S. Michael Thurman, DMD

Gum disease---or periodontal disease---is an infection of the bone and gum tissues caused by an accumulation of plaque and bacteria. Many symptoms of gum disease do not appear (or asymptomatic) until advanced stages of the disease, but indications may include persistent bad breath odor, sores or pus in between teeth, loose teeth or separation and movement in your regular bite, swollen gums, and bleeding when brushing or flossing. Although surgery is one option for combating gum disease, non-surgical treatments can be employed to help fight periodontal disease, such as Scaling and Root Planning (SRP).

SRP can be done in your general dentist's office by the hygienist and can save you thousands of dollars. However, gum disease is NOT curable, but can be maintained and its affects can be stopped and somewhat reversed. It is because of this reason that it is important that after your SRP procedure(s) that you see your dentist every 2-4 months for periodontal (gum) maintenance depending on the severity of the infection.   

Why can't I have a normal cleaning as opposed to an SRP?

Since gum disease is a chronic disease (meaning it gets worse over time) the bone and its ligaments around the teeth begin to deteriorate as the bacterial infection gets worse and worse. As the bone and ligaments deteriorate your teeth become loose and can start to shift, thus causing movement in your bite and eventually leading to tooth loss. A regular healthy mouth cleaning (prophy) does not address the infection, it is purely a preventive procedure and since you already have the infection you are then beyond preventive care. It's kind of like having a dirty car and polishing the car before it is clean. All you are doing is polishing the dirty onto the car and allowing the dirt to do more damage. 

Can I have a relapse of infection? If so, what do I do?

Yes, every patient with gum disease can relapse, because the disease is NON-CURABLE. Many patients have the initial SRP procedure and then quit treatment thinking they are cured; however, should a patient fail to maintain their gum maintenance the infection can return and should the infection come back worse surgery might be the next option. Sometimes when caught early enough the patient can be stabilized with another round of SRPs, but must maintain the gum maintenance appointments required to keep the infection at bay. 

Can't I just take an antibiotic to cure it?

Unfortunately, there is no antibiotic available to cure this disease. Scientists are unable to pin-point the direct cause of gum disease, therefore they are having a hard time developing an antibiotic cure-all. They have, however, developed an antibiotic called Arestin that when placed during the SRP procedure can help fight the bacterial infection that an SRP might leave behind.

So if you are experiencing any of the following symptoms:

·     persistent bad breath odor,

·     sores or pus in between teeth,

·     loose teeth or separation and movement in your regular bite,

·     swollen gums, and/or

·     bleeding when brushing or flossing.

Call your dentist today for a complete comprehensive exam and x-ray!

Why is pH so important?

pH is a measure of acidity.  The lower the pH, the more acidic something is, and the higher the pH, the more alkaline something is.  The pH scale goes from 1-14, 1 being the most acidic, 14 being the most alkaline, and 7 being neutral (like most water).

For years we have focused on the role of sugar in causing cavities.  While we know that sugar feeds the bacteria that produce acids, which in turn causes cavities, it is a prolonged acidic oral pH that is responsible for promoting these cavity-causing bacteria, and an acidic pH that is responsible for the demineralization of the enamel required for cavities to occur.

It breaks down like this. . .

If you want to stop the end result in this chain, you have to intercept the lowering of the pH, which you can do either by avoiding acidic and sugary food/drink and/or by using alkaline and neutralizing dental products.

Conversely, if we can keep the pH of the mouth neutral between meals, we can maintain health.  If the caries infection already exists, we can use alkaline pH products to promote the re-growth of healthy bacteria.

