Assesing Your Risk for Peridontol Disease
Periodontal disease or “gum disease” is typically caused by a build-up of plaque beneath the gum line. The bacteria in the plaque ignite the body’s inflammatory response, and the gums become red, swollen, and even bloody. While the main cause of periodontal disease is inflammation as a result of bacteria, other habits or environmental conditions, referred to as risk factors, can increase the likelihood that an individual will develop gum disease.
Common risk factors of periodontal disease include:
Age: Recent data from the Centers for Disease Control and Prevention (CDC) found that almost half of Americans over the age of 30 have some form of periodontal disease. In adults 65 and older, prevalence rates increase to 70.1 percent.
Smoking/tobacco use: Studies have shown tobacco use to be one of the most significant risk factors in the development and progression of periodontal disease.
Genetics: Research has found that a family history of periodontal disease may increase a person’s susceptibility to gum disease. Genetic testing can be conducted to identify if you are predisposed to periodontal disease.
Stress: Stress can make it more difficult for the body to fight off infection, including periodontal disease.
Medication: Some drugs like oral contraceptives, anti-depressants, and certain heart medicines can affect your periodontal health.
Poor nutrition and obesity: A diet low in nutrients can make it harder for the body to fight off infection. Research has also found obesity may increase the risk of periodontal disease.
Poor oral hygiene: Ignoring teeth and gums allows plaque to build up along the gum line. Not routinely brushing and flossing can easily lead to gingivitis, the first stage of periodontal disease.
Other systemic diseases: Recent studies have linked diabetes, cardiovascular disease, rheumatoid arthritis and erectile dysfunction to periodontal disease. These and other systemic diseases could interfere with the body’s inflammatory system and may worsen the condition of the gums.
It is recommended that you see a periodontist or dentist once a year for a comprehensive periodontal evaluation to assess gum health. If you are experiencing any of the risk factors mentioned, inform your periodontist, dentist, or hygienist so he or she can look for early signs of periodontal disease.
Considering risk factors as part of the treatment planning process allows for proactive management of an individual’s periodontal health and can potentially reduce the need for more complex periodontal procedures in the future.
Your Annual Comprehensive Periodontal Evaluation (CPE)
You already know that visiting your dental professional regularly for a check-up and cleaning is an essential part of keeping your oral health at its best. However, these visits may not specifically look for signs of periodontal disease.
The American Academy of Periodontology (AAP) recommends that you receive a comprehensive periodontal evaluation, or CPE, annually to determine if you have or if you are at risk for periodontal disease. By assessing your periodontal health yearly, you and your dental professional will know how healthy your teeth and gums are, and will be better able to assess if you need additional treatment. Your CPE can be performed at your regular yearly check-up by a member of the dental team, including a general dentist, registered dental hygienist, or periodontist.
Your dental professional will assess these six areas during your CPE:
- Your Teeth: Your dental professional will examine your teeth and any restorations you might have, including dental fillings, dental implants, crowns, and dentures. During the examination of your teeth, he or she will note the position of the teeth and their closeness to one another.
- Your Plaque: The amount and location of any plaque and/or tartar will be assessed
- Your Gums: An instrument called a dental probe will be inserted into the space between your tooth and gums to measure the depth of your gum pockets and to see how well your gums attach to your teeth. Any bleeding that occurs during the probing process, as well as any inflammation of your gums, will also be recorded.
- Your Bite: Your dental professional will then observe your bite, also known as occlusion. While you bite down, your dental professional will look to see how your teeth fit together and for any signs of tooth movement or loose teeth. This is important because moving or loose teeth can be a sign of periodontal disease.
- Your Bone Structure: Your dental professional will examine the bone in and around your mouth since it can be affected by periodontal disease. X-rays may be taken to help evaluate the quality of bone in your upper and lower jaw areas and to determine if any bone loss has occurred.
- Your Risk Factors: You will be asked about a variety of risk factors for periodontal disease, including age, tobacco use, if anyone else in your family has periodontal disease, or if you have another systemic condition that may be linked to periodontal disease, such as diabetes or cardiovascular disease.
When your dental professional has finished your comprehensive periodontal evaluation, he or she will discuss the findings with you and explain if any treatment is needed. This is a good time to ask any questions you may have about the evaluation, findings, or anything else regarding your oral health.
In addition to brushing twice each day, flossing at least once each day, and seeing your dental professional for regular cleanings, receiving your annual CPE is an essential part of your oral health routine.
I Have Periodontal Disease: What Happens Next?
If you’ve recently been diagnosed with periodontal disease, you probably have some questions about your treatment. Be assured that periodontists believe that periodontal therapy should be achieved in the least invasive and most cost-effective way possible; this includes non- surgical therapy.
Remember that the first step toward good oral health begins with proper oral hygiene. This includes brushing your teeth at least twice each day and flossing at least once each day. Good oral hygiene along with regular visits to a dental professional, such as a periodontist, can go a long way toward preventing certain forms of periodontal disease and reversing gingivitis, an early stage of periodontal disease.
If you have more significant disease, you may require an in-depth cleaning called scaling and root planing (SRP). SRP is a careful cleaning of the tooth root surfaces to remove plaque from pockets and to remove bacteria and toxins from the tooth root. Research has consistently shown that SRP reduces inflammation of the gums and reduces the amount of bacteria associated with periodontal disease. Due to these positive findings, SRP is usually the first mode of treatment recommended for most patients. In fact, many people do not require any further active treatment after SRP.
In some cases, systemic antibiotics (antibiotics that are taken by mouth) are prescribed at the time of SRP to help control bacteria levels. However, each time you take an antibiotic you increase your chance of developing drug resistant bacteria. Therefore, it is very important to take antibiotics only when necessary. Instead of a systemic antibiotic, your periodontist may prescribe a local delivery antimicrobial, medication that is delivered directly into periodontal pockets to control or kill periodontal bacteria. In general, local delivery antimicrobials do not lead to antibiotic resistance.
When tooth surfaces are not in harmony between the upper and lower teeth, an occlusal adjustment may be necessary. This is because teeth that do not properly fit together can affect the rate of progression of periodontal disease. During this procedure, your periodontist may take a mold of your teeth to determine the areas of concern, which will be adjusted. You may also need to wear an occlusal guard or night guard to be worn at certain times of the day to minimize the effects of teeth grinding.
