October 18, 2019
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Don’t wait until it hurts!

By: George Malkemus
March 8, 2019

If you’ve been skipping regular dental checkups because you don’t have any tooth pain, beware: you may have periodontal disease and not even feel it! Your gums and jawbone are just as important as your teeth for oral health, as well as your general health.  Periodontal disease is correlated with serious health problems, including heart disease, diabetes, strokes, ulcers and pre-term births. 

 What is Periodontal disease?

Periodontal disease is a serious bacterial infection that attacks the gums and bones that support the teeth.  Periodontal disease [from Latin: perio meaning surrounding and dontal meaning teeth, i.e., gums] is often times without obvious symptoms.  Frequently there is no noticeable pain and since gum disease usually advances slowly, people are unaware of the problem until the disease condition is severe. Untreated periodontal disease can lead to tooth loss. 

According to the American Dental Hygienists’ Association, 75 percent of Americans have some form of periodontal disease. Unfortunately, 50 percent of Americans do not receive regular dental care.

There are different types of periodontal disease:

Gingivitis: Gingivitis usually causes little or no pain. The gums appear red, swollen, and bleed easily. Fortunately, gingivitis can be reversed with immediate treatment at a dental office and consistent homecare.

Aggressive periodontitis: The word “aggressive” is appropriate for this type of periodontal disease, because it quickly destroys the bones and gums that attach to and support the teeth.

Chronic periodontitis: The most common effects of chronic periodontitis are increased tissue inflammation, receding gums, deeper pockets at the gum line, and destruction of the bone and gums that attach to and support the teeth.

Causes of Periodontal disease

One of the major reasons for periodontal disease (and the most preventable one) is the lack of proper homecare of the teeth and gums, i.e., correct and frequent brushing and flossing. Periodontal disease also may arise from tobacco use, stress, clenching or grinding (bruxism), diabetes, HIV/AIDS infections, malnutrition, and hormonal changes (such as during puberty, menstruation, pregnancy and menopause). No matter how it has occurred, periodontal disease requires regular dental treatments and rigorous homecare procedures.

What are the signs of Periodontal disease?

Periodontal disease generally is painless. So even if your gums and teeth don’t hurt, you should be on the lookout for signs of infection, including:

 •Gums that bleed, especially when brushing or flossing your teeth

•Gums that are red or swollen

•Receding gums

•Persistent bad breath

•Pus that appears between your teeth and gums

•Teeth that feel loose or feel different when you bite together

Checking for Periodontal disease

A comprehensive evaluation of the gums is done during a dental examination.

  X-rays are taken to determine the bone support for the teeth and gums.  In my office, computerized digital x-rays are used, which have the benefit of 80 percent less radiation and allow computer storage and enhancement capabilities. 

Gum measurements are taken around all the teeth to check gum pocket depths.  The deeper the pocket, the higher the number and the greater the infection found. Gum recession levels are measured as well. 

Teeth are checked for mobility.  Teeth movement indicates bone loss and advance gum infection. 

 Furcation involvement is checked.  A furcation is the area where the roots separate under the crown of a tooth.  Gum pockets that extend under a tooth where the roots divide become a difficult area to clean and treat. 

Areas of inflammation, swelling, bleeding and pus are recorded.  These are major indicators of gum infection.

Amounts of plaque, tartar and calculus are noted.  Plaque is a soft bacteria culture on the teeth, gums and tongue.  Tartar is a hard bacteria formation on the teeth above the gums. Calculus is a hard bacterial growth on the roots of the teeth below the gum line that cause root roughness and act as splinters irritating the gums.

What treatments can be done?

Various levels of gum therapy should be done, depending on your individual gum needs.

A Prophy (a commonly used abbreviation for the word prophylaxis) is a polish and cleaning of your teeth above the gum line.  It is all that is necessary in someone who does not have gum disease or only slight gingivitis.

Scaling and root planning is a deeper cleaning of the roots surfaces of teeth below the gum line.  An ultrasonic scaler uses vibration and heated water spray to remove the hard calculus deposits while smoothing the root surfaces.  

Periodontal maintenance therapy is a more frequent cleaning and monitoring of the gums, usually every three months.  

Antibiotic therapy can be used to reduce bacterial infection in the gums.  Arestin [minocycline hydrochloride] is an antibiotic that is used in my office during root planning and periodontal maintenance therapy. It comes in powder form and is placed around the teeth in the deeper gum pockets.  I have seen some amazing results with Arestin used where deep pockets have been eliminated without surgery. In fact, last year a patient had a loose molar with a deep pocket, advanced bone loss and deep furcation involvement.  In the past, the tooth would not have been able to be saved and would have needed an extraction, but with arestin and root planning the tooth is still going strong.

Medications that reduce the body’s inflammatory response to gum disease can reduce chronic periodontal disease.  Periostat is prescribed as a daily oral medication that reduces the body’s over-response to gum disease.  

Laser therapy can be used to reduce deep gum pockets and remove excess gum tissue. Laser use can sterilize the infected gum pocket, killing bacteria and allow the gum tissue to heal and tighten against the root of a tooth. Re-contouring of the gums with a surgical laser can make the gums much easier to clean.  The surgical laser can also improve the appearance of the gums in the front teeth by producing an even, pleasing gum line 

Periodontal surgery can remove deep infected gum pockets, re-contour underlining infected bone and promote gum tightening.                                                   

Gingival grafts can be added to the gum areas to fix gum recession. Advanced gum surgery and grafting are done by a periodontist, who is a specialist of the gums.

So, don’t wait till it hurts!  Have your gums and teeth checked regularly.


George Malkemus has a Family and Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200. Call 585-8595, or email info@  Visit Dr. Malkemus’ Web site at