Advice from Dr. Thurman

• Limit not only sugary/carbohydrate containing items in your diet, but also even non-sugar containing acidic beverages (i.e. diet soda, coffee, tea, sparkling water, alcohol, sports drinks, energy drinks).  It is these items in the diet that can cause intense or long-lasting acidic pH in the mouth that then causes healthy bacteria to die and cavity-causing bacteria to thrive, thus leading to a caries infection. If you decide to drink any of these types of drinks brush or swish with water immediately after.
• Drink more water! Water is a natural pH stabilizer for your mouth.
• Brush and floss before you go to sleep. This prevents food from being broken down and used to feed the cavity-causing bacteria allowing them to work double-time on your teeth while you are sleeping and your mouth is at its most vulnerable.
• Have your teeth cleaned every 3-4 months a year along with a periodic dental exam and bitewing x-rays 2 times a year. That old adage: “Visit the dentist 2 times a year” is outdated and never clinically proven to be effective in helping stop infection.
• Consider the acidity (pH) of the dental products you are using.  Do they neutralize your mouth?  Know your pH.  Don't just brush and floss. . . neutralize!

pH and cavities

• Studies have shown that a prolonged acidic (low pH) oral environment can cause an overgrowth of acidic bacteria
• Acidic bacteria cause tooth decay
• Keeping a neutral or alkaline pH in the mouth can prevent acidic bacterial growth
• New dental products with alkaline pH, xylitol, and fluoride are now available

Oral Health has been Associated with Some Respiratory Diseases

Respiratory diseases account for one in six deaths in the United States, making them collectively the third most common killer of Americans.¹ A growing body of research has established an association between oral health and some respiratory diseases. Three systematic literature reviews in recent years suggest that the oral cavity may provide a reservoir for pulmonary pathogens.^2-4 Furthermore, all three reviews concluded that oral hygiene procedures lower the risk of lung disease among elderly institutionalized individuals. One review presented evidence of the highest rating (I-A) in support of oropharyngeal decontamination to reduce the occurrence or progression of respiratory diseases.² Another review pointed to strong evidence that mechanical oral hygiene decreases mortality risk from pneumonia; indeed approximately one in 10 cases of death from pneumonia among dependent elderly patients may be prevented by such measures.⁴ The third review suggested that oral interventions may lower the incidence of respiratory diseases among the institutionalized elderly at highest risk.³

Although the link has not been proven to be causal, there are two mechanisms that could explain such a relationship. First, dental plaque biofilm harbors both periodontal and pulmonary pathogens.1 That is of particular importance for patients in intensive care who are mechanically ventilated. Mechanical ventilation has a strong association with pneumonia, and recent work has demonstrated that bacterial isolates from dental plaque are genetically indistinguishable from those cultured from bronchoalveolar lavage of ventilated patients.5 Secondly, enzymes associated with periodontal disease and the pathogens that cause it may facilitate adherence of respiratory pathogens to airways while also destroying protective salivary pellicles, in turn reducing non-specific host defense mechanisms.2 In addition, cytokines released from the periodontium and carried with aspirated saliva of high-risk patients could upregulate expression of mucosal surface adhesion receptors, further potentiating pathogen colonization.2

Oral Hygiene for At-Risk Patients

Specific interventions shown to reduce nosocomial respiratory tract infections include frequent tooth brushing and the preoperative use of 0.12% or 0.2% chlorhexidine mouthrinse or gel.4 This illustrates the potential for elevated dental hygiene care to reduce the frequency of respiratory infections among patients most at risk for respiratory diseases. Such patients at risk, including smokers and patients with current acute or chronic respiratory conditions such as chronic obstructive pulmonary disease (COPD), should be considered for more frequent and intensive dental hygiene care. Other important risk factors for respiratory disease, particularly pneumonia, include female gender, advanced age, other diseases (i.e., diabetes or congestive heart failure), and immune suppression (i.e., among people with HIV or undergoing cancer therapy).1 It is worth noting that smoking is a risk factor common to both COPD and periodontitis.6

It has been established that oral hygiene intervention significantly reduces the occurrence of pneumonia in institutionalized subjects.2,3 Thus, dental hygienists who complete a thorough oral health assessment of their patients most at risk for respiratory diseases are well positioned to identify and address threats to good oral health, and potentially to reduce both the initiation and severity of common respiratory infections.1 Heightened oral hygiene care involving higher frequency visits is therefore warranted for at-risk patients. However, because aspiration of bacteria-bearing particulates from the mouth is especially dangerous in this group, procedures may need to be tailored. For example, debridement with ultrasonic instrumentation should be accompanied by high volume evacuation.6