Following adequate time to respond to your treatment, you will be asked to return to your periodontist to determine if further treatment is necessary. If you need further treatment, your periodontist, in collaboration with your general dentist will develop a treatment plan to help restore your smile to a state of health. If you don’t need further treatment, you’ll enter into a maintenance phase. These appointments are usually more thorough than traditional six-month cleanings and may occur more often, which will help protect the health of your teeth and gums.
All About Dental Implants
A dental implant is an artificial tooth root that is placed into your jaw to hold a replacement tooth or bridge. Dental implants are an ideal option for people in good general oral health who have lost a tooth or teeth due to periodontal disease, an injury, or some other reason. If you still have questions after reading this information, have a conversation with your periodontist.
What procedures may have to be completed before placing my implant?
A procedure called “socket preservation” is sometimes needed to preserve bone and minimize bone loss adjacent to a tooth that has been removed. One common technique is to fill the socket with bone or bone substitute and allow the bone to heal for approximately four to twelve months before implant placement.
“Ridge modification” may be needed if you don’t have enough bone to support an implant. This bone loss could be caused by periodontal disease, wearing dentures, injury, or trauma. During this procedure, bone or bone substitute is added where needed to ensure a proper foundation for implants. Your bone usually needs four to twelve months of healing time before placing implants.
“Sinus augmentation” may be needed to place implants in the upper back jaw, where your bone is very close to your sinus. In this procedure, the sinus floor is raised so there is more room for new bone to grow to provide a proper foundation for implants. After four to twelve months of healing time, you will be ready to have your implants placed. All of these procedures have been shown to greatly increase your chances for successful
implants that can last for years to come.
What are the advantages of an implant over a bridge or denture? A dental implant provides several advantages over other tooth replacement options, including:
- Maintain the integrity of your remaining teeth. In addition to looking and functioning like a natural tooth, a dental implant replaces a single tooth without sacrificing the health of neighboring teeth. The other common treatment for the loss of a single tooth, a tooth-supported fixed bridge, requires that the adjacent teeth be ground down to support the cemented bridge. When replacing multiple teeth, bridges and partial dentures rely on support from adjacent teeth, while implant- supported bridges do not.
- Maintain bone health. Because a dental implant will replace your tooth root, your jawbone is better preserved. Implants integrate with your jawbone, helping to keep your bone healthy and intact. With a bridge or denture, some of the bone that previously surrounded the tooth starts to deteriorate.
- Long-term benefits. In the long term, implants are esthetic, functional, and comfortable. On the other hand, gums and bone can recede around a bridge or denture which leaves a visible defect, deteriorated bone from bridges and dentures can lead to a collapsed and unattractive smile, and cement holding bridges in place can wash out, allowing bacteria to decay the teeth that are anchoring the bridge. Finally, removable dentures can move around in your mouth, reducing your ability to eat certain foods.
Choose Tried-and-True Methods to Treat Gum Disease
Miracle cures, or quick fixes, have been around for centuries; certain foods, ointments, or potions have claimed to cure everything from hair loss to cancer. Marketed as quick, easy, and painless, these miracle cures often are not backed by science or approved by the Food and Drug Administration (FDA), which means that they may do more harm than good. Similar quick fixes that claim to treat periodontal disease are no different. Though elements of these quick and easy periodontal “cures” may be FDA approved, there may be little or no scientific proof that they are effective in the prevention and treatment of periodontal diseases. In fact, periodontal “miracle cures” may actually harm your oral health.
Periodontal disease is a chronic inflammatory disease that affects the gums and bone supporting the teeth, and has been associated with the progression of other diseases such as cardiovascular disease and diabetes. If you opt for a treatment for periodontal disease that has not been backed by scientific evidence, it’s possible that the treatment won’t effectively treat (or could even worsen) your condition. Just because a treatment is deemed “new” or “innovative” doesn’t mean that it works properly or better than more traditional treatments. By choosing the quick fix route first, your oral health may remain in poor condition and you may require additional treatment.
Instead, a better idea is to schedule an appointment with a periodontist when you notice signs of periodontal disease (red, swollen or tender gums; bleeding while brushing or flossing; gums that are receding or pulling away from the teeth; loose or separating teeth). A periodontist is a dentist who specializes in the prevention, diagnosis and treatment of periodontal disease and in the placement of dental implants. Periodontists receive extensive training in these areas, including three additional years of education beyond dental school. They are familiar with the latest techniques for diagnosing and treating periodontal disease, and their education and experience allow them to effectively treat periodontal disease using clinically proven treatments such as scaling and root planing, soft tissue grafts and regenerative procedures. A periodontist will evaluate your unique condition, and offer the treatment that is best for you; one that is supported by both science and experience. Your periodontist can also answer any questions that you may have about alternate treatment options.
Your oral health is invaluable. While quick fixes for periodontal disease may seem like a good option, it’s a better idea to research treatment options and discuss them with a periodontist first. The discussion has the possibility of saving you time and money in the long-run!
Your Gums and Your Smile
A smile is one of the most univer- sally recognizable expressions. Smiling can demonstrate a per- son’s happiness, confidence, at- tractiveness, sociability, and sin- cerity. However, the effects of gum disease or other oral tissue disorders cannot only be danger- ous to your health and well-being, but can also have the potential to ruin your smile.
Luckily, periodontists are the ex- perts in treating the tissues around the teeth. They have the know-how to treat the effects of gum disease or other oral tissue disorders and help improve your smile. There are a variety of periodontal cosmetic procedures that can improve and enhance the overall artwork of your smile.
Gum disease is one of the leading causes of tooth loss in adults. In the past, the only options for dis- guising tooth loss were dentures and bridges. Nowadays, dental implants are a more natural look- ing option because implants look and feel just like real teeth. They also allow the patient to speak and eat with comfort and confi- dence. During this procedure, a dental implant is attached to the root and after a healing period, an artificial tooth is attached. The result is a permanent replacement tooth that blends right in with the rest.
Gum recession as a result of gum disease causes the tooth root to become exposed, which can make teeth look long and can prema- turely age a person. In fact, the phrase “long in the tooth”, used to describe the elderly, is derived from this very reason. A periodon- tist can fix this problem with a procedure called root coverage. During this procedure, tissue from the mouth’s palate, or other syn- thetic materials, are used to facili- tate coverage of the exposed root.
