Neglecting the mouth is just as dangerous for the rest of us, according to the American Academy of Periodontology (AAP), which cites studies linking periodontal (gum) disease to heart and respiratory disease.

“When bacterial plaque is allowed to build up on your teeth, you put yourself at high risk for periodontal disease,” says Dr. Robert Schoor, president of the AAP. “And the bacteria associated with periodontal disease can travel into the blood stream to other parts of the body, jeopardizing your health.”

The impact of periodontal disease, one of the most common infections, is far more widespread than the mouth. One study found that people with advanced periodontal disease are 4.5 times more likely to have a chronic respiratory disease. Another study found that people with periodontal disease may have nearly twice the risk of having a fatal heart attack as those without periodontal disease.

While periodontal disease cannot always be avoided, proper oral hygiene is the best means of prevention.

• Daily flossing breaks up the bacterial colonies between teeth.
• Proper brushing prevents plaque buildup.
• Professional cleanings at least twice a year are necessary to remove calculus from places your toothbrush and floss may have missed.
• And, because there are often no symptoms of the disease in its early stages, a trip to a periodontist can determine if you have it.

The January 1999 Journal of Periodontology reports that at the very least, nearly 30 percent of people in this country age 30 to 54 have periodontitis – an advanced state of periodontal disease in which there is bone loss around the teeth. Study Abstract *

In addition to heart disease and respiratory disease, periodontal disease has been linked to diabetes and premature, underweight births.

A referral to a periodontist in your area and free brochure samples including one titled Ask Your Periodontist About Periodontal Disease & Heart Disease are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for

Edentulism (toothlessness) has been declining in the United States since the 1950s. According to the Centers for Disease Control and Prevention, not quite 25 percent of the current population over age 65 is toothless. And, because edentulism rates are often dependent upon sociological and technological factors, toothlessness should continue to decline as baby boomers age.

“My older patients are becoming increasingly concerned about their oral health and the aesthetics of their smile,” said Dr. Robert Schoor, president of the American Academy of Periodontology (AAP). “They want to keep their teeth, but when that’s not a possibility, many are opting for the next best thing – dental implants.”

A 1998 survey sponsored by the American Dental Association and Oral-B Laboratories found that almost two-thirds of respondents 65 and older said their teeth are better than their parents at their age. And, more than half said a smile is the first thing they notice about other people.

However, maintaining a healthy mouth is not just a matter of a pretty smile and being able to eat corn on the cob. A study in the January 1999 issue of the Journal of Periodontology reports that at the very least, half of people over age 55 have periodontitits (an advanced form of periodontal disease). Recent research has advanced the idea that periodontal diseases – a primary cause of tooth loss – are linked to a number of major health concerns, such as heart disease, stroke, respiratory disease, osteoporosis and diabetes.

“To help prevent periodontal diseases, improve overall health and maintain a nice smile, we need to take note of the changes taking place in our mouths as we age and discuss these changes with our dental professionals,” said Schoor. “The goal is to make adjustments in oral care before these changes result in full-blown problems in the mouth that could jeopardize overall health.”

Older adults are one of the highest risk age groups for cavities and periodontal disease. Reasons include:

• Dry mouth (xerostomia), which may be caused by medical disorders or hundreds of medications (such as high blood pressure drugs, diuretics and antidepressants), can leave mouths without enough saliva to wash away food and neutralize plaque, leaving the mouth more susceptible to tooth decay and periodontal disease. In addition, calcium channel blockers can cause gingival enlargement or overgrowth.
• Receding gums leave the roots of the teeth exposed, making them vulnerable to plaque’s cavity causing acids and periodontal disease.
• Medical conditions associated with aging, such as diabetes, can increase the risk of periodontal disease. In addition, memory problems may lead to lessened oral hygiene. And, arthritis can make brushing and flossing more difficult.
• Women who are menopausal or post-menopausal may experience discomfort in the mouth, including pain and burning sensations in the gum tissue, altered taste and dry mouth. These changes, attributed to hormonal fluctuations, can lead to periodontal disease.
• Lack of preventative dental care and infrequent visits to the dentist also place older adults at increased risk for oral health problems. At dental visits, patients should discuss with their dentists or periodontists their health histories and any medications (including over-the-counter and herbal remedies) they are taking. For those people already missing teeth, ask if dental implants are a viable option.