Teamwork

The association between oral and respiratory health is another example of how dental care may effectively extend well beyond the mouth. It shows how critical a role dental hygienists may play beyond their traditional arena of care by working with caregivers, nurses, and other healthcare professionals to increase not only oral health, but general health as well.1

References

1. Gluch JI. Exploring the connection. The relationship between respiratory diseases and oral health. Dimensions Dent Hyg 2009;7(10):54-57.
2. Azarpazhooh A, Leake JL. Systematic review of the association between respiratory diseases and oral health. J Periodontol 2006;77(9):1465- 1482.
3. Scannapieco FA, Bush RB, Paju S. Associations between periodontal disease and risk for nosocomial bacterial pneumonia and chronic obstructive pulmonary disease. A systematic review. Ann Periodontol 2003;8(1):54-69.
4. Sjogren P, Nilsson E, Forsell M, Johansson O, Hoogstraate J. A systematic review of the preventive effect of oral hygiene on pneumonia and respiratory tract infection in elderly people in hospitals and nursing homes: effect estimates and methodological quality of randomized controlled trials. J Am Geriatr Soc 2008;56(11):2124-2130.
5. Heo SM, Haase EM, Lesse AJ, Gill SR, Scannapieco FA. Genetic relationships between respiratory pathogens isolated from dental plaque and bronchoalveolar lavage fluid from patients in the intensive care unit undergoing mechanical ventilation. Clin Infect Dis 2008;47(12):1562-1570.
6. Agado B, Bowen DM. Does the link between COPD and periodontitis affect dental hygiene treatment? Access 2009;23(4):19-21.

What is Diagnodent?

Diagnodent is a non-invasive, painless tool used for detecting tooth decay that is not yet visible and would otherwise be undiagnosed by conventional methods alone. Leaders in the field of dental research agree that, when used by themselves, the traditional methods of detecting tooth decay are inadequate and outdated for modern dentistry. With the flouridation of water and improved oral hygiene standards, the very nature of tooth decay has changed. Due to these factors, most of our patients have harder and more resistant tooth enamel, which can conceal even aggressive decay if it is under the tooth surface.

How Does Diagnodent Work?

Diagnodent works by scanning your teeth to measure fluorescence within your tooth structure. Healthy teeth will have little or no fluorescence. Teeth that have decay present will have higher levels of fluorescence, which are proportionate to how extensive the decay is. Diagnodent translates these fluorescence readings into a digital numeric output. Also, these changes in fluorescence and numeric value are emitted as an audio signal which signals the presence of decay as it goes up in tone.

Q: Does it hurt?

A: No! DIAGNOdent is completely painless. It’s energy level similar to that of a laser pointer, the laser beam is harmless to surrounding tissues.

Q: What are the shortcomings of the traditional dental techniques like probing and x-ray imaging?

A: Believe it or not, as much as 50% of tooth decay may go undetected by traditional dental methods of probing and other diagnostic techniques.

Q: How long has this technology been around?

A: While the device has been in use in Europe for several years, the FDA has recently approved the use of the cavity-detecting laser for use by dentists in the U.S.

Q: Where does most tooth decay start today?

A: Today most tooth decay starts in the hard-to-see valleys and canyon-like anatomy of the tooth surface.

Q: Why are these pit and valley cavities more important to detect today than in the past?

A: In the past tooth decay predominated in between teeth. With the widespread use of fluoride, the very nature of tooth decay has changed. The outer surfaces of teeth are strengthened and more resistant. Today the pit and valley cavities are more prevalent than cavities in between teeth.

Q: Why can’t traditional methods like x-rays see these pit and valley cavities?

