Brush or Floss-Which Should You Do First??

Following a recent article from the Associated Press, there have been reports in the media that there is little evidence that flossing is required for good dental health.  We would like to give you our perspective on bacterial plaque removal and periodontal health. 

You are not healthy unless you are periodontally healthy

We know that bacterial plaque causes periodontal bone and tissue loss that can be disfiguring, cause loss of function, and affect your overall health.  As stated by the researcher from the Associated Press article, removal of bacterial plaque on a regular basis is essential.  Flossing is only one method of removing bacteria from between your teeth but certainly not the only method.   

CDC reports nearly half of adults over the age of 30 have periodontal disease

We know that according to the Centers for Disease Control’s most recent data, nearly 50% of adults over the age of 30 suffer from ongoing periodontitis and this disease is still the major cause of tooth loss in the US.  For patients over the age of 60 the incidence of periodontitis climbs to nearly 70%. 

Flossing manages the risk of developing periodontal disease and controls progression of the disease following treatment

We know that in some patients there is a genetic susceptibility to this chronic disease while others may be resistant.  This is not unlike other chronic diseases of aging such as heart disease, cancer, diabetes.  For example while we understand that a high fat diet and lack of exercise are primary risk factors, there are some patients that are genetically resistant to heart disease.  We all know patients who, despite smoking, live a long, cancer-free life.  There are obese patients who despite having the primary risk factors do not develop diabetes.  Periodontal diseases are similar in that there is a segment of the population that are resistant to developing periodontitis despite having a high risk factors present such as unremoved bacterial plaque.  Risk factors are an indication that you are likely to develop disease- not that you will have the disease.  You see, just like eating right, exercise and other healthy lifestyle behaviors, flossing manages your risk for developing and, after treatment, controlling your periodontitis.

A comprehensive periodontal evaluation is recommended for adults over 30 years of age 

The American Academy of Periodontology recommends that all dentists (not just periodontists) conduct a comprehensive periodontal evaluation at least on a yearly basis for all adults over 30.  Your dentist may refer you to a periodontist.  A periodontist is a specialist in treating periodontal diseases and conditions with three years of additional training after dental school. Periodontists have advanced training in managing your periodontitis, regenerating lost bone and tissue from recession, and performing dental implant surgery.  You do not have to lose your teeth to this devastating, chronic disease. Periodontists see patients referred by dentists, physicians or see patients without referral who are concerned about their periodontal health. 

TAKE CONTROL OF YOUR PERIODONTAL HEALTH AND CALL US TODAY FOR A COMPREHENSIVE PERIODONTAL EVALUATION.  You can reach our office to schedule an appointment at: (714) 441-0436. 

During your dental appointment, you may have heard your dentist or hygienist mention periodontal pockets, but do you really know what these are?  

Periodontal Pockets Defined

In a healthy mouth, the space between the gum and the tooth (which is measured from the top of the gum, down to where the gum attaches to the tooth) should only be 1-3 mm deep. Unfortunately, gum disease can create deeper spaces around the teeth, and these are known as periodontal pockets.  Left untreated, tooth loss can occur.

The Formation of Periodontal Pockets

Plaque and tartar build up along the gumline.  The bacteria in plaque causes gum inflammation which breaks down the soft tissue that supports the tooth.  As periodontal (gum) disease progresses, the bacteria also breaks down the supporting bone tissue.  This inflammation and bone loss causes a pocket to form between the teeth and the gums, and the deeper space becomes the perfect location for more plaque and tartar to hide out. 

Periodontal Pockets and Genetics

While the main cause of periodontal disease is bacteria, a patient’s susceptibility to this infection may be responsible for the level of severity of bone loss.  Evidence is growing, that a person’s response to inflammation may be genetically pre-determined.  So as a result, there are patients that may be more susceptible to a number of chronic diseases such as arthritis, diabetes and periodontal diseases based on their individual genetics.  Our office offers genetic testing as part of your personalized health care.

Treating Periodontal Pockets

The dentist or hygienist uses a periodontal probe to measure and record the depth of the spaces around each tooth.  If periodontal pockets are detected, the first stage in treatment is often a non-surgical approach called root planing. 

Our specialty practice uses advanced ultrasonics to remove established bacteria and inflamed tissue in a non-surgical approach to root planing.  This initial therapy will decrease the inflammatory aspect of periodontitis but will not regenerate lost tissue and bone.  Other approaches using lasers and locally applied antibiotics have been used but these other adjunctive treatments have not been found to be more effective than thorough root planning.   It is important that patients understand the most effective treatments for their condition that are also minimally invasive.  Ultrasonic root planning allows for soft tissue healing with some reattachment to healthier tooth root surfaces.  In cases of more severe bone loss, regeneration of soft tissue and bone may be possible with some of the new technologies we employ.  Following the root planning procedure, our doctors will re-evaluate your response and make further recommendations as needed.      

Once periodontal treatment has been completed, it is important to follow up with routine periodontal maintenance appointments.  The periodontist will recommend how frequently the maintenance appointment should occur.

Have you ever told you that you have inflamed gums (gingivitis) or gum disease, but you feel that your condition persists even though you continue to have regular cleanings?  If left untreated, gingivitis can progress to periodontitis, a more severe form of gum disease.  Most adults are not aware that they have periodontitis, since there is usually very little or no pain associated with it. 

The Difference between Gingivitis and Periodontitis

Gingivitis is a common and mild form of gum disease that causes irritation, bleeding, redness and swelling (inflammation) of your gums.  You should know that healthy gums should never bleed.  Bleeding is a sign of inflammation and a signal that your gums are not healthy. 

Periodontitis is a serious gum infection that damages the soft tissue and destroys the bone that supports your teeth.  As the inflammation present in gingivitis becomes more severe, its progression to periodontitis can cause loss of bone around teeth and gum recession.  Periodontitis is the leading cause of tooth loss in adults   The inflammation and infection associated with periodontitis has also been associated with persistent bad breath and growing evidence has linked periodontitis to other chronic inflammatory diseases such as heart disease, diabetes, rheumatoid arthritis, chronic respiratory infections and other serious health problems.  We now know that some individuals are genetically susceptible to periodontitis as well as some of these other chronic inflammatory diseases.

If you are concerned that your gingivitis has progressed to periodontitis, Dr. Clem and Dr. Yen will be able to better evaluate your current condition and guide you with which options are available to restore your periodontal and overall health.

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