A referral to a periodontist in your area and free brochure samples are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for

Periodontists offer a variety of cosmetic periodontal procedures for brides insecure about smiling in front of the camera.

Emerging research in esthetic and regenerative periodontal procedures enables periodontists to provide patients with treatment alternatives for imperfections such as “gummy” smiles and missing teeth that are functional and esthetically pleasing.

Before Treatment	After Treatment
Click for enlarged photos.

“Long gums can create a gummy smile,” said Dr. Robert Schoor, president of the American Academy of Periodontology (AAP). “To correct this, the periodontist simply reshapes the gum tissue, exposing the rest of the tooth.”

Stress and hormonal fluctuations during wedding planning can affect many tissues, including gum tissue, and increase susceptibility to periodontal disease. “Stress can make it more difficult for the body to fight off infection, including periodontal disease,” said Schoor.

In addition, oral contraceptives and pregnancy cause hormonal changes, which can negatively impact oral health. Women who are planning to become pregnant need to know that their periodontal health can affect their babies. “Pregnant women who have periodontal disease may be seven times more likely to have a baby that is born too early and too small,” said Schoor.

A referral to a periodontist in your area and free brochure samples including one titled Something To Smile About: Periodontal Cosmetic Procedures to Enhance Your Smile are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for

“Dental implants are a unique gift idea because they look and feel like real teeth and will be appreciated for years,” said Dr. Jack Caton, president of the American Academy of Periodontology. “Dental implants are permanent tooth replacements that look and feel so much like natural teeth, patients usually forget they’re not.”

A dental implant is an artificial tooth root placed into the jaw to hold a replacement tooth or bridge in place. Since the dental implant integrates into the structure of the bone, it prevents the bone loss and gum recession that often accompanies bridgework and dentures. While high-tech in nature, dental implants are actually more tooth-saving than traditional bridgework, since implants do not rely on neighboring teeth for support.

“Dental implants not only create a winning smile, but more importantly have significant functional benefits to overall good health,” said Caton. “People with dentures or loose and missing teeth have restricted diets since biting into fresh fruits and vegetables is often not only difficult, but also painful. Dental implants are so secure that the patient will never give a second thought when biting into a crisp apple.”

Periodontal disease is a major cause of tooth loss for Americans. Periodontal disease is a bacterial gum infection that destroys the attachment fibers and supporting bone that hold the teeth. If left untreated, periodontal disease can lead to tooth loss. Periodontal disease can be a silent disease, but oftentimes it does come with warning signs.

Warning signs of periodontal disease may include:

• persistent bad breath
• gums that bleed when you brush your teeth
• red, swollen and bleeding gums
• gums that have pulled away from the teeth
• loose or separating teeth
• pus between the gum and tooth
• a change in the way your teeth fit together when you bite

Dental implants will require the same type of care as your own teeth. It is important to keep the dental implant clean with at-home oral care and regular dental visits. “After treatment, the periodontist will work closely with the patient and dentist to develop the best care plan for the patient’s treatment goals,” says Caton.

A referral to a periodontist in your area and free brochure samples are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for

Are the majority of your patients adequately concerned about the health of their gums?

Periodontal disease is a major cause of tooth loss in adults. Nearly 90 percent of the 201 periodontists polled reported that flossing frequency is one of the areas of oral care that patients are most lax in, and about 61 percent reported that their patients’ flossing technique could use improvement, two essential components of an effective oral care regimen.

According to the poll, the biggest offenders are overwhelmingly male patients. Ninety-seven percent of those surveyed reported that their female patients practice better oral hygiene habits than males.

Not only is it important for patients to establish a regular routine for oral care, it is also important that they use proper techniques so that they don’t damage their gums. In the survey, hard bristled toothbrushes beat out popcorn seeds and candy as the item having done the most damage to patients’ periodontal health. And several periodontists wrote in that they’d also seen improperly used oral rinses, toothpicks and floss holders cause damage.

