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Many believe that periodontal disease is a disease that is solely based on genetics. My grandparents had dentures, my parents had dentures, so will I. The truth is, that genetics plays a role, but is not a sentence for dentures. There are risks and limitations in the progression of periodontal disease… Can each patient limit the risks of developing full blown progressive periodontal disease?….The answer is a resounding…YES! It takes a good oral hygiene regimen, knowledge of the current state of your condition, and frequent professional cleaning to keep our mouths in a healthy, disease-free state.

Risk Factors Of Periodontal Disease

Patient Caused Risk Factors

Poor Oral Hygiene – This is an obvious one that each individual can control. Brushing, flossing, rinsing, and seeking regular dental care are essential steps to remain periodontal disease free and avoid progression beyond gingivitis.

Age – Research has shown that older people have the highest rates of periodontal disease. The research shows that over 70% of Americans 65 and older have periodontitis.


Poor nutrition– Eating an unhealthy diet will not supply you with the essential vitamins and minerals necessary for tissue healing and repair.

Anatomy – The local anatomic risk factors for periodontal disease include:,

1. Furcation anatomy. These are the spaces between roots of molars.  In many instances, the entrance of  such furcations are restricted enough to limit access for proper hygiene maintenance. Risk factors for periodontal disease are classified according to their involvement in tooth furcations. A Grade I CEP presents with minimal projection of enamel toward the entrance of the furaction. A Grade II CEP approximates the entrance of the furcation, and the tip of a Grade Ill CEP is well within the furcation.

2. Common anatomic deformities. These interfere with a patient’s ability to effectively remove plaque biofilm which are one of the risk factors for periodontal disease. An example are Cervical enamel projections (CEP). CEPs are tooth developmental deformities of the CEJ found on molars.

4. Palato-gingival grooves (PGG). POGs are tooth developmental deformities of maxillary central and lateral incisors. They begin in lingual pits and extend vertically onto root surfaces. PGGs could, on rare occasions, extend to the root apex. PGGs are commonly associated risk factors for periodontal disease with increased gingival inflammation, plaque accumulation, and probing depth.

5. Open contacts, loss of interdental papilla, and food impaction. Open contacts between teeth may allow for easy food impaction. Food impaction is defined as the forceful wedging of food between teeth. Loss of the pointed papilla between teeth leaves another area for food impaction.

Medications – Some drugs, such as oral contraceptives, anti-depressants, and certain heart medicines, can have an affect on your oral health, causing dry mouth, inflammation and gum tissue overgrowth. It is important to tell your dentist the medications you might be on so they can tailor a treatment schedule for your needs.

Other Disease – These include cardiovascular disease, diabetes, and rheumatoid arthritis.  These diseases can interfere with the inflammatory process, causing healing problems, and may worsen the condition of the gums.

Poor Nutrition – A diet without all the essential nutrients for our bodies to function can compromise our immune systems, decrease healing ability, and make tissue weaker and easier to breakdown. This will make it harder to fight off infection. Since, periodontal disease essentially begins as an infection, this lack of nutrition can make the periodontal disease develop and progress faster than it normally would. Studies have also linked obesity with an increased risk of periodontal disease.

Dentist Caused Risk Factors

Overhanging dental restorations – A poorly completed dental restoration typically has dental material overhanging the tooth. This creates an issue keeping the area clean and also creates an area for food and bacteria to build up. These overhangs can be irritating to the tissues and retain plaque and food more easily.

Violation of the “biologic width” –  is the height between the deepest point of the gum pocket and the bone. This distance is important to consider when fabricating any dental restorations, because they must respect the natural architecture of the gingival attachment if harmful consequences are to be avoided. These consequences include bone and tissue recession.

Open contacts and food impaction – If a dentist places a new dental restoration and does not create the proper tight contact between adjacent teeth, that area becomes a food and plaque trap. It will necessitate improved dental hygiene in that area to keep it clean. More often than not, food and debris will accumulate creating a localized area of periodontal disease.

