Gum disease begins with plaque, which is always forming on your teeth, without you even knowing it. When it accumulates to excessive levels, it can harden into a substance called tartar (calculus) in as little as 24 hours. Tartar is so tightly bound to teeth that it can be removed only during a professional cleaning.

Gingivitis and periodontitis are the two main stages of gum disease. Each stage is characterized by what a dentist sees and feels in your mouth, and by what’s happening under your gumline. Although gingivitis usually precedes periodontitis, it’s important to know that not all gingivitis progresses to periodontitis.

In the early stage of gingivitis, the gums can become red and swollen and bleed easily, often during toothbrushing. Bleeding, although not always a symptom of gingivitis, is a signal that your mouth is unhealthy and needs attention. The gums may be irritated, but the teeth are still firmly planted in their sockets. No bone or other tissue damage has occurred at this stage. Although dental disease in America remains a serious public health concern, recent developments indicate that the situation is far from hopeless.

Frederick N. Hyman, D.D.S., a dental officer in the FDA’s dermatologic and dental drug products division, says that because people seem to be paying more attention to oral hygiene as part of personal grooming, the payoff is “a decline in gingivitis over recent years.” Hyman adds that “gingivitis can be reversed in nearly all cases when proper plaque control is practiced,” consisting, in part, of daily brushing and flossing.

When gingivitis is left untreated, it can advance to periodontitis. At this point, the inner layer of the gum and bone pull away from the teeth (recede) and form pockets. These small spaces between teeth and gums may collect debris and can become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gumline. Bacterial toxins and the body’s enzymes fighting the infection actually start to break down the bone and connective tissue that hold teeth in place. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed.

At this point, because there is no longer an anchor for the teeth, they become progressively looser, and the ultimate outcome is tooth loss.

More than 75 percent of Americans over 35 have some form of gum disease. In its earliest stage, your gums might swell and bleed easily. At its worst, you might lose your teeth. The bottom line? If you want to keep your teeth, you must take care of your gums.

The mouth is a busy place, with millions of bacteria constantly on the move. While some bacteria are harmless, others can attack the teeth and gums. Harmful bacteria are contained in a colorless sticky film called plaque, the cause of gum disease. If not removed, plaque builds up on the teeth and ultimately irritates the gums and causes bleeding. Left unchecked, bone and connective tissue are destroyed, and teeth often become loose and may have to be removed.
A recent poll of 1,000 people over 35 done by Harris Interactive Inc. found that 60 percent of adults surveyed knew little, if anything, about gum disease, the symptoms, available treatments, and — most importantly — the consequences. And 39 percent do not visit a dentist regularly. Yet, gum disease is the leading cause of adult tooth loss. Moreover, a Surgeon General’s report issued in May 2000 labeled Americans’ bad oral health a “silent epidemic” and called for a national effort to improve oral health among all Americans.

The good news is that in most people gum disease is preventable. Attention to everyday oral hygiene (brushing and flossing), coupled with professional cleanings twice a year, could be all that’s needed to prevent gum disease — and actually reverse the early stage — and help you keep your teeth for a lifetime.
In addition, several products have been approved by the Food and Drug Administration specifically to diagnose and treat gum disease, and even regenerate lost bone. These products may help improve the effectiveness of the professional care you receive. (See “FDA-Approved Products for Gum Disease”.)

Keeping your own teeth is important for healthy eating. Natural teeth help you chew foods better and easier than you can with dentures. Because infections can make gums sore and uneven, dentures may not fit right. Be sure to tell your dentist if your dentures hurt.
Have a dental checkup at least every six months.

Take good care of your teeth and gums. At least twice a day, brush your teeth with a soft bristle toothbrush and fluoride toothpaste. Use dental floss every day to clean between the teeth.

If your gums bleed while you are brushing your teeth or eating, or a bad taste stays in your mouth, go to the dentist. Tell your dentist about any other changes you see, such as white patches, in your mouth.

Smoking makes gum problems worse. Your doctor or dentist can help you quit.
The National Oral Health
Information Clearinghouse
1 NOHIC Way
Bethesda, MD 20892-3500
Voice: (301) 402-7364
TTY: (301) 656-7581
Fax: (301) 907-8830
E-mail: nohic@nidcr.nih.gov
The National Oral Health Information Clearinghouse is a service of the National Institute of Dental and Craniofacial Research, National Institutes of Health.

For the nearly 21 million Americans that have diabetes, many may be surprised to learn about an unexpected complication associated with this condition. Research shows that there is an increased prevalence of gum disease among those with diabetes, adding serious gum disease to the list of other complications associated with diabetes, such as heart disease, stroke and kidney disease.

