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If you have been told you have periodontal (gum) disease, you're not alone. An estimated 80 percent of American adults currently have some form of the disease.
Gum disease is a threat to your oral health. Research is also pointing to possible health effects of periodontal diseases that go well beyond your mouth. Whether it is stopped, slowed or gets worse depends a great deal on how well you care for your teeth and gums every day.
Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless "plaque" on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form bacteria-harboring "tartar" that brushing doesn't clean. Only a professional cleaning by a dentist or dental hygienist can remove tartar.
The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called "gingivitis." In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.
When gingivitis is not treated, it can advance to "periodontitis" — which means "inflammation around the tooth." In periodontitis, gums pull away from the teeth and form "pockets" that are infected. The body's immune system fights the bacteria as the plaque spreads and grows below the gum line. 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. If not treated, the bones, gums and connective tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.
People usually don't show signs of gum disease until they are in their 30s or 40s. Men are more likely to have periodontal disease than women. Although teenagers rarely develop periodontitis, they can develop gingivitis, the milder form of gum disease. Most commonly, gum disease develops when plaque is allowed to build up along and under the gum line.
Here are some things you can do to prevent periodontal diseases:
Symptoms are often not noticeable until the disease is advanced. They include:
Any of these symptoms may signal a serious problem, which should be checked by a dentist. At your dental visit:
The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. Additionally, modifying certain behaviors, such as quitting tobacco use, might also be suggested as a way to improve treatment outcome.
The dentist, periodontist or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather and helps remove bacteria that contribute to the disease.
Medications may be used with treatment that includes scaling and root planing, but they cannot always take the place of surgery. Depending on the severity of gum disease, the dentist or periodontist may still suggest surgical treatment. Long-term studies will be needed to determine whether using medications reduces the need for surgery and whether they are effective over a long period of time. Here are some medications that are currently used:
|Medications||What is it?||Why is it used?||How is it used?|
|Prescription antimicrobial mouthrinse||A prescription mouthrinse containing an antimicrobial called chlorhexidine||To control bacteria when treating gingivitis and after gum surgery||It's used like a regular mouthwash|
|Antiseptic "chip"||A tiny piece of gelatin filled with the medicine chlorhexidine||To control bacteria and reduce the size of periodontal pockets||After root planing, it's placed in the pockets where the medicine is slowly released over time|
|Antibiotic gel||A gel that contains the antibiotic doxycycline||To control bacteria and reduce the size of periodontal pockets||The periodontist puts it in the pockets after scaling and root planning — the antibiotic is released slowly over a period of about seven days|
|Antibiotic micro-spheres||Tiny, round particles that contain the antibiotic minocycline||To control bacteria and reduce the size of periodontal pockets||The periodontist puts the micro-spheres into the pockets after scaling and root planning — the particles release minocycline slowly over time|
|Enzyme suppressant||A low dose of the medication doxycycline that keeps destructive enzymes in check||To hold back the body's enzyme response — if not controlled, certain enzymes can break down gum tissue||This medication is in pill form and used in combination with scaling and root planing|
Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications. A periodontist may perform flap surgery to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the patient, dentist and hygienist to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again.
In addition to flap surgery, your periodontist may suggest bone or tissue grafts. Grafting is a way to replace or encourage new growth of bone or gum tissue destroyed by periodontitis. A technique that can be used with bone grafting is called guided tissue regeneration, in which a small piece of mesh-like fabric is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow.
Since each case is different, it is not possible to predict with certainty which grafts will be successful over the long term. Treatment results depend on many things, including severity of the disease, ability to maintain oral hygiene at home and certain risk factors, such as smoking, which may lower the chances of success. Ask your periodontist what the level of success might be in your particular case.
When considering any extensive dental or medical treatment options, you should think about getting a second opinion. To find a dentist or periodontist for a second opinion, call your local dental society. They can provide you with names of practitioners in your area. Additionally, dental schools may sometimes be able to offer a second opinion. Call the dental school in your area to find out whether it offers this service.