Occlusal trauma – If a new restoration is not properly set in alignment with the other teeth, a patient can create damage to the tooth as well as the surrounding tissue just from the act of chewing. The bite should always be checked and adjusted after dental work to prevent trauma to an individual tooth.

Periodontal Disease Conclusion

Luckily, with the exception of the anatomy we are born with, all of these periodontal disease risk factors can be overcome. The first step is to practice good oral hygiene by brushing, flossing, and using an antibacterial mouthrinse. The second step is to choose a well qualified dentist and keep a regular schedule to help give you the best fighting chance at preventing,  treating and stabilizing periodontal disease.

Gingivitis is simply inflammation of the gum tissue in the mouth. It is a reversible, non-destructive form of periodontal disease. While there are many causes of gingivitis, the

Gingivitis Marielaina Perrone DDS

Gingivitis Can be Prevented!

number one cause is poor dental hygiene.

Gingivitis can develop as

-a side effect to medication

-surges in hormones

-mouth breathing

-dry mouth

-poor nutrition

-disease state

-tobacco use

-poor oral hygiene.

When dental hygiene is not sufficient, bacteria in dental plaque release acids that stimulate the inflammatory response by the body. This in turn cause the gums to appear puffy, red, and bleed easily upon brushing. It takes some work to restore the gums back to a healthy state. Frequent professional cleaning along with regular tooth brushing and flossing can help to remove plaque and keep it from building up on the teeth and gums.

Signs Of Gingivitis

-swollen, shiny, and tender gums

-blood on toothbrush while brushing

– pink toothpaste when spitting out

-pus around teeth

-bad breath

-gum redness

-visible tartar deposits

-bad taste in mouth

-gums bleed easily

-gum ulcers

Other Causes Of Gingivitis

Medications. Many prescription and over-the-counter medications come with the side effect causing dry mouth or xerostomia, and sometimes gum overgrowth. Saliva is important to help keep your teeth clean by controlling the growth of bacteria as well as maintaining a neutral environment to prevent tooth decay. That means that the less saliva you have, the greater your risk for gingivitis (and tooth decay!). Many common medications including antidepressants, blood pressure meds,  asthma inhalers, and cold medications can reduce the amount of saliva in your mouth. Seizure medications, and some blood pressure medications can cause the gum tissue to grow. This extra tissue, makes it more difficult to keep clean. It is important you always read the side effects for any medications you are taking to ensure you take the proper steps like drinking more water and brushing more often following meals.

-Infection/ Disease: Various types of viral infections or fungal infections can cause periodontal disease. Oral Thrush is an example. Thrush occurs when a type of fungus that occurs normally in the mouth gets out of control and forms lesions that can infect the tongue and gums. Also, an infection caused by the herpes virus can cause

Gingivitis Marielaina Perrone DDS

periodontal disease. It is important to get these infections under control as soon as possible as they are quite treatable in most cases. There are also other diseases that can effect the oral tissue, such as oral cancer, and diabetes.

-Nutrition: If you follow a fad diet or a diet that is severely lacking in calcium and vitamins B and C, you may be at increased risk for periodontal disease.

Mouth Breathing: leaving the mouth open to breathe while awake or sleeping, dries the mouth substantially. Oral dryness  allows gingivitis to occur more readily.making healing more difficult

Tobacco use: Smoking directly effects the gums by decreasing blood circulation and thereby increasing inflammation. Smokeless tobacco cause irritation in direct response to the product eroding the tissue.

Hormone surges: Hormonal imbalance during puberty, menstruation, pregnancy, and menopause can cause gingivitis. The drastic hormone changes allow gum tissues to become inflamed quite readily.

Possible Complications From Gingivitis

In most cases, if gingivitis is properly treated and the patient follows good dental hygiene there will be no complications. However, if left untreated, gingivitis can worsen and develop into a more advanced version of periodontal disease called periodontitis. This form of periodontal disease is quite destructive and will cause loss of bone and eventually loss of teeth.

Possible complications from gingivitis can include:

-Abscess in the gum tissues.

-Abscess in the jaw bones.