A: Pit and valley cavities are traditionally the most difficult to detect using x-rays due to the direction the images are taken from. Images are taken from the side of the tooth, which essentially hides the cavity from the dentists view.

Q: If DIAGNOdent is good at finding pit and fissure cavities do I still need x-rays?

A: Yes, x-ray imaging is an indispensable diagnostic tool for dentistry. X-rays and DIAGNOdent complement each other. X-rays are good at finding cavities in between teeth and on the roots. DIAGNOdent is good at find cavities on the tooth’s biting surface.

Q: If you can’t see it with your naked eye then why should one be concerned?

A: An almost undetectable area of decay can aggressively penetrate inward towards the soft surfaces of the tooth and literally destroy the tooth from the inside out. This can happen before a cavity is even visible to the naked eye.

Q: Why can’t traditional methods like the dental probe find these pit and valley cavities?

A: This type of decay can make diagnosis with traditional methods difficult because the outer tooth surface often appears to be intact and the probe may be too large to detect the cavity.

Q: How does DIAGNOdent work?

A: DIAGNOdent is first calibrated to your unique tooth structure by scanning a cleaned tooth surface with a harmless laser beam. After calibration a team member will gently scan your teeth. A small countertop unit emits an audio signal and registers a digital read-out, which identifies cavities developing below the surface - the higher the amount of fluorescence detected by the machine, the greater the degree of decay within the tooth.

Q: What is the benefit to me?

A: Because the decay is detected earlier, the number of dental procedures - and hence, the cost - can often be reduced. It’s a great way to keep little problems from becoming big problems.

Q: How long does the DIAGNOdent process take?

A: A few minutes are all it takes to scan your entire mouth.

Q: How much does it cost?

A: Dr. Thurman uses the DIAGNOdent laser as a routine part of exams and there is no additional fee associated with the scan.

Q: What is the DIAGNOdent actually measuring?

A: The DIAGNOdent measures laser fluorescence within the tooth structure. As the incident laser light is propagated into the site, two-way handpiece optics allows the unit to simultaneously quantify the reflected laser light energy. At the specific wavelength that the DIAGNOdent laser operates, clean healthy tooth structure exhibits little or no fluorescence, resulting in very low scale readings on the display. However, carious tooth structure will exhibit fluorescence, proportionate to the degree of caries, resulting in elevated scale readings on the display.

Q: Can DIAGNOdent read caries under an existing amalgam?

A: If there is caries at the margin, it will give an accurate reading; however if the caries is under the floor of the amalgam the reading will not be accurate.

Q: Can DIAGNOdent be used on both primary and permanent teeth?

A: Studies have shown the unit is equally accurate in both primary and permanent teeth.

Q: As the device is a laser, is protective eye wear required?

A: No. The device is harmless when used as directed.

ViziLite Plus as part of a comprehensive oral screening

Oral cancer is one of the most curable diseases when it's caught early. That's why the ViziLite Plus exam has been developed. ViziLite Plus uses technology that has proven successful in identifying soft tissue abnormalities in other areas of the body. A ViziLite Plus exam is particularly important if you are at increased risk for developing oral cancer.

The ViziLite Plus exam can help your dentist or hygienist identify abnormal tissue, that might develop into oral cancer.

An annual ViziLite Plus exam, in combination with a regular visual examination, provides a comprehensive oral screening procedure for patients at increased risk for oral cancer. The ViziLite Plus exam is painless and fast, and could help save your life.

ViziLite Plus is performed immediately following yearly visual examinations.

Importance of Early Detection

Early detection is the key to reducing the devastating impact of oral cancer on victims and their families. Annual oral cancer screening of patients at increased risk for oral cancer, patients age 18 and older, and tobacco users of any age, is the only way to achieve the early detection of oral cancer necessary to reduce the death rate of oral cancer - a death rate that has remained unchanged for more than 40 years.

Doesn't my dentist already do a cancer screening?