Periodontists also have the ability to fix a “gummy smile” when a person’s teeth appear too short. The teeth may actually be the proper length, but they’re covered with too much gum tissue. Your periodontist can correct this by performing a procedure called crown lengthening. During this procedure, excess gum and bone tissue is reshaped to expose more of the natural tooth. Think of it like pushing back the cuticles on a fingernail. The outcome is longer looking teeth and a winning smile.
Your gums are an important part of your smile. They frame the teeth and play an integral role in the overall aesthetics of your eve- ryday appearance. While taking care of them by brushing and flossing daily is the best way to maintain a healthy mouth, talk to your periodontist about the proce- dures available to maximize the potential of your smile.
Create a Beautiful Smile with Periodontal Plastic Surgery
A confident, beautiful smile is one of the first things people notice about your face. If you’re not happy with your smile, a periodontist can help! Just as cosmetic surgery has been helping people improve their appearance, several periodontal plastic surgery procedures are available to help enhance the aesthetics of your teeth and gums. Here are some examples of popular procedures:
Crown lengthening is a procedure to remove excess gum tissue, exposing more of the “crown” of the tooth. This procedure is for patients who feel their teeth are too short or their gum line is uneven. The gum line is then sculpted to create the right proportion between gum tissue and tooth surface. This can be done to just one tooth, or to enhance your entire smile.
A dental implant is an artificial tooth root placed in the jaw to hold a replacement tooth or bridge in place, or to provide support for a denture. Dental implants are the answer for many people with missing or damaged teeth- implants look and feel just like your own teeth!
During a root coverage procedure, gum tissue from your palate is used to cover the exposed tooth roots. These procedures are used to cover roots, develop gum tissue where needed, or to make dental implants look more natural. In some cases,
this procedure can cover exposed roots to protect them from decay or prepare your teeth for orthodontic treatment. Your tooth sensitivity may be reduced as well, and your smile may also improve!
Ridge augmentation procedures are used to correct irregularities in the jawbone where your natural teeth are missing. They are also used to prevent the jawbone from collapsing after a tooth extraction, and help to even out dental implants that may seem too long compared to the rest of your teeth.
Pocket Depth Reduction
Deep pockets caused by periodontal disease can be corrected through pocket depth reduction. This procedure is used to clean the pockets and secure the gum tissue in its original place. Reducing pocket depth and eliminating existing bacteria are important to prevent damage caused by the progression of periodontal disease and to help maintain your healthy smile.
Sometimes you may need a few of these procedures to build the framework for your perfect smile. Often, periodontal plastic surgery is used to lay the foundation for further cosmetic enhancements, such as orthodontics and veneers. A combination of periodontal procedures can result in a beautiful new smile and improved periodontal health- your keys to smiling, eating, and speaking with comfort and confidence.
Anatomical Crown Exposure and Crown Lengthening Proceures
Anatomical crown exposure and crown lengthening procedures are used when your periodontist or dentist must adjust the levels of gum tissue and sometimes bone around a tooth in order to create a new gum- to–tooth relationship. These procedures may be performed for esthetic or functional reasons.
Anatomical Crown Exposure
Anatomical crown exposure is used on patients whose teeth appear too short, or their gum line is uneven or “gummy.”
During anatomical crown exposure, your dental professional removes excess gum tissue and sometimes bone tissue to expose more of the tooth crown, the white enamel- covered part of the tooth. Once the excess gum and tissue is removed, the gum line is then sculpted to create a more correct proportion between gum tissue and tooth surface. This can be done to just one
tooth to even out your gum or to several teeth to expose a natural and broad smile.
Your dentist or periodontist may recommend dental crown lengthening to make a restorative or cosmetic dental procedure possible. When a tooth is decayed or broken below the gum line or has insufficient tooth structure for a restoration, such as a crown or bridge, crown lengthening allows your periodontist or dentist to adjust the gum and bone level to expose more of the tooth so it can be restored.
Anatomical crown exposure and/or crown lengthening both provide a solution to optimize the health, appearance, and comfort of your teeth. These procedures can give you a beautiful new smile and boost your overall confidence, but most importantly, they can help improve your overall periodontal health.
Need a Dental Implant? Fear Not!
For some people, there is noth- ing more terrifying than the thought of a trip to the dentist. Even scarier for some is the prospect of replacing a missing tooth with a dental implant. However, as dental implants grow in popularity as a perma- nent solution to tooth loss, it is time to put nervous minds at ease.
A recent survey conducted infor- mally by the American Academy of Periodontology asked perio- dontal patients what factors stopped them from getting a dental implant. The second most popular answer given by respon- dents was “fear or anxiety”. However , the same survey also revealed that of those patients who had previously received a dental implant, more than half reported “very little to no pain or discomfort” experienced during the process and only 33% de- scribed the procedure as “somewhat painful or uncom- fortable”. These survey results help demonstrate that although dental implant procedures illicit fear or anxiety in potential pa- tients, the reality is that the ac- tual experience is not something to be frightened of.
Why is everyone so afraid of procedures such as dental im- plants? Perhaps fearing the den- tist and certain dental proce- dures is something that is in-grained in our minds from a young age. Perhaps it is the re- sult of ongoing, perpetuated stereotypes. Regardless of the cause, it is important to find ways to “unlearn” this fear, es- pecially if your dental profes- sional recommends a dental im- plant as the best course of treat- ment. Seeing a dental profes- sional regularly and trusting his or her advice will help you to best maintain your oral health and minimize expense, time, and discomfort.
If you decide to get a dental im- plant and are feeling anxious or fearful, find ways to feel more in control of your experience.
- Ask your periodontist to explain the procedure. Knowing exactly what will occur when the dental im- plant is placed can help put your mind at ease.
- Have your periodontist explain your options for techniques to control pain and stress, such as medica- tions, anesthesia, sedation, or relaxation techniques that can make your treatment virtually painless.
I Had No Idea Periodontal Disease Is Linked to...
You may have seen stories in the news about the connection between periodontal disease and heart disease, stroke, and diabetes. However, those aren’t the only health conditions that are related to periodontal disease. Research has shown that having periodontal disease can put you at risk for a few surprising conditions including rheumatoid arthritis, certain cancers, and even kidney disease.
Over 1.3 million Americans suffer from rheumatoid arthritis (RA), a chronic, inflammatory disease of the joints that can lead to long- term joint damage. A study published in the Journal of Periodontology uncovered yet another potential side effect of RA; researchers discovered that patients with RA are eight times more likely to have periodontal disease than those without RA. However, the research indicates that poor oral hygiene alone did not account for the connection between RA and gum disease, which means that other factors play a role as well. Both RA and gum disease are systemic inflammatory disorders which may explain the connection between the two.