Unsatisfactory home care seems to persist despite the fact that nearly all the periodontists surveyed reported that they or a staff member review and ask patients to demonstrate oral home care techniques either every visit or on those visits when it seems necessary. When trying to motivate and educate patients, periodontists report that mirrors, X-rays, and drawings or photos depicting periodontal disease are helpful. “I like to have the patient and spouse in the exam room and show both, with a hand mirror, the difference between healthy gums and disease. I point out plaque and pocket depths,” said Steven Uretsky, D.M.D., a private practitioner in Pittsburgh. Patients should not be afraid to ask their periodontists to help them improve their oral care techniques or to use visuals to help them understand what’s happening in their mouth, said survey participants.

And, when it comes to motivating factors to accept treatment, nearly 71 percent of periodontists reported their patients are most motivated by a fear of loosing teeth. However, other important reasons cited for seeking periodontal treatment included aesthetic reasons such as improving the look of the gum line or getting rid of bad breath, improving functional problems such as difficulty chewing, and lowering the risk of heart disease, respiratory disease, preterm births or diabetes.

While patients often cite lack of time and dexterity problems as reasons for not flossing, many periodontists report having heard some rather unique excuses, including: I used all of my floss tying up my tomato plants; I gag when I see what comes out when I floss; and, my kids use it to tie up their siblings, so we can’t keep it in the house. Excuses aside, as many periodontists like to point out, it’s only important to floss the teeth you want to keep.

A referral to a periodontist in your area and free brochure samples including one titled How to Brush and Floss are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for

A dental implant is an artificial tooth root placed into the jaw to hold a replacement tooth or bridge in place. Nearly 88 percent of the 295 periodontists polled reported that they perform implant surgery. Many of these respondents wrote in that their patients with implants often tell them that they forget the implants are not their natural teeth.

The survey showed that people from all age groups are opting for implants. However, 43 percent of the periodontists polled said half or more of the implants they place are for people ages 55 to 79, while 31 percent reported that half or more of the implants that they place are for the baby boomers – people ages 35 to 54. The top reasons for tooth loss leading to implant placement were periodontal disease, tooth decay and accidents, violence or injuries.

Dental implants have proven to be the answer for many people with missing or damaged teeth – from the 21-year-old woman who had trained herself not to smile or laugh for fear of exposing her damaged front teeth to the public speaker who had experienced losing his teeth during a speech. “I’ve been told by my patients that getting implants changed their whole life and made them look and feel younger,” said Ira Port, D.M.D., a periodontist in Toms River, N.J., echoing a sentiment expressed by many of the periodontists surveyed.

Periodontists say the biggest deterrent for patients who decide against dental implants is cost. The average charge for a single implant placed by a periodontist is between $1,000 and $2,000, according to the survey. Implants are usually not covered by dental insurance. However, periodontists point out that implants, while expensive in the short term, are long-lasting and more tooth-saving than traditional bridgework since they do not rely on neighboring teeth for support. “You can’t put a price tag on some of the esthetic and health benefits of dental implants,” said Michael McGuire, D.D.S., president of AAP. “Dental implants integrate with the jawbone to help prevent the loss of bone that accompanies conventional dentures or bridges. Loss of bone can lead to visible defects for people missing a single tooth or collapsed smiles for people who have lost all of their teeth. In addition, implants allow most people to return to a regular diet, including apples and corn on the cob.”

Another deterrent cited by about 10 percent of the periodontists was the time commitment involved in getting implants. The survey found that on average placing a single implant takes between five-and-a-half and seven-and-a-half months. After the implant is placed, it usually takes about two to six months for it to bond with the bone to form an anchor for the artificial tooth. During this time a temporary tooth replacement option can be worn. Often, a second step is then necessary to uncover the implant and attach an extension, which completes the foundation for the new tooth. The gums are allowed healing time following this step.