Yes, your dentist does check your neck and oral tissues for lumps, red or white patches or recurring sore areas. But typically, these techniques catch cancer at very advanced stages and mortality drops dramatically. Early detection is key to a successful treatment. With Vizilite Plus Dr. Thurman can detect early stages of cancer more easily and should be checked yearly.

Did you know that Charleston County has one of the highest percentage of Oral Cancer Cases in SC?

An estimated 28,000 new cases of oral cancer and 7,200 deaths from these cancers occurred in the United States in 2004. The age-adjusted incidence was more than twice as high among men than among women, as was the mortality rate. More than 40% of persons diagnosed with oral cancer die within five years of diagnosis.

More than 90% of oral cancers can be attributed to tobacco use, alcohol use, and both tobacco and alcohol use. Sun exposure can also be a risk factor for oral cancer. Low consumption of fruit and some types of human papilloma virus infections have also been implicated.

Oral cancer is the 9th most common cancer in South Carolina, with 2,897 oral cancers diagnosed between 1996 and 2001 (or about 480 new cases per year). South Carolina ranks 2nd in the nation for deaths from oral cancer. The majority (70%) of oral cancers occurred in males, with black males having the highest incidence. There are three counties in South Carolina (Charleston, Georgetown, and Richland) with oral cancer rates higher than the state average.

Invisalign is a patented proprietary system that uses 3D modeling software and cutting-edge manufacturing technology to provide a clear, removable solution for straightening teeth. Invisalign is effective at treating a wide variety of orthodontic issues including:

• Crowding
• Spacing
• Overbite
• Underbite
• Deep bite
• Open bite

Invisalign was designed with leading orthodontists and is FDA cleared.

Invisalign has the experience of over 1,000,000 patients worldwide, and has a 96% of patient satisfaction rate. And, 9 out of 10 patients would recommend Invisalign to their friends and family.

In today’s busy and aesthetically-conscious world, many patients prefer Invisalign’s clear and removable orthodontic solution to traditional brackets and wires. There are a number of other
clear aligners out there, however none have the product experience, efficacy and customization
of Invisalign.

How is it made?

Designed just for you

So what happens when you decide Invisalign is for you? Simply visit Dr. Thurman, an Invisalign-trained doctor, for a consultation to discuss the goals you have for your smile. Once Dr. Thurman determines that Invisalign is right for you, he will write up a detailed treatment plan, and a set of virtually invisible aligners will then be sent to Dr. Thurman. Your Invisalign system may look like a simple piece of plastic, but it's much more. With advanced technology, your Invisalign aligners are custom-made for you, and only you. Over time, your teeth should move to reveal the smile you've been looking for. So take a look at the steps you and Dr. Thurman will take to get you to a brand-new smile.

Step 1

Your initial consultation with Dr. Thurman, offered free of charge. During this visit, you'll discuss the issues you have with your teeth and what kind of results you would like to see. Once Dr. Thurman decides your situation is suitable for Invisalign treatment, a treatment plan will be mapped out with your goals in mind. Then, impressions and pictures of your teeth will be taken for digitization purposes.

Step 2

The impressions of your teeth will be digitized in order for your doctor to work with a computerized 3-D image of your teeth. Then,
Dr. Thurman will plan your tooth movements throughout your entire treatment timeline. You'll be able to see a virtual representation of your teeth before, during, and after completion of the Invisalign process so you can see what your smile should look like when you're done with treatment.

Step 3

From Dr. Thurman's precise treatment plan, customized aligners are created with advanced technology for you to wear at each stage of your treatment. While the number of aligners varies for each individual situation, a full set of treatment typically includes 20-30 aligners per arch.

Step 4

You should wear your aligners at all times, with the exception of eating and drinking, in order to complete your treatment in the timeline determined by you and Dr Thurman. You'll go in for occasional checkups, to monitor your progress and to receive your next set of aligners. During the entire treatment process, you'll be able to watch your teeth gradually moving into place. Your smile will, little by little, move into something you'd like to show off. The people around you will be sure to notice your new-found confidence.