-Infection in the jaw bone or gum tissues.

-increased susceptibility to heart disease.

-Loss of esthetic gum contours. The points of gum tissue between the teeth disappear, leaving behind a “black triangle”. Red, jelly-roll margins at the gum line of the tooth. Pink stippling disappears.


-Recurrent gingivitis.

-Trench mouth, or ANUG.  Ulcerations of the gums caused by bacterial infection.

Gingivitis can cause damage in other areas of the body if allowed to remain untreated. The bacteria from the gums can enter the bloodstream and cause infections elsewhere. Periodontal disease has been linked to heart disease, stroke and erectile dysfunction. It may also cause the delivery of premature infants as well as low birth weight infants to gingivitis-infected mothers. Those with diabetes may have problems controlling blood sugar levels if they also suffer from gingivitis.

Prevention of Gingivitis

Gingivitis may be prevented or cured by following some simple preventative measures:

-Brush teeth, gum line, and tongue daily. Teeth should be brushed at least twice a day. Both morning and night and after meals when possible.Gingivitis Marielaina Perrone DDS

-Use a soft bristled toothbrush, which is less likely to damage teeth or gums. Replace toothbrush every three months or sooner if needed.

-Use a fluoride toothpaste.

– Do not snack in the middle of the night. Chew gum after daytime snacks.

-Floss at least once a day.

-Rinse with an effective mouthwash, such as listerine.

-Visit the dentist at least once every six months for cleaning and examination to keep gingivitis away.

-Avoid sugary foods, tobacco and drinking excessive amounts of alcohol.


Gingivitis is very treatable. The first step, is understanding what is making it occur. Following a regular dental hygiene regimen will keep gingivitis at bay and not allow it to progress to periodontal disease. A few minutes a day is all it takes to maintain a healthy teeth and gums. Remember to visit your dentist regularly for dental examinations and professional cleanings to avoid the onset of gingivitis.


Pregnancy can be a nervous time for many parents especially when an illness or medical emergency arises for the mother. Most moms tend to be are extremely cautious about

Pregnancy Marielaina Perrone DDS

Be Educated On What Drugs Are Safe During Pregnancy

taking any drugs during pregnancy. They are fearful of harming their baby and rightfully so.  In some instances, taking medications can be helpful to both mother and baby. The medications can relieve pain, infection, and stress.

Drug and chemical exposure  during pregnancy are believed to account for approximately 1% of all birth defects. Birth defects are most commonly associated with poor nutrition, smoking and alcohol, previous diseases, genetics, pharmaceutical effects, and maternal age.

Pregnancy Risk Categories For Drugs

Category A – These drugs have been well studied over the years and have not demonstrated any risk to the fetus in any trimester of pregnancy.

Category B – No evidence of risk in humans. This category has shown adverse effects in animal trials but in controlled human trials have been deemed to be safe with no increased risk of fetal abnormalities.

Category C – Potential risk during pregnancy is present here. Not enough studies have proven the safety of these drugs but in some cases they are deemed necessary to use as the benefits outweigh the potential risks during pregnancy.

Category D – These have shown positive evidence of risk to the fetus. However, these drugs may be used in life threatening or in care of a serious disease for which safer drugs cannot be used or are ineffective.

Category X – Contraindicated in pregnancy. The risk of these drugs clearly outweighs any potential benefits. These drugs include Accutane, thalidomide, and Xanax

Drugs Used In Dentistry

Local Anesthetics – Most local anesthetics as used in dentistry have been shown to be relatively safe. Any local anesthesia can cross the placenta and cause fetal depression, therefore dosage should be limited to the minimum required for effective pain control. Luckily, most dentistry can be completed with very small amounts of local anesthetic, thus causing no danger to mom or baby. A major study was completed spanning about 35 years and tracking 55,000 children. The study showed no evidence of any adverse reactions from local anesthetic use in pregnant women. Different types of local anesthesia include:

 Epinephrine (adrenalin) –  used in local anesthesia to improve local anesthetic efficiency. It is longer lasting and allows for less bleeding during surgical procedures. Normal dental doses do not pose any significant risk to fetus. Epinephrine has been shown to cause constriction of the umbilical artery but has only been seen to cause issue when paired with an already compromised fetus.

