found in plaque produces toxins or poisons that irritate the gums, which may cause them to turn red, swell and bleed easily. If this irritation is prolonged, the gums separate from the teeth, causing pockets (spaces) to form. As periodontal diseases progress, the supporting gum tissue and bone that holds the teeth in place deteriorate. If left untreated, this leads to tooth loss.

Preventing Gum Disease

The best way to prevent gum disease is effective daily brushing and flossing as well as regular professional examinations and cleanings. Unfortunately, even with the most diligent home dental care, people still can develop some form of periodontal disease. Once this disease starts professional intervention is necessary to prevent its progress.

Other important factors affecting the health of your gums include:

• Smoking

• Diabetes

• Stress

• Clenching and grinding teeth

• Medication

• Poor nutrition

• Using Smokeless Tobacco is gambling with your health!

Smokeless "Spit" tobacco contains over 2,000 chemicals, many of which have been directly related to causing cancer. Here are a few photos of mouth problems caused by the reaction of tobacco in the mouth. Photos courtesy of A. Christen, Indiana University. Source of information: US Surgeon General Report, 1986.

Carcinogensis Associates with Smokeless Tobacco Use

1. The scientific evidence is strong that the use of smokeless tobacco can cancer in humans. The association between smokeless tobacco use and cancer is strongest for cancers of the oral cavity.

2. Oral cancer has been shown to occur several times more frequently among snuff dippers than among non tobacco users, and the excess risk of cancers of the cheek and gum may reach nearly fifty-fold among long-term snuff users.

3. Some investigations suggest that the use of chewing tobacco also may increase the risk of oral cancer.

4. Evidence for an association between smokeless tobacco use and cancers outside the oral cavity in humans is sparse. Some investigations suggest that smokeless tobacco users may face increased risks of tumors of the upper digestive tract, but results are currently inconclusive.

5. Experimental investigations have revealed potent carcinogens in snuff and chewing tobacco. These include nitrosamines, polycyclic aromatic hydrocarbons, and radiation-emitting polonium. The tobacco-specific nurseries Anniston and 4-(methyl)-1-(3-pyridyl-1-butanone have been detected in smokeless tobacco at levels 100 times higher than the regulated levels of other antihistamines found in bacon, beer and other foods. Animals exposed to these tobacco-specific nurseries, at levels approximating those thought to be accumulated during a human lifetime by daily smokeless tobacco users, have developed an excess of a variety of tumors. The antihistamines can be metabolized by target tissues to compounds that can modify cellular genetic material.

6. Bioassays exposing animals to smokeless tobacco, however, have generally shown little or no increased tumor production, although some bioassays suggest that snuff may cause oral tumors when tested in animals that are infected with herpes simplex virus.

Non cancerous and Pre Cancerous Oral Health Effects Associated with Smokeless Tobacco Use

1. Some snuff-induced oral leukoplakic lesions have been noted upon continued smokeless tobacco use to undergo transformation to a dysplastic state. A portion of these dysplastic lesions can further develop into carcinomas of either a verrcous or squamous cell variety.

2. Recent studies of the effects of smokeless tobacco use on gingival and periodontal tissues have resulted in equivocal findings. While gingival recession is a common outcome from use, gingivitis may or may not occur. Because longitudinal data are not available, the role of smokeless tobacco in the development and progression of gingivitis or periodontitis has not been confirmed

3. The evidence concerning the effects of smokeless tobacco use on the salivary' glands is inconclusive.

Nicotine Exposure: Pharmacokinetics, Addiction, and Other Physiologic Effects

1. The use of smokeless tobacco products can lead to nicotine dependence or addiction.

2. An examination of the pharmacokietics of nicotine (i.e., nicotine absorption, distribution, and elimination) resulting from smoking and smokeless tobacco use indicates that the magnitude of nicotine exposure is similar for both.

3. Despite the complexities of tobacco smoke self-administration, systematic analysis has confirmed that the resulting addiction is similar to that produced and maintained by other addictive drugs in both humans and animals. Animals can learn to discriminate nicotine from other substances because of its effects on the central nervous system. These effects are related to the dose and rate of administration, as is also the case with other drugs of abuse.

4. It has been shown that nicotine functions as a reinforcer under a variety of conditions. It has been confirmed that nicotine can function in all of the capacities that characterize a drug with a liability to widespread abuse. Additionally, as is the case with most other drugs of abuse, nicotine produces effects in the user that are considered desirable to the user. These effects are caused by the nicotine and not simply by the vehicle of delivery (tobacco or tobacco smoke).

