There are different types of cleanings depending on whether the patient has a healthy mouth, gingivitis, or periodontal disease.
A healthy mouth consists of coral pink (depending on ethnicity, there are natural pigments that change the color of gums to darker shades of brown) gums that are stippled like an orange peel. The gums are not red, purple or puffy. The gums do not bleed when the patient brushes his teeth. The gums are comfortable when the doctor or hygienist use a metal instrument called a probe to measure for pockets around the teeth. Pockets are the “turtle neck sweater” shaped spaces between the gum and the tooth. In a healthy mouth, pockets measure 3 millimeters or less. The level of the gums meets the crown of the tooth at the enamel, and there is gum tissue covering the space between the teeth. No dark triangles visible between the teeth.
Gums with gingivitis are usually red, purple, swollen, puffy and easily bleed. The surface of the gums appear smooth and shiny instead of like an orange peel. This disease is caused by bacterial plaque and by irritation from hard deposits called calculus. Bacterial plaque is a sticky substance that contains bacteria, bacterial glue, bacterial waste products and toxins. It gives teeth a “furry” feel and can be brushed or flossed away. Calculus can form in as little as 24 hours and is caused by calcium and other minerals in the saliva being trapped by any plaque that was not removed by brushing or flossing. Calculus is mainly found on the tongue side of the lower front teeth and on the cheek side of upper molars. Calculus must be removed by special instruments at the dental office as they are now “stuck” to the teeth so tightly (like barnacles on the hull of a ship) that brushing or flossing cannot remove it.
The cause of periodontal disease was poorly understood until recently. It is not a severe form of gingivitis. In fact, the two diseases are caused by completely different bacteria.
The bone loss that accompanies periodontal disease is actually an exaggerated immune system response. You’re immune system will attack your bone in an effort to remove the bacteria and toxins. This auto-immune reaction is an inherited response, so if your parents had it, you probably do too.
Gingivitis and periodontal disease can occur together or separately. If you have periodontal disease without gingivitis, you will have bone loss and not necessarily experience sensitive or bleeding gums. Periodontal disease can only be diagnosed using a full mouth series of X-rays and a full probing of each individual tooth.
The disease can be localized to specific areas of the mouth or generalized throughout the entire mouth. Severe bad breath, loose teeth, teeth that fall out by themselves and pus exuding from the gums can all be found in advanced periodontal disease. Periodontal disease is treatable, but it is not curable because it is genetic. In order to keep this disease under control, a person must be seen for follow-up treatment every three months or more frequently as needed.
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