Gum disease can affect whole body health, but diagnosing and treating it hasn't been easy. Two new, patient-friendly techniques are now available to address cases.
Though long recognized as the leading cause of tooth loss, infected gums also have been linked to heart disease -- because the same bacteria have been found in each -- and may also be associated with diabetes and low birthweight babies. Causes range from poor oral hygiene to genetics and weakened immune systems. Smoking and medications also may be factors.The condition -- also called periodontal disease -- often responds to deep cleaning and scaling of infected roots. If these fail, surgery may be necessary to clean bacteria-packed gaps between teeth and gums and to graft bone and gum using tissue from other parts of the body.
Periodontists assess damage through X-rays, probes and by measuring root recession. A new device called a Perioscope makes diagnosis and cleaning simpler; another device called the PerioLaser shortens treatment and recovery time for those who do need surgery.
"People think their mouths are different from their bodies," said Mark Silberg, a Robinson periodontist who has added the Perioscope to his arsenal of diagnostic and treatment tools.
"The mouth is an 'it,' and the rest is 'me,' " he said. "It's an interesting disconnect that people make," he said.
Silberg believes that perioscopy, involving a 0.9-mm fiber-optic cable and tiny camera, provides a more complete picture than traditional diagnostic techniques.
"You don't know how extensive damage is until you lift the gum line, and that might mean cutting the gum," he said.
In perioscopy, the camera takes pictures of the gums that are then magnified and projected onto a screen both dentist and patient can see -- sometimes making diagnostic surgery unnecessary.
"The Perioscope gives us better accuracy. It means less guesswork," said Silberg, of the $15,000 device he purchased in October from Dental View, of Irvine, Calif. "You can really see the buildup of junk on the surface of the root."
When infection is so advanced that surgery is needed, Silberg uses perioscopy to guide him during procedures. Novocaine is usually needed because the instrument goes deep under the gums.
Otherwise, his hygienists use the new device to pinpoint infection during scaling and deep cleaning of teeth, which reduces costs to patients by about a third, said Silberg, who supervises their work. "It takes the same amount of time as conventional methods -- one to two hours for two to four teeth. But it's $350 to $500 instead of $700 to $800 for conventional means."
Louis Wassermann of Green Tree was introduced to perioscopy recently after spending $2,500 for a deep cleaning of his teeth -- a section at a time -- through the conventional, surgical method.
"The stitching left me sore. The only thing that surprised me [about the Perioscope] is that it took as long as it did, but I couldn't feel anything and the recovery time was nothing."
Wasserman, 73, didn't know he had gingivitis -- the milder form of gum disease -- until the dentist he'd seen for years retired.
"My gums would bleed when I brushed them and they're hard to floss because they're crooked. I had gum disease but didn't know it. Between my regular dentist and Dr. Silberg, I have to see someone every three months."
In another advance, the Food and Drug Administration last month approved a new laser treatment called PerioLaser developed by two California dentists. A fiber no wider than three human hairs is inserted into the gum pocket and selectively destroys bad tissue.
Traditional surgery usually involves four sessions at four hours each. With the laser, treatment is concluded in two two-hour sessions. Patients can return to work and a regular diet within 24 hours. Following traditional surgery, recovery can take up to eight weeks, during which patients can experience considerable pain and swelling and are restricted to liquid or soft diets.
