Periodontal diseases are infections of the gums which gradually destroy the supporting apparatus of natural teeth. There are numerous disease entities requiring different treatment approaches. Dental plaque is the primary cause of gum disease in genetically susceptible individuals. Plaque is a colorless film, which sticks to your teeth at the gumline.  One of the main components of plaque is oral bacteria.  Daily brushing and flossing will prevent most periodontal conditions.

Frequently Asked Questions About Periodontal Disease

Why is oral hygiene so important? After the age of 35, adults 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 Diseases is by good toothbrushing and flossing techniques, performed daily..

How Did I Get Periodontal Disease?
Periodontal diseases can be accelerated by a number of different factors. However, the main cause is 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).

Bacteria found in plaque produces toxins 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 teeth in place deteriorate. If left untreated, this can ultimately lead 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, a certain percantage of the population can still develop some forms of periodontal disease. Once this disease starts, professional intervention is necessary to prevent its progress.

Gum Grafting Procedures (see case example under Periodontal Procedures page)
(Subepithelial connective tissue grafts)
When recession of the gingiva occurs, the body loses a natural defense against both bacterial penetration and trauma. When gum recession has occurred, gum reconstruction using grafting techniques in an option.  

When there is only minor recession, some healthy gingiva often remains and protects the tooth, so that no treatment other than modifying home care practices is necessary. However, when recession reaches the mucosa, the first line of defense against bacterial penetration is lost.

In addition, gum recession often results in tooth root sensitivity to hot and cold foods as well as an unsightly appearance of the gum and tooth. Also, gum recession, when significant, can predispose to worsening recession and exposure of the root surface, which is softer than enamel, leading to root decay and root gouging or notching.

A gingival graft is designed to solve these problems. A thin piece of tissue is taken from the roof of the mouth, or gently moved over from adjacent teeth, to provide a stable band of attached root protecting gum or gingiva around the tooth. The gingival graft may be placed in such a way as to cover the exposed portion of the root and restore the normal appearance of the tooth.

The gingival graft procedure is highly predictable. When done with the benefit of a surgical microscope, the procedure is very comfortable, offers superior esthetic results and heals very quickly. Today's microsurgical procedures offer comfort and esthetic results far better than those offered using a conventional surgical approach so prevalent in periodontics for many years.

Other Important Factors Affecting the Health of Your Gums
Poor nutrition 
Pregnancy and puberty 
Poor bite or alignment of teeth 

Heart and Periodontal Disease

It's possible that if you have periodontal disease, you may be at risk for cardiovascular disease...

For a long time we've known that bacteria may affect the heart.

Now evidence is mounting that suggests people with periodontal disease - a bacterial infection, may be more at risk for heart disease, and have nearly twice the risk of having a fatal heart attack, than patients without periodontal disease.

While more research is needed to confirm how periodontal bacteria may affect your heart, one possibility is that periodontal bacteria enter the blood through inflamed gums and cause small blood clots that contribute to clogged arteries.

Another possibility is that the inflammation caused by periodontal disease contributes to the buildup of fatty deposits inside the heart arteries.

One out of every 5 Americans has one or more types of heart disease. If you are one of these Americans, or if you are at risk for periodontal disease, see a periodontist for a periodontal evaluation - because healthy gums may lead to a healthier body.

Diabetes and Periodontal Disease
The two-way relationship between periodontal disease and diabetes...

For years we've known that people with diabetes are more likely to have periodontal disease than people without diabetes.

Recently, research has emerged suggesting that the relationship goes both ways - periodontal disease may make it more difficult for people who have diabetes to control their blood sugar.

More research is needed to confirm how periodontal disease can make it more difficult to control blood sugar. What we do know is that severe periodontal disease can increase blood sugar, contributing to increased periods of time when your body functions with a high blood sugar. And, if you are a diabetic, you know that this puts you at increased risk for diabetic complications. In other words, controlling your periodontal disease may help you control your diabetes.

