Smoking and Periodontal Disease

By now almost everyone knows that smoking has been linked with lung disease, cancer, and heart disease. But most people aren’t aware that smokers are three to six times more likely to have periodontal disease, and two times more likely to lose teeth. Fill in your email address to the right to learn more!

What is periodontal disease?

Periodontal disease is an infection of the tissues that support your teeth.

Your gum tissue is not attached to the teeth as high as it may seem-there is a very shallow v-shaped crevice called a sulcus between the tooth and gums.  Periodontal diseases attack just below the gum line in the sulcus, where they cause the attachment of the tooth and its supporting tissues to break down. As the tissues are damaged, the sulcus develops into a pocket. Generally, the more severe the disease, the greater the depth of the pocket.

What causes periodontal diseases?

The sticky film that constantly forms on your teeth is called plaque, and is made mostly of bacteria. Some of these bacteria produce byproducts (called toxins or enzymes) that can irritate the tissues that support your teeth. These byproducts can damage the attachment of the gums, periodontal ligament, and bone to your teeth.

You can remove plaque with good oral hygiene-brushing your teeth twice a day and cleaning between them once a day with floss or another interdental cleaner. When plaque is not removed through good oral hygiene, it builds up along the gum line and increases your risk of developing periodontal disease.

Plaque that is not removed regularly can harden into a rough porous deposit called calculus, or tartar. Tartar itself does not seem to cause disease, but it may make it more difficult for you to remove plaque so it should be removed regularly. Tartar only can be removed when your teeth are professionally cleaned in the dental office.

Do some factors increase the risk of developing periodontal diseases?

Yes, some factors can increase the risk of developing periodontal diseases. If one or more of the following apply to you, it is especially important that you practice good oral hygiene and follow your dentist’s advice to maintain healthy teeth and gums.

  • People who smoke or chew tobacco are more likely to have periodontal disease. And it’s more likely to be more severe than in those who do not use any tobacco products.
  • Some systemic disease, such as diabetes, can lower your body’s resistance to infection, making periodontal diseases more severe.
  • Many medications, such as steroids, some types of anti-epilepsy drugs, cancer therapy drugs, some calcium channel blockers, and oral contraceptives can affect the gums. In addition, medications that reduce your salivary flow can result in a chronically dry mouth, which can irritate your oral soft tissues. Let your dentist know about your medications and update your medical history files at the dental office when any changes occur.
  • Bridges that no longer fit properly, crooked teeth or fillings that have become defective can contribute to plaque retention and increase your risk of developing periodontal disease.
  • Pregnancy or use of oral contraceptives increases hormone levels that can cause gum tissue to be more sensitive to the toxins and enzymes produced by plaque and can accelerate growth of some bacteria. The gums are more likely to become red, tender and swollen, and bleed easily.

How would I know if I had periodontal disease?

It is possible to have periodontal disease and have no warning signs. That is one reason why regular dental checkups and periodontal examinations are very important.  However, several warning signs can signal that you have a problem with periodontal disease. If you notice any of the following, see your dentist:

  • Gums that bleed easily;
  • Red, swollen, or tender gums;
  • Gums that have pulled away from the teeth;
  • Pus between the teeth when the gums are pressed;
  • Persistent bad breath or bad taste;
  • Permanent teeth that are loose or separating;
  • Any change in the way your teeth fit together when you bite;
  • Any change in the fit of partial dentures.

Types of periodontal diseases

Periodontal disease is classified according to the severity of the disease. The two major stages of the disease are gingivitis and periodontitis.

Gingivitis is a milder and reversible form of periodontal disease that only affects the gums. It develops as toxins in plaque irritate gums, making them red, tender, swollen, and likely to bleed easily. It can usually be eliminated by daily brushing, cleaning between your teeth, and regular dental cleanings.

Gingivitis may lead to more serious, destructive forms of periodontal disease, called periodontitis. There are several forms of periodontitis, with the most common being chronic adult periodontitis.

Periodontitis occurs when toxins, enzymes, and other plaque byproducts destroy the tissues that anchor teeth into the bone. The gum line recedes, which can expose the tooth’s root. Exposed root can become susceptible to decay and sensitive to cold and touch.

As we mentioned earlier, the sulcus deepens into a pocket in the early stage of periodontal disease. Plaque that collects in these pockets can be difficult to remove during regular brushing and interdental cleaning. Byproducts from the plaque that collect in these pockets can continue to damage the gums, periodontal ligament, and bone. In some cases, so much ligament and bone are destroyed that the tooth becomes loose. Usually, your dentist can still treat the disease at this point. In the worst of cases, a loose tooth may need to be extracted or may fall out on its own.

How can I prevent periodontal diseases?

Daily good oral hygiene can help reduce your risk of developing periodontal diseases.

  • Brush your teeth twice a day. With proper brushing, you can remove plaque from the inner, outer and chewing surfaces of each tooth. Your dentist or dental hygienist can show you a proper brushing technique.  Using a fluoride-containing toothpaste also will help protect your teeth against cavities.
  • Carefully clean between your teeth once a day with dental floss or another interdental cleaner to remove plaque from areas your toothbrush can’t reach. It only takes a few minutes each day and is just as important in maintaining oral health as brushing your teeth.  If you need extra help controlling gingivitis and plaque that forms above the gum line, your dentist may recommend using an ADA-accepted antimicrobial mouthrinse or other oral hygiene aids as an effective addition to your daily oral hygiene routine.  When choosing dental care products, look for those that display the American Dental Association’s Seal of acceptance-your assurance that they have met ADA standards of safety and effectiveness.
  • Eat a balanced diet for good general health.
  • Visit your dentist regularly.

Checking for periodontal diseases

During your checkup, the dentist will examine your gums. This is called a periodontal examination. He or she will use an instrument called a periodontal probe to gently measure the depth of the sulcus surrounding each tooth. The healthy sulcus depth is usually three millimeters or less.

Periodontal deseases cause the sulcus (the shallow v-shaped crevice between your teeth and gums) to deepen into a pocket. A periodontal probe can determine whether you have developed any pockets and the depth of those pockets. Generally, the more severe the disease, the deeper the pocket.

Dental X-rays, or radiographs, also may be taken to evaluate the amount of bone supporting the teeth and to detect other problems not visible during the clinical examination.If periodontal disease is diagnosed, the dentist may provide treatment or may refer you to a periodontist, a dentist who specializes in the treatment of periodontal disease.

How are periodontal diseases treated?

Treatment methods depend upon the type of disease and how far the condition has progressed.  The first step usually is a thorough cleaning that includes scaling to remove plaque and tartar deposits. The tooth roots also may be planed to smooth the root surface, allowing the gum tissue to heal and reattach to the tooth. In some cases, the occlusion, or bite, may require adjustment.

Your dentist also may recommend medications to help control infection, pain, or to encourage healing. These medications can be given in various forms: a pill that you would swallow, a liquid mouthrinse, or in a form that the dentist could place directly in the periodontal pocket after scaling and root planing.