Thanks to new materials and techniques, dentists are more successful than ever before at reversing the disease process and preserving, repairing, and replacing teeth. This report will introduce you to the latest developments — from smart fillings that can help prevent cavities to new methods for placing dental implants. It sifts through the hype surrounding certain dental products and procedures. Can chewing xylitol gum protect against tooth decay? Are silver fillings and fluoridation safe? Which toothbrush really works best? You’ll find the answers to these questions within this report.
You'll also find a wealth of information on techniques to repair or replace damaged teeth — including root canal therapy, bridges, orthodontic treatment, dentures, and implants — as well as advice on managing dental emergencies. In addition, it provides information on cosmetic procedures, such as bleaching, bonding, veneers, and tooth reshaping.
Prepared by the editors of Harvard Health Publications in conjunction with Ricardo Teles, DDS, DMSc, Vice Chair, Department of Applied Oral Sciences, Forsyth Institute Clinical Instructor in Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine. 49 pages. (2014)
Gum disease, also known as periodontal disease, is the primary culprit in adult tooth loss. It occurs when plaque formation spirals out of control, eventually destroying teeth and surrounding structures.
Gum disease is caused by bacteria in the mouth. Bacteria cause cavities, too. But there’s a difference: the bacteria that cause cavities need oxygen to survive, while the bacteria that attack the gums prefer a low-oxygen or oxygen-free environment. The effects of periodontal disease range from mild redness and swelling of the gums (gingivitis) to complete destruction of the tooth’s bony support structure (advanced periodontitis).
How gum disease develops
Gum disease gets its foothold when plaque forms in the sulcus, a shallow trough where the gum meets the tooth. Without proper cleaning, plaque can build up here like leaves in a gutter. Successive layers of plaque prevent oxygen from reaching the deepest part of the sulcus. This lets bacteria that thrive in a low-oxygen environment prosper.
Toxins released by these bacteria inflame the surrounding tissue. The appearance of inflammation is a sign of gingivitis. In some areas, the surface of the plaque hardens into tartar, letting more plaque accumulate.
Your immune system responds to the bacterial activity by sending a legion of white blood cells to the infection. How well these cells combat the bacteria depends on the type and number of bacteria present and your body’s ability to fight off disease. As gum disease gets worse, chemicals released by the immune response begin attacking the gum tissue itself.
The tissue that attaches the tooth to the gum is the first to be destroyed. The detached gum then pulls back from the root of the tooth, deepening the gingival pocket and leaving the exposed portion of the tooth root vulnerable to cavity-causing bacteria.
Next, the disease attacks the underlying ligament that holds the tooth to the jawbone. At this point, gingivitis turns into periodontitis. As the ligament continues to break down and more bone is lost, the tooth loosens in its socket. Eventually, it may fall out.
Sometimes, deep pockets close up at the top. This walls off the pus in a bubble of inflamed gum tissue called an abscess. The swelling and inflammation can loosen nearby teeth and speed the destruction of the surrounding bone.
Dentists gauge the severity of periodontal disease by how fast it moves from one stage to the next and how well the person responds to treatment. Inflammation doesn’t always move on to periodontitis. How and why the transformation takes place is still a bit of a mystery. About one-third of adults may have a genetic predisposition to gum disease. That makes them much more likely to succumb to periodontitis, despite brushing and flossing to keep it at bay.