If you are among the nearly 16 million Americans in the U.S. who live with diabetes, or are at risk for periodontal disease, see a periodontist for an evaluation - because healthy gums may lead to a healthier body.

Pregnancy and Periodontal Disease
It's possible that if you have periodontal disease and are pregnant, you may be at risk for having a premature, low birthweight baby...

For a long time we've known that many risk factors contribute to mothers having babies that are born prematurely at a low birthweight - smoking, alcohol use, drug use and infections.

Now evidence is mounting that suggest a new risk factor - periodontal disease. Pregnant women who have periodontal disease may be seven times more likely to have a baby that is born too early or too small.

More research is needed to confirm how periodontal disease may affect pregnancy outcomes. What we do know is that periodontal disease is an infection and all infections are cause for concern among pregnant women because they pose a risk to the health of the baby.

If you are planning to become pregnant or are at risk for periodontal disease be sure to include a periodontal evaluation with a periodontist as part of your prenatal care - because healthy gums may lead to a healthier body and a healthy baby.

Respiratory and Periodontal Disease
It's possible that if you have periodontal disease, you may be at risk for respiratory disease...

For a long time we've known that people who smoke, are elderly, or have other health problems that suppress the immune system, are at increased risk for the development of respiratory diseases like pneumonia, bronchitis, emphysema and Chronic Obstructive Pulmonary Disease.

More research is needed to confirm how periodontal disease may put people at increased risk for respiratory disease. What we do know is that infections in the mouth, like periodontal disease, are associated with increased risk of respiratory infection, especially those confined to a nursing home or hospital environment.

If you are at risk for respiratory disease or periodontal disease, see a periodontist for a periodontal evaluation - because healthy gums may lead to a healthier body.

Brushing and Flossing
While Brushing the outside surfaces of your teeth, position the brush at a 45- degree angle where your gums and teeth meet. Gently move the brush in a circular motion several times using small, gentle strokes. Use light pressure while putting the bristles between the teeth, but not so much pressure that you feel any discomfort.

When you are done cleaning the outside surfaces of all your teeth, follow the same directions while cleaning the inside of the back teeth.

To clean the inside surfaces of the upper and lower front teeth, hold the brush vertically. Make several gentle back-and-forth strokes over each tooth. Don't forget to gently brush the surrounding gum tissue.

Next you will clean the biting surfaces of you teeth. To do this use short, gentle strokes. Change the position of the brush as often as necessary to reach and clean all surfaces. Try to watch yourself in the mirror to make sure you clean each surface. After you are done, rinse vigorously to remove any plaque you might have loosened while brushing.

If you have any pain while brushing or have any questions about how to brush properly please be sure to call the office.

How to Floss
Periodontal disease usually begins between the teeth where you toothbrush can't reach. Flossing is a very effective way to remove plaque from those surfaces. However, it is important to develop the proper technique. We understand that learning to floss can be a frustrating task.  The following instructions will help you; but remember, time, practice and patience are keys to becoming a good flosser.   As the old expression goes "Only floss the teeth you want to keep!".

Start with a piece of floss (waxed is easier) about 18' long. Lightly wrap most of the floss around the middle finger of one hand. Wrap the rest of the floss around the middle finger of the other hand.

To clean the upper teeth, hold the floss tightly between the thumb and forefinger of each hand. Gently insert the floss tightly between the teeth using a back-and-forth motion. Don't force the floss or try to snap it in to place. Bring the floss to the gumline then curve it into a C-shape against one tooth. Slide it into the space between the gum and the tooth until you feel light resistance. Move the floss up and down on the side of one tooth. Remember there are two tooth surfaces that need to be cleaned in each space. Continue, and floss each side of all the upper teeth. Be careful not to cut the gum tissue between the teeth. As the floss becomes soiled, turn from one finger to the other to get a fresh section.

To clean between the bottom teeth, guide the floss using the forefinger of both hands. Don't forget the back side of the last tooth on both sides, upper and lower.