About 73 percent of periodontists described the level of pain or discomfort that the majority of patients experience in the process of getting implants as very little to none. Another 23 percent said getting implants is only somewhat painful or uncomfortable during limited periods of time. Many periodontists wrote in that their patients have commented after getting implants that they were surprised by the lack of pain.

Not everyone is a candidate for dental implants. Adequate bone in your jaw is needed to support the implant, and the best candidates have healthy gum tissues that are free of periodontal disease. People who have missing or damaged teeth should ask their periodontists if they are a candidate and about the process and cost involved for them.

A referral to a periodontist in your area and free brochure samples including one titled Dental Implants: Teeth that Look and Feel Just Like Your Own are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for

Researchers analyzed the case of a 26-year-old female who had localized gingival recession around the area of her lip piercing. The patient noticed soon after getting the oral barbell that her gums started to progressively recede in the area of the piercing. The barbell had direct contact with the area where the gums were receding. Since the patient’s gingival recession was present only in the area of the oral metal device, the piercing was considered to be the cause of the gingival recession.

Click for enlarged photo.

“Oral piercing has become a popular trend, and most people do not seek advice from a dental or medical professional prior to the piercing,” said Michael McGuire, D.D.S, president of the American Academy of Periodontology (AAP). “Another important concern is hygienic maintenance of the pierced oral area. The mouth contains millions of bacteria, and infection is a common complication of oral piercing.”

Other consequences of oral piercing may include swelling, increased flow of saliva, pain, fractured teeth, interference with speech and metal hypersensitivity. “Many people with oral piercing do not think about the harmful effects it can have on their oral and overall health,” explained McGuire. “In this particular case, the doctors were surprised that the patient had a history of mitral valve prolapse, and she was unaware of the consequences of piercing on her medical status. In fact, a case of infective endocarditits following nasal piercing has been reported.”

A referral to a periodontist in your area and free brochure samples are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for

For example, nearly 39 percent of periodontists believe it is best to floss before brushing your teeth, while about 35 percent say after is better, according to an online survey of 195 periodontists conducted recently by the American Academy of Periodontology (AAP). In addition, about half of those surveyed said people should spend about two minutes brushing. However, another 43 percent recommend about three minutes or more.

“Patients often ask how long they should spend brushing,” said Ravi Smith, D.D.S., a periodontist in San Francisco. “I do not recommend a timed regimen. Rather, I tell them however long it takes for them to properly brush all surfaces of their teeth.”

As for oral care products that promote fresh breath, nearly 44 percent of respondents said using a tongue scraper is an important part of an oral care routine while about 56 percent said it’s not. In addition, about 63 percent recommend mouthwash to patients concerned about fresh breath, while nearly 37 percent do not. For a quick breath refresher, 43 percent say sugarless gum is the best option; about 28 percent said a breath mint; and nearly 18 percent said breath spray.

More agreement exists on how many times a day brushing and flossing is necessary. About 82 percent of periodontists said they recommend brushing two or three times a day, and nearly 74 percent recommend flossing once per day. About 82 percent of periodontists say they personally floss daily, a much larger percentage than in the general population.

“The answer to many of the common questions dental professionals hear from their patients is that really it depends on the individual,” said Michael McGuire, D.D.S., president of the AAP. “Therefore, I advise people to ask their dental professional to talk with them about oral care products and to teach them how to properly brush and floss.”

Many periodontitsts wrote in that teaching patients about proper oral care regimens can have dramatic effects. “I recently had a 65-year-old patient who said he had only flossed once in his life,” wrote one periodontist. I explained to him the importance of cleaning between his teeth. He came back for an evaluation two months after treatment and said he was now flossing five days a week. Needless to say, his periodontal health has improved significantly.”

A referral to a periodontist in your area and free brochure samples including one titled Who Is a Periodontist and Why Do I Need One? are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

The American Academy of Periodontology is a 7,900-member association of dental professionals specializing in the prevention, diagnosis and treatment of diseases affecting the gums and supporting structures of the teeth and in the placement and maintenance of dental implants. Periodontics is one of nine dental specialties recognized by the American Dental Association.