5. Nicotine is similar in all critical measures to prototypic drugs of abuse such as morphine and cocaine. The methods and criteria used to establish these similarities are identical to those used for other drugs suspected of having the potential to produce abuse and physiologic dependence. Specifically, nicotine us psychoactive, producing transient dose-related changes i mood and feeling. It is a euphoriant that produces dose-related increases in score on standard measures of euphoria. It is a reinforcer (or reward, in both human and animal intracenous self-administration paradigms, functioning as do other hags of abuse Additionally, nicotine through smoking produces the same effects, and it causes neuroadaptation, leading to tolerance and physiologic dependence. Taken together, these results confirm the hypothesis that the role of nicotine in the compulsive use of tobacco is the same as the role of morphine in the compulsive use of opium derivatives or of cocaine in the compulsive use of opium derivatices or of cocaine in the compulsive use of era derivatives.

6. The evidence that smokeless tobacco is addicting includes the pharmacologic role of nicotine dose in regulating tobacco intake, the commonalities between nicotine and other prototypic dependence producing substances; the abuse liability and dependence potential of nicotine; and the direct, albeit limited at present, evidence that orally delivered nicotine retains the characteristics of an addictive drug.

7. Several other characteristics of tobacco products in general, including smokeless tobacco, may function to enhance further the number of persons who are afflicted by nicotine dependence: nicotine-delivering products are widely and relatively inexpensive; and the self-administration of such products is legal, relatively well tolerated by society, and produces minimal disruption to cognitive and behavioral performance. Nicotine produces a variety of individual-specific therapeutic actions such as mood and performance enhancement; and the brief effects of nicotine ensure that conditioning occurs, because the behavior is associated with numerous concomitant environmental stimuli.

8. All commonly marketed and consumed smokeless tobacco products contain substantial quantities of nicotine. The nicotine is delivered to the central nervous system in addicting quantities when used in the fashion that each form is commonly used (or as recommended in smokeless tobacco marketing campaigns).

9. Since the exposure to nicotine from smokeless tobacco is simi liar in magnitude to nicotine exposure from cigarette smoking, the health consequences of smoking that are caused by nicotine also would be expected to be hazards of smokeless tobacco use. Areas of particular concern in which nicotine may play a contributory or supportive role in the pathogenesis of disease include coronary artery and peripheral vascular disease, hypertension, peptic ulcer disease, and fetal mortality and morbidity.

Smokeless Tobacco Is Less Risky Than Smoking, though still dangerous. Some other effects are:

TOOTH ABRASION - Grit and sand in smokeless tobacco products scratches teeth and wears away the hard surface or enamel. Premature loss of tooth enamel can cause added sensitivity and may require corrective treatment.

GUM RECESSION - Constant irritation to the spot where a small wad of chewing tobacco is placed can result in permanent damage to periodontal tissue. It also can damage the supporting bone structure. The injured gums pull away from the teeth, exposing root surfaces and leaving teeth sensitive to heat and cold. Erosion of critical bone support leads to loosened teeth that can be permanently lost.

INCREASED TOOTH DECAY - Sugar is added to smokeless tobacco during the curing and processing to improve its taste. The sugar reacts with bacteria found naturally in the mouth, causing an acid reaction, which leads to decay.

TOOTH DISCOLORATION AND BAD BREATH - Common traits of long-term smokeless tobacco users are stained teeth and bad breath. Moreover, the habit of continually spitting can be both unsightly and offensive.

NICOTINE DEPENDENCE - Nicotine blood levels achieved by smokeless tobacco use are similar to those from cigarette smoking. Nicotine addiction can lead to an artificially increased heart rate and blood pressure. In addition, it can constrict the blood vessels that are necessary to carry oxygen-rich blood throughout the body. Athletic performance and endurance levels are decreased by this reaction.

UNHEATHY EATING HABITS - Chewing tobacco lessens a person's sense of taste and ability to smell. As a result, users tend to eat more salty and sweet foods, both of which are harmful if consumed in excess.

ORAL CANCER - With the practice of "chewing" and "dipping," tobacco and its irritating juices are left in contact with gums, cheeks and/or lips for prolonged periods of time. This can result in a condition called leukoplakia. Leukoplakia appears either as a smooth, white patch or as leathery-looking wrinkled skin. It results in cancer in 3 percent to 5 percent of all cases.

OTHER CANCERS - All forms of smokeless tobacco contain high concentrations of cancer-causing agents. These substances subject uses to increased cancer risk not only of the oral cavity, but also the pharynx, larynx and esophagus.

DANGER SIGNS - If you use smokeless tobacco, or have in the past, you should be on the lookout for some of the early signs of oral cancer:

• A sore that does not heal

• A lump or white patch

• A prolonged sore throat

• Difficulty chewing

• Restricted movement of the tongue or jaws

• A feeling of something in the throat

Pain is rarely an early symptom. For this reason, all tobacco users need regular dental checkups.