When you are done, rinse vigorously with water to remove plaque and food particles. Don't be alarmed if during the first week of flossing your gums bleed or are a little sore. If your gums hurt while flossing you could be doing it too hard or pinching the gum. As you floss daily and remove the plaque your gums will heal and the bleeding should stop.

Caring for Sensitive Teeth
Sometimes after dental treatment, teeth are sensitive to hot and cold. This shouldn't last long, but only if the mouth is kept clean. if the mouth is not kept clean the sensitivity will remain and could become more severe. If your teeth are especially sensitive consult with Dr. Fleckenstein. He may recommend a medicated toothpaste or mouth rinse made especially for sensitive teeth.

Choosing Oral Hygiene Products
There are so many products on the market it can become confusing and choosing between all the products can be difficult. Here are some suggestions for choosing dental care products that will work for most patients.

Automatic and "high-tech" electronic toothbrushes are safe and effective for the majority of the patients. Oral irrigators (water spraying devices) will rinse your mouth thoroughly, but will not remove plaque. You need to brush and floss in conjunction with the irrigator.

Some toothbrushes have a rubber tip on the handle, this is used to massage the gums after brushing. There are also tiny brushes (interproximal toothbrushes) that clean between your teeth. If these are used improperly you could injure the gums, so discuss proper use with Dr. Fleckenstein.

Fluoride toothpastes and mouth rinses if used in conjunction with brushing and flossing can reduce tooth decay as much as 40%. Remember, these rinses are not recommended for children under six years of age.  Anti-plaque rinses, approved by the American Dental Association, contain agents that may help bring early gum disease (gingivitis) under control. While these rinses have been shown as an effective tool in treatment of gingivititis, that are not effective alone in the treatment of periodontitis, due to their inability to reach the bacteria under the gumline.  Use these in conjunction with brushing and flossing.

Your periodontist is the best person to help you select the right products that are best for you.

Professional Cleaning
Daily brushing and flossing will keep dental calculus to a minimum, but a professional cleaning will remove calculus in places that your toothbrush and floss have missed. Visit your periodontist, as he or she is an important part of your program to prevent gum disease. We will help customize your plan for supportive periodontal therapy based upon your needs and health. Keep your teeth for your lifetime.  

Oral Pathology
The inside of the mouth is normally lined with a special type of skin (mucosa) that is smooth and coral pink in color. Any alteration in this appearance could be a warning sign for a pathological process. The most serious of these is oral cancer. The following can be signs of the beginning of a pathologic process or cancerous growth:

Reddish patches (erythroplasia) or whitish patches (leukoplakia) in the mouth

A sore that fails to heal and bleeds easily

A lump or thickening on the skin lining the inside of the mouth

Chronic sore throat or hoarseness

Difficulty in chewing or swallowing

Soreness of the muscles that open or close the mouth

Noises or loss of function of the jaw joints 

Toothaches or gum soreness that persists for more than a week 

These changes can be detected on the lips, cheeks, palate, gum tissue around the teeth, tongue, face, and/or neck. Pain is not always necessary to define pathology and, curiously, is not often associated with oral cancer. However, any patient with facial and/or oral pain without an obvious cause or reason may also be at risk for oral cancer.

We would recommend performing an oral cancer self- examination monthly ESPECIALLY IF YOU SMOKE. Remember that your mouth is one of your body's most important warning systems. Do not ignore suspicious lumps or sores, please contact us so we may help you.

Kurt B. Fleckenstein DDS, MS
Photo demonstrating dental plaque in a patient with advanced gum disease.
Kurt B. Fleckenstein, DDS, MS, PLLC
Diplomate of the American Board of Periodontology

Practice Limited to Periodontics and Implant Dentistry
Periodontal Disease
Kurt B. Fleckenstein, DDS, MS, PLLC
2674 5th Avenue, Huntington, WV, 25702