For more information, contact the AAP Public Affairs Department at 312/573-3243 or 312/573-3242.

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These procedures remain a beauty secret, even while 67 percent of periodontists report that they are doing more cosmetic periodontal procedures than they were five years ago.

“Cosmetic periodontal procedures can dramatically improve a smile’s appearance, often making a bigger change than more well-known smile enhancements such as tooth whitening,” said Michael McGuire, D.D.S., president of the AAP.

For gummy smiles, crown lengthening recontours excess gum and bone to expose more of the natural tooth. Conversely, when teeth appear too long, soft tissue grafts cover exposed roots with gum tissue from another source. Most of the time, periodontists perform crown lengthening and soft tissue grafts for functional rather than esthetic reasons. Crown lengthening is often done to prepare a tooth that is to be fitted with a crown, and soft tissue grafts protect exposed roots from decay and can reduce further recession and bone loss.

However, when these procedures have major esthetic benefits, periodontists agree it is rewarding for them and can be life changing for their patients.

“A young woman visited my office for an evaluation of her gummy smile,” relates David Lamberts, DDS, a periodontist in Grand Rapids, MI. “She would not smile very wide, even though she had beautiful teeth. We did crown lengthening on her six upper front teeth. Now she confidently displays a gorgeous wide smile.”

Before Treatment	After Crown Lengthening
Click for enlarged photos Photos by David Lamberts, DDS

A referral to a periodontist in your area and free brochure samples including one titled Something to Smile About: Periodontal Cosmetic Procedures to Enhance Your Smile are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for

Researchers from Loma Linda University School of Dentistry and Ohio State University College of Dentistry examined and surveyed 52 young adults with pierced tongues. They found gum recession in 35 percent of subjects with pierced tongues for four or more years, and in 50 percent wearing long-stemmed barbells for two or more years.

“During tongue movement, long-stem barbells are more likely to reach and damage the gums than short barbells,” said Dr. Dimitris Tatakis, professor of periodontology at the Ohio State University College of Dentistry and coauthor of the study. “Over time, this damage may cause the gums to recede, which can lead to more serious dental/oral complications.”

Additionally, 47 percent of young adults wearing either type of barbell for four or more years had chipped teeth. The prevalence of tooth chipping was significantly greater in those wearing short-stemmed barbells (1/4 inch – 5/8 inch) for four or more years.

Researchers believe tooth chipping is a result of habitual biting of the barbell. “A short barbell is possibly easier to position between teeth, which could be one reason why we are seeing more chipped teeth in this group,” said Tatakis. “Another factor that was not investigated could be the size or material type of the screw caps attached to the barbell.”

Dr. Timothy Roberts from the University of Rochester School of Medicine in New York presented study results on 4,500 adolescents aged 12 to 21 and found that teens with body piercings are more likely to smoke cigarettes, use drugs and exhibit other types of unhealthy behavior. Study findings were presented at the Society of Adolescent Medicine’s annual meeting in Boston.

“Mouth piercings and smoking combined could cause a mouthful of trouble,” said Dr. Kenneth Bueltmann, president of the American Academy of Periodontology. “As a smoker, you are more likely than nonsmokers to have calculus on your teeth, deep pockets between your teeth and gums and loss of the bone and tissue that support your teeth. Combine these problems with gum recession from tongue piercing and you are on your way to having a serious infection called periodontal disease and not to mention a not so cool looking mouth.”

“Given this new information, I strongly recommend discussing potential risk factors with your dentist before mouth piercing,” said Bueltmann. “Additionally, anyone with a pierced mouth should receive a thorough oral examination of their gums and teeth to identify problem areas. Taking precautions now will increase your chance of keeping your teeth for a lifetime instead of needing dentures like many of your grandparents.”

In addition to periodontal diseases (serious bacterial infections that destroy the attachment fibers and supporting bone that hold your teeth in your mouth) tongue piercing may cause other complications such as t ongue swelling, difficulties with chewing, swallowing and speech, increase of saliva flow, localized tissue overgrowth and metal hypersensitivity.

A referral to a periodontist in your area and free brochure samples are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for