Men are especially at risk for developing certain cancers if they have periodontal disease. Research published in The Lancet Oncology found that men with a history of
gum disease are 14 percent more likely to develop cancer than men with healthy gums. In fact, researchers discovered that men with periodontal disease are 49 percent more likely to develop kidney cancer, 54 percent more likely to develop pancreatic cancer, and 30 percent more likely to develop blood cancers.
A study published in the Journal of Periodontology suggests that toothless adults may be more likely to have chronic kidney disease than adults with all of their teeth. Untreated periodontal disease can lead to bone loss around teeth, which can then cause teeth to loosen and fall out. Periodontal disease is a leading cause of tooth loss in adults. In the study, the lack of teeth was found to be significantly associated with chronic kidney disease. The two diseases may be connected by chronic inflammation, as both are considered inflammatory conditions.
To help protect yourself from these health conditions, including periodontal disease, make sure to brush your teeth twice each day, floss at least once each day, and see a dental professional for cleanings twice each year. If periodontal disease develops, a consultation with a dentist or periodontist may lead to effective treatment. The key to a healthy body may start with a healthy mouth!
What Happens in Your Mouth Doesn’t Necessarily Stay in Your Mouth
Research has shown that there may be an association between periodontal disease and other chronic inflammatory conditions, such as cardiovascular disease and diabetes, among others. Scientists believe that inflammation may be the cause behind the link between periodontal disease and other chronic conditions. Inflammation, the body’s reaction to fight off infection, guard against injury, or shield against irritation, initially intends to have a protective effect. Untreated chronic inflammation, on the other hand, can lead to the destruction of affected tissues, which can lead to more serious health conditions.
If you think or know you have one of the inflammatory conditions listed below, it is important to talk with both your physician and a dental health professional, such as a periodontist, to help reduce your risk of further disease progression. Dental professionals and medical professionals will often work together to manage their patients living with, or at risk for, the following diseases:
Cardiovascular disease (CVD) is one of the leading killers of men and women each year. Research has shown that inflammation is a major risk factor for developing CVD, and that people with periodontal disease may have an increased risk for CVD. Though more research is needed to better understand the connection between periodontal disease and CVD, don’t be surprised if your periodontist asks you about your heart health or if your cardiologist or physician asks you about your periodontal health.
Periodontal disease can be a complication of diabetes. Researchers have found that people with poorly
controlled Type 2 diabetes are more likely to develop periodontal disease. However, the risk isn’t just one way; people with periodontal disease may find it more difficult to control their blood sugar levels, which can increase the risk for diabetic complications. If you are living with diabetes, it is crucial that you pay close attention to your periodontal health.
Studies have shown that women with periodontal disease may be at an increased risk of pregnancy complications, such as delivering a preterm or low birth weight baby. More research is needed to determine the exact relationship, but expectant mothers should consider having a periodontal evaluation to ensure that their periodontal health is at its best.
Research has suggested that bacteria found in the mouth can be drawn into the respiratory tract and cause an inflammatory response in the lungs, commonly known as pneumonia. In addition, periodontal disease may also worsen existing chronic lung conditions. Anyone with lung or respiratory problems should consider a complete oral health examination to determine if gum disease is present.
Since periodontal disease has been shown to have a connection with other chronic diseases, you should try to keep your teeth and gums healthy. First, be sure to brush your teeth at least twice each day and floss your teeth at least once each day. Additionally, you should receive a comprehensive periodontal exam each year from your general dentist or your periodontist. Doing so can help ensure that your periodontal health is at its best, which can help keep your entire body healthy.
Working Together for Healthy Gums and a Healthy Heart
Gum disease and cardiovascular disease are both major public health issues that impact a large number of Americans every day. While these two diseases impact separate areas of the body, research indicates that periodontal disease and cardiovascular disease are connected; having one disease may actually increase your risk of developing the other.
Periodontal disease and cardiovascular disease are both considered chronic inflammatory conditions. Inflammation is the body’s instinctive reaction to fight off infection. Inflammation is initially good for your body because it helps in the healing process. However, chronic and prolonged inflammation can lead to severe health complications. Researchers believe that inflammation provides the basis for the connection between gum disease and heart disease1. And now, periodontists and those who treat cardiovascular disease are working together to provide the best care to patients.
The Perio-Cardio Connection
In July 2009, a consensus paper2 was published in both the Journal of Periodontology and The American Journal of Cardiology. The paper was jointly developed by periodontists and cardiologists. Periodontists are dentists with advanced training in the treatment and prevention of periodontal disease, and cardiologists are doctors who specialize in treating diseases of the heart. The paper summarizes the evidence that links periodontal disease and cardiovascular disease, and provides clinical recommendations for periodontists and cardiologists to use in managing their patients living with, or at risk for, either disease.
What does this Mean for You?
You might be surprised when your periodontist now asks even more questions about your medical history, especially questions about your family history of heart disease and any behaviors that may affect your heart health such as smoking. Your cardiologist may start to ask you about your dental history and might even look in your mouth to evaluate your teeth and gums! These new recommendations are intended to help periodontists and cardiologists better manage your risk factors for future disease progression, and ensure your well- being. Hopefully by working together with your periodontist to ensure healthy teeth and gums, you will also ensure a healthy heart throughout your entire life.
1 Journal of Periodontology. August 2008, Vol. 79, No. 8s, Pages 1501-1614.
2 V Friedewald, K Kornman, J Beck, et al. Editors' Consensus: Periodontitis and Atherosclerotic Cardiovascular Disease. Journal of Periodontology. July 2009, Vol. 80, No. 7, Pages 1021-1032.
Diabetes and Periodontal Disease: A Two-Way Relationship
The American Diabetes Association defines diabetes as a serious disease in which the body does not produce or properly use insulin, a hormone that is needed to convert sugar, starches, and other food into energy needed for daily life. Approximately 23.6 million Americans have diabetes; however, 5.7 million of them have not yet been diagnosed.