Emerging research also suggests that the relationship between serious gum disease and diabetes is two-way. Not only are people with diabetes more susceptible to serious gum disease, but serious gum disease may have the potential to affect blood glucose control and contribute to the progression of diabetes. Research suggests that people with diabetes are at higher risk for oral health problems, such as gingivitis (an early stage of gum disease) and periodontitis (serious gum disease). People with diabetes are at an increased risk for serious gum disease because they are generally more susceptible to bacterial infection, and have a decreased ability to fight bacteria that invade the gums.

The Surgeon General’s Report on Oral Health states that good oral health is integral to general health. So be sure to brush and floss properly and see your dentist for regular checkups.

If I Have Diabetes, am I at Risk for Dental Problems?

If your blood glucose levels are poorly controlled, you are more likely to develop serious gum disease and lose more teeth than non-diabetics. Like all infections, serious gum disease may be a factor in causing blood sugar to rise and may make diabetes harder to control.

Other oral problems associated to diabetes include: thrush, an infection caused by fungus that grows in the mouth, and dry mouth which can cause soreness, ulcers, infections and cavities.

How Can I Help Prevent Dental Problems Associated with Diabetes?

First and foremost, control your blood glucose level. Then, take good care of your teeth and gums, along with regular checkups every six months. To control thrush, a fungal infection, maintain good diabetic control, avoid smoking and, if you wear them, remove and clean dentures daily. Good blood glucose control can also help prevent or relieve dry mouth caused by diabetes.

What Can I Expect at My Checkup? Should I Tell My Dental Professional About My Diabetes?

People with diabetes have special needs and your dentist and hygienist are equipped to meet those needs — with your help. Keep your dentist and hygienist informed of any changes in your condition and any medication you might be taking. Postpone any non-emergency dental procedures if your blood sugar is not in good control.

Depending on where the tooth is located, there may be other risks. If the tooth is in the back of your upper jaw, the infection can involve your sinuses, and your dentist may suggest antibiotics and decongestants. The roots of the back teeth in the lower jaw are close to some major nerves, so surgery on one of these teeth carries a slight risk of nerve damage. However, your endodontist will use your X-rays to see how close the roots are to the nerves, and the chances of anything happening are extremely small.
An apicoectomy is usually a permanent solution, and should last for the life of the tooth.

The area may bruise and swell. It may be more swollen the second day after the procedure than the first day. Any pain usually can be controlled with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofem (Advil, Motrin and others) or prescription medication.

To allow for healing, you should avoid brushing the area, rinsing vigorously, smoking or eating crunchy or hard foods. Do not lift your lip to examine the area, because this can disrupt blood-clot formation and loosen the sutures.

You may have some numbness in the area for days or weeks from the trauma of the surgery. This does not mean that nerves have been damaged. Tell your dentist about any numbness you experience.

Your stitches will be removed 2 to 7 days after the procedure, and all soreness and swelling are usually gone by 14 days after the procedure.

Even though an apicoectomy is considered surgery, many people say that recovering from an apicoectomy is easier than recovering from the original root-canal treatment.

To complete the apicoectomy, 3 to 4 millimeters of the tooth’s canal are cleaned and sealed. The cleaning usually is done under a microscope using ultrasonic instruments. Use of a surgical microscope increases the chances for success because the light and magnification allow the endodontist to see the area better. Your endodontist then will take an X-ray of the area before suturing the tissue back in place.

Most apicoectomies take between 30 to 90 minutes, depending on the location of the tooth and the complexity of the root structure. Procedures on front teeth are generally the shortest. Those on lower molars generally take the longest.

Your dentist may take X-rays and you may be given an antimicrobial mouth rinse, anti-inflammatory medication and/or antibiotics before the surgery.

If you have high blood pressure or know that you have problems with the epinephrine in local anesthetics, let your dentist know at the consultation. The local anesthetic used for an apicoectomy has about twice as much epinephrine (similar to adrenaline) as the anesthetics used when you get a filling. The extra epinephrine constricts your blood vessels to reduce bleeding near the surgical site so the endodontist can see the root. You may feel your heart rate speed up after you receive the local anesthetic, but this will subside after a few minutes.

In many cases, a second root canal treatment is considered before an apicoectomy. With advances in technology, dentists often can detect additional canals that were not adequately treated and can clear up the infection by doing a second root canal procedure, thus avoiding the need for an apicoectomy.

An apicoectomy is not the same as a root resection. In a root resection, an entire root is removed, rather than just the tip.

An apicoectomy may be needed when an infection develops or persists after root canal treatment,or retreatment. During root canal treatment, the canals are cleaned, and inflamed or infected tissue is removed. Root canals are very complex, with many small branches off the main canal. Sometimes, even after root canal treatment, infected debris can remain in these branches and possibly prevent healing or cause re-infection later. In an apicoectomy, the root tip, or apex, is removed along with the infected tissue. A filling is then placed to seal the end of the root.

An apicoectomy is sometimes called endodontic microsurgery because the procedure is done under an operating microscope.