And for a limited time, until April 15, 2010, you can receive a $1000 savings on Invisalign Treatment and get entered into our drawing for additonal prizes. Call or email the office for your Complimentary Invisalign Consult today!

S. Michael Thurman, DMD, PA               

(843)884-6166

info@MThurmanDMD.com                                                                                                                               

What Is Periodontal Disease?

If your hands bled when you washed them, you would be concerned. Yet, many people think it's normal if their gums bleed when they brush or floss. In a 1999 study, researchers at the U.S. National Institutes of Health (NIH) found that half of Americans over 30 had bleeding gums.

Swollen and bleeding gums are early signs that your gums are infected with bacteria. If nothing is done, the infection can spread and destroy the structures that support your teeth in your jawbone. Eventually, your teeth can become so loose that they have to be extracted.

"Perio" means around, and "dontal" refers to teeth. Periodontal diseases are infections of the structures around the teeth, which include the gums, periodontal ligament and alveolar bone. In the earliest stage of periodontal disease — gingivitis — the infection affects the gums. In more severe forms of the disease, all of the tissues are involved.

For many years scientists have been trying to figure out what causes periodontal disease. It is now well accepted that various types of bacteria in dental plaque are the major villains. Researchers also are learning more about how an infection in your gums can affect your overall health.

In recent years, gum disease has been linked to a number of other health problems. This is a new and exciting area of research, but it remains controversial. Studies have produced varying answers about the extent of the connection between gum disease and other medical problems, and more research is needed.

Researchers are studying possible connections between gum disease and:

• Atherosclerosis and heart disease — Gum disease may increase the risk of clogged arteries and heart disease, although the extent of this connection is unclear. Gum disease also is believed to worsen existing heart disease.
• Stroke — Gum disease may increase the risk of the type of stroke that is caused by blocked arteries.
• Diabetes — people with diabetes and periodontal disease may be more likely to have trouble controlling their blood sugar than diabetics with healthy gums
• Premature births— A woman who has gum diseases during pregnancy may be more likely to deliver her baby too early and the infant may be more likely to be of low birth weight. One study showed that up to 18% of premature, low-birth-weight babies might be linked to maternal gum disease.
• Diabetes — People with diabetes and periodontal disease may be more likely to have trouble controlling their blood sugar than diabetics with healthy gums.
• Respiratory disease— Gum disease may cause lung infections and worsen existing lung conditions when bacteria from the mouth reach the lungs.

What Causese Periodontal Disease?

Periodontal disease is caused by bacteria in dental plaque, the sticky substance that forms on your teeth a couple of hours after you have brushed. Interestingly, it is your body's response to the bacterial infection that causes most of the problems. In an effort to eliminate the bacteria, the cells of your immune system release substances that cause inflammation and destruction of the gums, periodontal ligament or alveolar bone. This leads to swollen, bleeding gums, signs of gingivitis (the earliest stage of periodontal disease), and loosening of the teeth, a sign of severe periodontitis (the advanced stage of disease).

Practicing good oral hygiene and visiting your dentist regularly (about once every six months, or more often if you have gum disease) can prevent periodontal disease. Daily brushing and flossing, when done correctly, help remove most of the plaque from your teeth. Professional cleanings by your dentist or dental hygienist will keep plaque under control in places that are harder for a toothbrush or floss to reach.

If oral hygiene slips or dental visits become irregular, plaque builds up on the teeth and eventually spreads below the gum line. There, the bacteria are protected because your toothbrush can't reach them. Good flossing may help dislodge the plaque; but if it is not removed, the bacteria will continue to multiply, causing a more serious infection. The buildup of plaque below the gumline leads to inflammation of the gums. As the gum tissues become more swollen, they detach from the tooth forming a space, or "pocket," between the tooth and gums. In a snowball effect, the pockets encourage further plaque accumulation since it becomes more difficult to remove plaque. If left untreated, the inflammatory response to the plaque bacteria may spread to the periodontal ligament and alveolar bone, causing these structures to be destroyed.