If you or someone you know has diabetes, you already understand the importance of keeping the disease under control. However, you may not know that good oral health not only keeps the mouth and gums free from periodontal disease, but also might have a significant impact on the control of diabetes. Periodontal disease is an inflammatory response to a bacterial infection that, if left untreated, may cause damage to the tissues and bone surrounding the teeth and may even lead to tooth loss. People with diabetes are three to four times more likely to develop periodontal disease, which, like any other infection in the body, can impair their ability to process and/or utilize insulin. Additionally, people with diabetes tend to have more severe levels of bone loss, and often experience more aggressive disease activity. This can ultimately lead to tooth loss, which can make chewing and digesting food difficult. For people with diabetes, this can have a devastating impact on the ability to maintain proper nutrition and control blood sugar levels.
Just as diabetes can increase a patient’s chance of developing periodontal disease, research suggests that periodontal disease may make it more difficult for people who have diabetes to control their blood
sugar. Periodontal disease increases the body’s systemic inflammatory signals that serve to increase blood sugar. This contributes to increased periods of time when the body functions with an unhealthy blood sugar level. Consequently, it is important for people with diabetes to treat periodontal disease to eliminate the infection for optimal metabolic control.
Periodontal disease is a leading complication of diabetes; therefore, it is important for people with diabetes to know their treatment options. If detected early, a periodontist can provide treatment that can stop the gum disease and bring the gums back to a state of health, preventing additional bone or tooth loss. In fact, periodontal treatment has been shown to improve blood sugar levels in people with diabetes, suggesting that treating patients’ periodontal disease could decrease insulin requirements.
If diabetes is well controlled, treatment will be similar to the treatment of someone who doesn’t have diabetes. In the early stages of gum disease, treatment usually includes scaling and root planning, a procedure in which plaque and calculus are removed from the pockets around the tooth and near the gums. People with diabetes may want to schedule their dental appointments early in the morning after they have eaten a normal breakfast in order to stabilize and prevent a severe or sudden drop in blood sugar levels. Upon determining a treatment plan, your periodontist and physician will work together to help you control both your diabetes and gum disease.
Targeting Tobacco Use
You are probably aware of the devastating effects that smoking and tobacco use can have on your heart, lungs, and other organs. However, you might not be familiar with the whole other “mouthful” of problems caused by tobacco use. For example, tobacco use is a significant risk factor in the development and progression of periodontal disease, which is a major cause of tooth loss in adults. The sooner you take aim at your tobacco use and quit, the closer you will be to healthy teeth and gums!
Tobacco users are more likely to have calculus, dental plaque that hardens on your teeth and can only be removed during professional cleanings. If this calculus is not removed and it remains below the gum line, the bacteria in the calculus will infect the gums causing redness and swelling, otherwise known as inflammation. This inflammation damages the tissues that support the teeth, including the bone. When this happens, the gums can separate from the teeth, forming pockets. Tobacco users often have deeper pockets than people who do not use tobacco. These pockets can then fill with more bacteria, which leads to more inflammation. If the infected pockets are left untreated, the gums may shrink away from the teeth, making teeth appear longer and possibly causing them to become loose and fall out.
The detection of periodontal disease is often more difficult in tobacco users. This is because the nicotine and other chemicals found in tobacco products can hide the symptoms commonly associated with periodontal disease, such as bleeding
gums. Since the detection of periodontal disease in tobacco users can be difficult, necessary treatment is sometimes delayed.
Treating periodontal disease in tobacco users can be a difficult task, but not an impossible one. Smoking and tobacco use reduces the delivery of oxygen and nutrients to the gingival tissues, weakening the body’s defense mechanisms. This can slow down the healing process and make periodontal treatment results less predictable. For example, dental implants that are placed in a tobacco user’s mouth fail more often than they would in a patient who does not use tobacco. Additionally, the actual treatment of periodontal disease can vary widely depending on how far the disease has progressed. If caught in the early stages, simple non- surgical periodontal therapy may be used.
Because the treatment of periodontal diseases can be more difficult in tobacco users, your periodontist will urge you to quit your tobacco use. Quitting seems to gradually erase the harmful effects of tobacco use on periodontal health. One study showed that 11 years after quitting, a former smoker’s likelihood of developing periodontal diseases was not much different from one who had never smoked. And with the increasing amount of research indicating that periodontal health may be related to overall health, reducing your risk of periodontal disease is more important than ever. Start taking aim at quitting your tobacco use today and move one step closer to a lifetime of periodontal health and happy smiles!
Inflammation and Periodontal Disease
Most people know that maintaining healthy teeth and gums is a necessary step in achieving overall wellbeing. In fact, now not only dentists encourage brushing and flossing, but many physicians also promote oral hygiene as a way to help keep the rest of the body healthy. Several research studies have suggested that gum disease may be associated with other health issues, including heart disease, stroke and diabetes. And with more and more research reinforcing the connection between periodontal and systemic health, scientists are beginning to understand why these connections exist. One theory points to chronic inflammation as the culprit.
Inflammation is the body’s natural response to harm, such as an injury or infection. For many years, dentists believed that gum disease developed as a result of a bacterial infection caused by the build-up of plaque between the teeth and under the gums. While plaque build-up is still a factor in the development and progression of gum disease, researchers now suspect that the more severe symptoms, namely swollen, bleeding gums; recession around the gum line, and loss of the bone that holds the teeth in place, may actually be caused by the chronic inflammatory response to the bacterial infection, rather than the bacteria itself.
Scientists hypothesize that the chronic inflammatory response mechanism may be the reason behind the periodontal-systemic health link. Many of the diseases associated with periodontal disease are also considered to be systemic inflammatory disorders, including cardiovascular disease, diabetes, rheumatoid arthritis, kidney disease and even certain forms of cancer, suggesting that chronic inflammation itself may be the basis for the connection.
More research is needed to pinpoint the precise biological mechanisms responsible for the relationship between gum disease and other disease states. However, since previous findings have indicated that gum disease sufferers are at a higher risk for other diseases, it is critical to maintain periodontal health in an effort to achieve overall health.
Dentists recommend daily oral care, including regular brushing and flossing, and routine visits to the dentist to avoid gum disease. If gum disease develops, consultation with a dental professional such as a periodontist can lead to effective treatment. A periodontist is a dentist with three years of additional specialized training in the prevention, diagnosis and treatment of gum disease.
For more information on the role of inflammation in oral health, tips on how to prevent or treat gum disease, to find out if you are at risk, or to find a local periodontist, visit perio.org.
How to Reduce Inflammation at Home
Gum disease is a chronic inflammatory disease that affects the supporting bone and tissues around the teeth. The inflammatory reaction is your body’s way of removing the toxins released by bacteria that live on your teeth and gums. However, when the inflammation lasts for too long or is too strong, it starts to break down the tissues around your teeth, including your gums and supporting bone. This may cause teeth to become loose and even fall out.
