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Periodontal Disease

Periodontal Disease
    This is actually a range of diseases but when we speak about periodontal disease we are usually referring to Chronic Adult Periodontal Disease (CIPD) which will be discussed in more detail here.
    CIPD is one of the most common diseases in the world, with most people suffering from it somewhere in their mouths at some time or other. It is clear that there is both a genetic and an ethnic susceptibility to CIPD. In addition, people with certain diseases such as diabetes and smokers are more at risk.


What happens with CIPD? 
    In susceptible people, it appears that stimulus from specific groups of bacteria in the mouth can lead to an abnormal immune response in the gum. The combination of this response and toxins from these bacteria leads to an irreversible loss of attachment between the tooth and the bone of the jaw.

What are the signs of CIPD in the mouth?
    One of the most important things to know about CIPD is that it can be completely symptom free. The disease process tends to follow an intermittent path over many years and often a person is entirely unaware that they are affected until the disease has reached more advanced stages. That is why regular dental check-ups are important so that CIPD and other dental diseases can be identified and treated in their earliest stages.
    When CIPD is established in the mouth, as the attachment loss around teeth progresses, one of the most common developments is that gum pockets form between the gum and the side of the tooth. The gum may look exactly the same as before but if your dentist uses a special probe to check between the gum and the tooth, the probe can be pushed down further than normal into the pocket. Gum pockets then seem to exacerbate the CIPD problem as it is so difficult for you to keep these areas clean using a toothbrush and floss at home.
    Late stage CIPD can give other symptoms such as loose teeth, teeth drifting and also the gums receding exposing the roots.


How can CIPD be treated?
    The first and most important stage of treatment is diagnosis of CIPD. Once this has been diagnosed it is important to look if you have any systemic risk factors such as certain diseases (diabetes being a good example) or smoking. If these risk factors can be modified then that is the next step. With diabetes it is vital that this is well controlled and liaising with your GP can help here. For smokers, giving up is vital. Various aids to this are available and again liaising with your GP to arrange these can make all the difference.
    The cornerstones of effective treatment of CIPD are consistently excellent oral hygiene, the cleansing of the affected root surfaces to remove infected and toxin containing material, and the reduction in specific types of bacteria whose presence is associated with CIPD.
    There are various treatment protocols but one of the most common is called quadrant root surface debridement. In this treatment your hygienist will treat a quarter of your teeth at each visit and will use a combination of ultrasonic and hand instruments to debride and cleanse your roots. This is often carried out with local anaesthesia.
    Another common technique is called full mouth disinfection where systemic antibiotics (in tablet form) are given and full mouth root surface debridement occurs over one or two longer visits.
    Once the initial treatment to stabilise your gum health has happened it is vital that an individually tailored program of longer term care and maintenance of your gum health is followed to avoid a recurrence of CIPD.