Two hundred million Americans are estimated to have periodontal disease. Let’s get a few simple explanations out-of-the-way first so you can better understand the information that follows.
Classically there are two different categories of periodontal disease. The earliest form is gingivitis. Gingivitis is inflammation of the gum tissue. The gums may be red, swollen, and tend to bleed easily. Here pockets are shallow, 1-3 millimeters. A pocket is a measurable distance between the edge of your gum and the bone. With gingivitis, there is no bone loss, and the pockets are really due to swelling of the tissue. If this stage of periodontal disease is not remedied, it may progress to the next category – periodontitis. Periodontitis means the disease has progressed to where bone loss is occurring, and pockets go from 3 to 10 millimeters and deeper.
To keep the answer as simple as possible – bugs. “But everyone has bacteria in their mouth,” you say. That is true. It is estimated that there are 500 types of bacteria in the mouth. It is not how many types as much as the amount of the bad ones.
How do I know what’s in my mouth? To know specifically, you need to take a plaque sample from under your gum, and culture it. Plaque is a sticky substance that you sometimes can rub off of your tooth with your fingernail. Luckily, you do not have to go through that to know if you are in trouble.
A plaque sample can be taken and looked at under a microscope. In a healthy mouth, there will be little activity, few white blood cells, tiny circular bacteria, and in general, a quiet scene.
In a very unhealthy situation, there will be many, many white blood cells. The white blood cells are called into action to combat infection. Long before bone destruction begins, the presence of large numbers of white blood cells are present to warn us of impending problems. There will also be lots of snake-like bacteria called spirochetes, and usually large cigar-shaped rods and amoeba present. The slide is frenetic, much like Times Square at rush hour.
In between these two extremes of health and severe problems are various stages of pathology.
Using a microscope is critical
Without the use of the microscope, I am like a carpenter without a hammer. I really do not have a clue as to what is going on. Taking a plaque sample and looking under a microscope is critical to evaluating the patient’s status prior to treatment, and to monitor ongoing systemic and local treatment.
Traditional methods for assessing periodontal health
Most dentists do not use a microscope; instead they rely on traditional methods of assessing the periodontal health of the patient. This involves probing and measurement of pocket depth. Anything greater than 3 millimeters of depth is usually an indication of a problem. Another indication is bleeding upon probing. Most dentists view this as proof of periodontal disease. What this is really indicating is capillary fragility.
Capillary fragility may be an indication of periodontal disease; however, it may be present for other reasons, such as low levels of vitamin C, mercury fillings, hormonal fluctuations or imbalances, diet, or prescription drugs, for example birth control pills.
Loss of bone on x-ray is another traditional indication of periodontal disease. This is helpful, but is more of an indication that bone loss has occurred, and not necessarily that it is still ongoing. Knowing a patient has a pocket or has bone loss on an x-ray only tells me something historical, that bone loss has occurred in the past. To know if infection is still present, a microscope is indispensable.
You can live with a pocket and not have gum surgery if the pathological process that led to the bone loss is halted. This is why every new patient that I see has a slide taken. I cannot count the number of times that a mouth has seemingly looked healthy and on the slide is a raging battle.
Unexpected results from the slide of Health Practitioner resulted in early intervention.
One patient, a health care provider, very much into health and with no complaints was shocked when I showed him his slide. His mouth was a cesspool of spirochetes and amoeba. Something was not right; blood testing showed a compromised immune system, and anemia. It seems that the Vegan diet he was on was not optimal for him.The slide allowed us to intervene, before overt problems developed.
It is important to remember that these infections can be passed on to our loved ones through kissing, sharing food and drink. Thus, it becomes important to monitor the rest of the family, especially if resolution of the patient’s problem is not occurring.
Two important reasons for treating periodontal disease
Why is it important to treat periodontal disease and to hopefully treat it at its earliest stage? There are two big reasons: 1) It is a sign there is a problem in host resistanceand 2) The bacteria and its toxic by-products that are in the pockets do not necessarily stay there. The same blood which travels in your gums travels all over your body. In fact, periodontal bacteria have been found in the atherosclerotic plaque in the heart.
Next issue I will address the topic of periodontal bacterial and the heart, as well as other health problems that may be linked to periodontal disease.
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© 2004, Mark A. Breiner, DDS
The information presented is for educational purposes only. You should consult a qualified dentist or health practitioner for diagnosis and treatment.