Unfortunately, inflammation doesn’t only occur in your mouth. Several other serious conditions, including cardiovascular disease, diabetes, and rheumatoid arthritis, are caused by the same chronic inflammation that causes periodontal disease.
The good news is that your dental professional can help you reduce the inflammation in your mouth as a result of periodontal disease through treatments such as scaling and root planing. But you can also help to reduce the inflammation in your mouth and even in your entire body right at home. Here are a few things you can try:
Eat the right foods sardines and walnuts, have been shown to reduce inflammation. Green tea, which also contains antioxidants, has been shown to reduce the risk of gum disease and cardiovascular disease by reducing inflammation in the body.
People who maintain a healthy body weight and exercise regularly have been shown to have lower incidences of periodontal disease than those who do not exercise regularly. Moderate exercise may also help reduce inflammation in your body, but extreme exercise (running a marathon, for example) can actually increase systemic inflammation. It’s a good idea to discuss your exercise plan with a health professional to ensure that it’s a good fit for your lifestyle.
Brush and floss your teeth
When you brush your teeth twice a day and floss at least once a day, you remove the bacteria on your teeth and gums that causes the inflammatory response that leads to gum disease. Therefore, it’s important to take care of your teeth every day by brushing and flossing, and don’t forget to see your dental professional for regular cleanings and check ups, including a yearly comprehensive periodontal evaluation (CPE).
Brush and Floss for Healthy Gums!
One of the easiest ways to help prevent gum disease is to brush and floss every day, so therefore it is very important to know the correct way to take care of your teeth and gums. It does not matter if you brush first or floss first, as long as you do both (twice a day!).
The most commonly used toothbrush is the manual toothbrush. Another option is the electric toothbrush, which uses electrical power to move the brush head. The resulting vibrations that are created gently clean the teeth. It is important to always choose a soft brush head when using either a manual or electric toothbrush, and to replace the toothbrush when the bristles begin to bend (or every two to three months).
According to a recent study in the Journal of Periodontology1, all dental flosses are equally effective. This means that it does not matter which type of floss you choose to use. There are many different varieties of floss, including waxed, unwaxed, flavored, and shred-resistant, so there is a type of floss out there for everyone!
How to Brush
Position the toothbrush at a 45 degree angle where your gums and teeth meet. While applying slight pressure, gently move the brush in a circular motion using short strokes. Use this method to clean the front of your teeth, then move to the back of your teeth, then the biting surfaces, and then your tongue, using the same gentle movements. Be sure you are constantly moving the brush head to avoid damaging your gums!
How to Floss
Using about 18 inches of floss, wrap the floss around your middle finger. Wrap the rest around your other middle finger, leaving 2-3 inches of floss between your fingers. While tightly holding the floss between your thumbs, insert it between two teeth. Curve the floss into a “C” shape against the tooth, and gently slide it up and down. Then, with the floss still in between the two teeth, switch the “C” shape against the adjacent tooth, and repeat the sliding motion. Move to the next tooth over, and repeat the process, unwrapping fresh floss from your middle finger as you go.
For more information on brushing and flossing techniques, to learn other ways to prevent gum disease, or to find a periodontist in your area, visit perio.org.
1 G Terézhalmy, R Bartizek, A Biesbrock. Plaque- Removal Efficacy of Four Types of Dental Floss. Journal of Periodontology. February 2008, Vol. 79, No. 2, Pages 245-251
2 R Ide, T Hoshuyama, K Takahashi. The Effect of Periodontal Disease on Medical and Dental Costs in a Middle-Aged Japanese Population: A Longitudinal Worksite Study. Journal of Periodontology. November 2007, Vol. 78, No. 11, Pages 2120-2126
More Tips to Keep Your Teeth and Gums Healthy
Most people recognize how important it is to keep your teeth and gums healthy, but over time, different lifestyle factors can negatively impact your periodontal health. To help maintain healthy teeth and gums, keep these tips in mind:
Strive to be stress free
Minimize the stress in your life. Research has shown that people who are having a difficult time coping with stress can neglect their oral hygiene.1 Additionally, researchers have also associated the hormone cortisol with periodontal disease.2 Chronic stress has been shown to increase levels of cortisol, and these increased levels can be a factor in developing periodontal disease.
Kick the tobacco habit
Tobacco use is one of the most significant risk factors in the development and progression of periodontal disease. Tobacco’s negative effects on oral health are well documented. Most people that have recurrent periodontal disease are smokers, and smoking is also associated with complications after oral surgery.
Drink alcohol in moderation
Drinking the occasional glass of red wine has been shown to have positive effects on the body; however, heavy drinking can negatively impact your oral health. Alcohol can irritate your gums, tongue, and other oral tissues. It can also contribute to poor healing after surgery and can halt your oral hygiene routine. In addition, heavy drinkers often suffer from tooth decay as a result of the increased exposure to sugars and acids that are often found in alcoholic drinks.
Stock up on healthy foods
You know that a healthy diet is important for your overall health, but it’s also very important for your oral health! A good diet will help your immune system be at its best to help fight infections, including periodontal disease. In addition to eating a well- balanced, nutritious diet, research has shown that both yogurt3 and green tea4 may add an extra boost to your periodontal health.
1 Peruzzo, DC et al. A systematic review of stress and psychological factors as possible risk factors for periodontal disease. J Periodontol. 2007 Aug;78(8):1491-504.
2 Cury PR et al. Hydrocortisone Affects the Expression of Matrix Metalloproteinases (MMP-1, -2, -3, -7, and -11) and Tissue Inhibitor of Matrix Metalloproteinases (TIMP-1) in Human Gingival Fibroblasts. J Periodontol. 2007 Jul;78(7):1309-15.
3 Shimazaki Y et al. Intake of Dairy Products and Periodontal Disease: The Hisayama Study. J Periodontol. 2008 Jan;79 (1):131-7.
4 Kushiyama M et al. Relationship Between Intake of Green Tea and Periodontal Disease. J Periodontol. 2009 Mar;80(3): 372-7.
Periodontal Health and the Battle of the Sexes
Periodontal disease and its associated complications affect both men and women, so it’s important that both sexes are doing everything they can to maintain their periodontal health.
However, research1 published in the Journal of Periodontology suggests that women are more proactive in maintaining healthy teeth and gums than men. In fact, the study found that women are almost twice as likely to have received a regular dental check-up in the past year, and women in the study also had better indicators of periodontal health, including lower incidence of dental plaque than men.