Another problem is that if plaque is allowed to build up on teeth, over time it becomes calcified, or hardened, and turns into calculus (commonly called tartar). Since calculus is rougher than tooth enamel or cementum (a layer that covers the tooth root), even more plaque attaches to it, continuing this downward spiral. Using a tartar-control toothpaste may help slow accumulation of calculus around your teeth, but it can't affect the tartar that has already formed below the gum line.

Risks and Prevention

Although bacterial plaque buildup is the main cause of periodontal disease, several other factors, including other diseases, medications and oral habits, also can contribute. These are factors that can increase your risk of gum disease or make it worse once the infection has set in.

• Genetics — Researchers believe up to 30% of the population may have a genetic susceptibility to periodontal disease. Having a genetic susceptibility, however, doesn't mean gum disease is inevitable. Even people who are highly prone to periodontal disease because of their genetic make-up can prevent or control the disease with good oral care.
• Smoking and tobacco use — Smoking increases the risk of periodontal disease and the longer, and more one smokes, the higher the risk. If periodontal disease is present, smoking makes it more severe. Smoking is the main cause of periodontal disease that is resistant to treatment. Smokers tend to collect more tartar on their teeth, develop deeper periodontal pockets once they have gum disease and are likely to lose more bone as the disease progresses. Unlike many other factors that affect the health of your gums, you have control over this one. Quitting smoking can play a major role in bringing periodontal disease under control.
• Misaligned or crowded teeth, braces or bridgework — Anything that makes it more difficult to brush or floss your teeth is likely to enhance plaque and tartar formation above and below the gum line, which increases your chance of developing gum disease. Dentists and periodontists can show you the best ways to clean your teeth, especially in hard-to-clean circumstances. For example, there are special tools and ways of threading floss to clean around bridgework or slide under braces. And if overcrowded or crooked teeth are a problem, your dentist might recommend orthodontics to straighten out your smile and give you a better chance of preventing disease.
• Grinding, gritting or clenching of teeth — These habits won't cause periodontal disease, but they can lead to more severe disease if inflammation is already present. The excessive force exerted on the teeth by these habits appears to speed up the breakdown of the periodontal ligament and bone. In many cases, patients can learn to stop this habit simply by recognizing when it is happening and then relaxing. If these efforts don't work, your dentist or periodontist can create a custom guard appliance (sometimes called an occlusal guard, night guard, mouth guard or bite guard) that helps reduce the pressure of clenching or grinding on the teeth.
• Stress — Stress can worsen periodontal disease and make it harder to treat. Stress weakens your body's immune system, which makes it harder for your body to fight off infection, including periodontal disease.
• Fluctuating hormones — Whenever hormones fluctuate in the body, changes can occur in the mouth. Puberty and pregnancy can temporarily increase the risk and severity of gum disease, as can menopause.
• Medications — Several types of medications can cause dry mouth, or xerostomia, including antidepressants, diuretics and high blood-pressure medications. Without the protection of adequate amounts of saliva, plaque is more likely to form. Other medications may cause the gums to enlarge, which in turn makes them more likely to trap plaque. These medications include phenytoin (Dilantin and other brand names), used to control seizures; cyclosporine (Neoral, Sandimmune), used to suppress the immune system; and nifedipine (Adalat, Cardizem and others) and other calcium channel blockers, used to treat angina or heart arrhythmias.
• Diseases — Although the exact mechanisms aren't totally understood, certain diseases increase susceptibility to periodontal diseases. For example, people with diabetes are more likely to get periodontitis, than people without diabetes and it's likely to be more severe. Other diseases, such as leukemia, inflammatory bowel disease and HIV infection, also can increase the risk. Having one of these diseases will make control of periodontal disease more difficult, but a good periodontist or dentist who is aware of the additional risks and difficulties should be able to offer the kind of guidance needed to maintain your periodontal health.
• Poor nutrition — Nutrition is important for overall good health, including a working immune system and healthy gums and mouth.

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