Overall, the study suggested that women have a better understanding of oral health, as well as a more positive attitude towards dental visits. This understanding is important for women, as hormonal fluctuations throughout a woman’s life may affect her periodontal health and, therefore, overall health. Certain life stages may increase women’s susceptibility to periodontal disease, which may require special attention:
- Puberty: Studies show that elevated hormone levels may cause an increase in gum sensitivity and lead to a greater inflammatory reaction, which can cause gums to become swollen, turn red, and feel tender.
- Menstruation: During menstruation, some women may experience menstruation gingivitis, which may cause gum bleeding, redness, or swelling of the gums between the teeth.
- Menopause: Hormonal changes may cause women to experience discomfort in their mouths, including pain, burning sensations in the gum tissue, or mouth sores.
Men have special periodontal health considerations, as well. A June 2008 Lancet Oncology study found that men with periodontal disease may be more likely to develop kidney cancer, pancreatic cancer, and blood cancers. Periodontal disease has also been linked to higher risk of developing prostate cancer.
Both men and women should strive for periodontal health by brushing twice each day, flossing at least once each day, and seeing a dental professional, such as a periodontist, regularly. Additionally, it’s a good idea to get a comprehensive periodontal evaluation every year. A dental professional, such as a periodontist, can conduct this exam to assess your periodontal disease status.
Pregnancy and Periodontal Disease
There used to be an old wives’ tale that said “A tooth is lost for every child.” While it may seem far- fetched, it may actually be based loosely on fact. Your teeth and gums can be affected by pregnancy, just like other areas of your body.
Most commonly, pregnant women can develop gingivitis, or pregnancy gingivitis, beginning in the second or third month and can increase in severity through the eighth month of pregnancy. During this time, some women notice swelling, bleeding, redness, or tenderness in the gum tissue.
In some cases, gums swollen by pregnancy gingivitis can react strongly to local irritants and form a large lump. These growths, called pregnancy tumors, are not cancerous and are generally painless. They usually disappear after pregnancy, but some may require removal by a dental professional, such as a periodontist. The best way to avoid periodontal conditions associated with pregnancy is to begin with healthy gums. If you are thinking about becoming pregnant, you should visit your dentist or periodontist for a comprehensive periodontal evaluation.
If you are pregnant, or planning to become pregnant, you need to know that your periodontal health may affect the pregnancy and ultimately the health of your baby.
Pregnant women who experience periodontal disease during their pregnancies may be twice as likely to develop preeclampsia, which is characterized by high blood pressure and the presence of protein in the urine. It can put you and your baby at risk for severe complications.
Additionally, studies have suggested that women who experience periodontal disease during pregnancy may be at risk of having a premature or low birth weight baby. The good news is that researchers are making strides to find out exactly how periodontal disease affects pregnancy outcomes. Some studies have suggested that treating periodontitis during pregnancy may reduce the risks of a preterm birth. Preventing gum problems from developing during the stresses of pregnancy also appears to be important in improving the health of mother and baby.
If you are already pregnant and have been diagnosed with periodontal disease, treatment by your dental professional may reduce your chances of having a preterm, low birth weight baby. Talk to your dentist or periodontist for more information. If you’re considering pregnancy, it’s a good idea to include a periodontal evaluation as part of your prenatal care. A healthy mouth can help give you, and your baby, something to smile about!
Periodontal Health Is Important for Men, Too!
Men already have a lot to worry about when it comes to health; they face shorter life spans, greater risk of heart attacks, and higher rates of cancer than women. One more thing can be added to that list: research shows that periodontal disease is more prevalent in men than women, and men lose more teeth on average than women!
Men’s periodontal health may be poorer than women’s due to their lack of action when it comes to oral hygiene. Research published in the Journal of Periodontology found that women are almost twice as likely as men to have received a regular dental check-up in the past year, and women were more likely than men to schedule suggested treatment following those dental check-ups. Furthermore, men have worse indicators of periodontal health than women, including higher incidence of dental plaque, tartar, and bleeding on probing. This may be because women are three times more likely to floss every day than men.
A man’s health may be uniquely impacted by periodontal disease as well. Periodontal disease can lead to tooth loss and has been linked to heart disease, diabetes, and other inflammatory conditions. Research has suggested that the following conditions may be associated with periodontal disease in men, making it important that men diligently maintain periodontal health.
Prostate-specific antigen (PSA) is an enzyme created in the prostate that is normally secreted in very small amounts. However, when the prostate becomes inflamed, infected, or affected by cancer, PSA levels rise. Research has shown that men with indicators of periodontal disease (including bleeding on probing) as well as prostatitis (inflammation of the prostate) have higher levels of PSA than men with only one of the conditions. This means that prostate health may affect periodontal health, and vice versa, similar to the relationship between periodontal disease and diabetes.
Research indicates that periodontal disease and cardiovascular disease are associated; having periodontal disease may actually increase your risk of cardiovascular disease. This may be because both conditions are chronic inflammatory conditions, and researchers believe that inflammation provides the basis for the connection between gum disease and heart disease. Since men are already more likely to develop heart disease than women, maintaining periodontal health may be another way to reduce this risk.
Men with periodontal disease, especially those younger than 30 or older than 70, are at increased risk of developing impotence, according to research presented at a 2012 meeting of the American Urological Association. Researchers believe that inflammation may be the link between the two conditions; prolonged chronic inflammation (the same type of inflammation that is associated with periodontal disease and other inflammatory conditions) can cause damage to blood vessels which can lead to impotence.
Research published in the June 2008 issue of The Lancet Oncology found that men with a history of gum disease are 14% more likely to develop cancer than men with healthy gums. Specifically, men with periodontal disease may be 49% more likely than women to develop kidney cancer, 54% more likely to develop pancreatic cancer, and 30% more likely to develop blood cancers.
Men: you can help prevent these serious conditions, including periodontal disease, by ensuring that your oral health is at its best every day! Take proper care of your teeth and gums by brushing your teeth twice each day, flossing at least once each day, and seeing your dental professional for regular cleanings and an annual Comprehensive Periodontal Evaluation.
Periodontal Health in Children and Adolescents
Periodontitis is thought of as an adult problem as the result of aging. But, did you know that gingivitis, a mild form of periodontitis, is often found in both children and adolescents? Additionally, research shows that more advanced, harmful forms of periodontal disease can occur in these younger age groups. The good news a few easy steps can help prevent periodontal diseases.
There are three types of periodontal diseases found in children and adolescents.
- Chronic gingivitis causes gum tissue to swell, turn red and bleed easily. Left untreated, chronic gingivitis can eventually lead to more serious forms of periodontal disease.
- Aggressive periodontitis affects the first molars and incisors. It can include bone loss and patients may form very little dental plaque.
- Generalized aggressive periodontitis involves the entire mouth. Patients have heavy accumulations of plaque, calculus and inflammation of the gums.
Eventually, periodontitis can cause the teeth to become loose and possibly to fall out.
For your teen, hormonal changes due to puberty can put them at risk for periodontal disease. During puberty, an increased level of hormones, such as progesterone and possibly estrogen, cause increased blood circulation to the gums. This may increase the gum's sensitivity and lead to a greater reaction to any irritation, including food particles and plaque. During this time, the gums may become swollen, turn red and feel tender.
As your teen gets older, the tendency for the gums to swell in response to irritants will lessen. However, during puberty, it is very important to follow a good dental hygiene regimen, including regular brushing and flossing, and regular dental visits. In some cases, a dental professional may recommend periodontal therapy to help prevent damage to the tissues and bone surrounding the teeth.
Early diagnosis is important for successful treatment of periodontal diseases. Therefore, it is important that children and teens receive a comprehensive periodontal examination as part of their routine dental visits.
The most important preventive step against periodontal disease is to establish good oral health habits with your child. There are basic preventive steps to help your child maintain good oral health:
- Establish good dental hygiene habits early. When your child is 12 months old, you can begin using toothpaste when brushing his or her teeth. When the gaps between your child's teeth close, it's important to start flossing.
- Set an example. Serve as a good role model by practicing good dental hygiene habits yourself.
- Make time. Schedule regular dental visits for family checkups, periodontal evaluations and cleanings bi-annually.
- Check your child's mouth for the signs of periodontal disease. Symptoms of gum disease include bleeding gums, swollen and bright red gums, gums that are receding away from the teeth and bad breath.
- Early diagnosis ensures the greatest change for successful treatment. It is important that children receive a periodontal examination as part of their routine dental visits
A Lifetime of Healthy Teeth and Gums
People are now living longer and healthier lives, and older adults are more likely than ever before to keep their teeth for a lifetime. However, research has shown that older people also have the highest rates of periodontal disease. In fact, at least half of people over age 55 have some form of periodontal disease, and almost one out of four people over 65 have lost all their teeth.
No matter what your age, it is important to keep your teeth and gums healthy. If you’ve succeeded in avoiding periodontal disease as you age, it is especially important to continue to maintain your oral care routine. Be sure to brush and floss daily, and see a dental professional, such as a periodontist, regularly. You should also receive a comprehensive periodontal exam each year. This will ensure that your oral health (and possibly even your overall health) stays at its best. If you have dexterity problems or a physical disability and are finding it difficult to properly brush or floss your teeth, your dentist or periodontist can suggest options such as an electric toothbrush or floss holder.
Research has shown that periodontal disease is a chronic inflammatory disease that may put you at a higher risk for other diseases including cardiovascular disease, diabetes, and
Alzheimer’s disease. During your regular visits with your dentist or periodontist, be sure to let him or her know if you have any of these medical conditions or if you have a family history of disease. Likewise, if you have been diagnosed with periodontal disease, it’s a good idea to share this information with your physician to ensure that you’re receiving appropriate care.
You should also tell your dentist or periodontist about any medications you are taking, because many medications can impact your oral health and therefore affect your dental treatment. Hundreds of common medications - including antihistamines and high blood pressure medications - can cause side effects such as soft tissue changes, taste changes, and gum overgrowth. Another possible side effect of some medications is dry mouth, a condition that leaves the mouth without enough saliva to wash away food from your teeth. This may leave you more susceptible to tooth decay and periodontal disease, and can cause sore throat, problems with speaking, and difficulty swallowing.
Maintaining your oral health should be a priority at any age. As you get older, be sure to continue to take care of your teeth and gums to ensure that they’ll stay healthy and strong for life!
What You Need to Know about Bisphosphonates
You may have heard recent reports about bisphosphonate drugs and their potential effect on periodontal health. These reports can be alarming and even misleading, especially for those taking bisphosphonates. The information below explains what bisphosphonates are, how they are related to periodontal health, and how bisphosphonates may impact your periodontal treatment.
Bisphosphonates, also known as bone-sparing drugs, are used to treat and prevent osteoporosis, and are also prescribed to patients diagnosed with certain bone cancers. Bisphosphonates can be administered in two ways: orally and intravenously (IV). Oral, or tablet, bisphosphonates (common names include Fosamax, Boniva, and Actonel) are usually prescribed for osteoporosis, while IV bisphosphonates (common names include Aredia and Zometa) are typically prescribed for patients with advanced bone cancers to help decrease pain and fractures.
In rare instances, some people that have been treated with bisphosphonates, especially the intravenous form, develop a rare condition called osteonecrosis of the jaw (ONJ), which can cause severe, irreversible, and often debilitating damage to the jaw. ONJ can be worsened by invasive dental procedures such as tooth extractions or dental implants. People may not have symptoms in the early stages of ONJ, but pain can gradually develop as the condition progresses.
Symptoms of ONJ include:
- Loose teeth
- Numbness or a feeling of heaviness in the jaw
- Pain, swelling, or infection of the gums or jaw
- Gums that do not heal
- Exposed bone
Currently, there is no treatment that definitely cures ONJ. However, antibiotics and anti-inflammatory drugs may help relieve some of the pain associated with ONJ. Most people diagnosed with ONJ will also need surgical treatment.
If your physician prescribes a bisphosphonate, especially IV bisphosphonates, it is very important to tell your dental professional, because your dental treatment plan may be affected. There have been other risk factors associated with ONJ including age, gender, and other medical conditions, so it is important to share all health information with your dental professional.
It is also important to maintain your oral health if you are taking bisphosphonates. Even though the risk of developing ONJ while taking a bisphosphonate remains very small, if you need periodontal surgery, your dental professional may recommend that you interrupt your bisphosphonate therapy prior to, during, and/or after your procedure. Be assured that both the medical and dental communities are studying ways to ensure the safest outcomes for patients taking bisphosphonates who require invasive dental procedures.