Pregnancy Marielaina Perrone DDSLevonordefrin – used in local anesthesia, and similar to epinephrine in its action.  It is less potent than epinephrine, but it is used in higher concentrations, dosage is about 5x more than the usual epinephrine dose. For this reason levonordefrin is NOT recommended during pregnancy.

Lidocaine – Deemed completely safe in normal dentistry dosing levels.

-NSAIDS –  non steroidal anti inflammatory drugs which include, aspirin, ibuprofen(Advil, Motrin), and naproxen sodium(Alleve). These drugs all block formation of prostaglandin. Prostaglandin is one of the hormones involved in the induction of labor.  By blocking prostaglandin production, these drugs may prolong labor.  Aspirin decreases the ability to form a blood clot, and can cause increased bleeding  if taken within 5 days of delivery. Aspirin and other NSAIDS should be avoided especially during the third trimester of pregnancy. The alternative here for pregnant women would be to take acetominophen(Tylenol). Acetominophen causes less tummy irritation and does not cause a tendency to bleed.

-Opiates – such as codeine should be used with caution and only when indicated. The use of codeine during pregnancy has been studied extensively. The studies have shown that codeine is associated with multiple congenital defects, including heart defects and cleft palate or cleft lip. The association with these defects may also be due to the medical condition associated with their use.

-Antibiotics – The penicillin and cephalosporin antibiotics most commonly used in dentistry (penicillin V, amoxicillin, and caphalexin) are generally considered safe for use during pregnancy. Clindamycin, metronidazole, and erythromycin are also believed to have minimal risk. Tetracyclines, including doxycycline, have shown to cause tooth discoloration and impaired bone metabolism. As a side note, taking antibiotics while using birth control medications will generally cause the birth control to be ineffective.

-Sedative Agents – are used to relax and calm you, such as valium. These agents decrease action of the nervous system, and can cross the placental barrier. One of the most commonly prescribed drugs in this category is valium. It has been shown to cause  cleft lip and cleft palate when taking during pregnancy. So, caution should be taken when using valium over a prolonged period of time during pregnancy.

-Nitrous Oxide and General Anesthesia – The various side effects of inhaling nitrous oxide during pregnancy include behavioral and skeletal deformations, Cosmetic Dentist Marielaina Perrone DDSspontaneous abortions and reduced fertility. Nitrous oxide can inactivate vitamin B12. This in turn will affect DNA synthesis. DNA is crucial, as it is the genetic building blocks for your baby’s formation. For this reason, it is recommended to minimize exposure to nitrous oxide during the first trimester.


It is important to understand what we put into our bodies, and how they effect us, especially during pregnancy. When pregnant, the importance of being aware can not be stressed enough. Most often we can avoid medications during pregnancy, but it is not always the case. We can still have health issues during pregnancy, and knowing which drugs are safer, and those to stay away from may be critical. Your dental health is important before, during , and after pregnancy for both you and your baby. Dental care should be embraced before and during pregnancy to maintain a healthy oral environment to limit any potential issues that may develop. Choose your dentist wisely and ensure they are well versed in handling a patient thinking about becoming or are already pregnant to ensure a safe delivery.

Many people think it is okay for some gum bleeding during brushing or flossing but that is simply not true. Bleeding gums equal unhealthy gums. Periodontal disease canBleeding Gums Marielaina Perrone DDS creep up silently attacking your gums and bone in your mouth. This is especially important with recent studies showing periodontal disease being linked to systemic diseases like stroke, heart disease, and diabetes.

In most cases, inflamed, swollen and bleeding gums are a sign of gingivitis. However,  there are a number of other factors that could be causing your gum problems. Whatever the cause of sore, painful gums, there are steps you can take to minimize gum damage and discomfort. Some people avoid dental cleanings at home or in the dental office because it always makes them bleed. What they need to understand is, that the only reason they are bleeding is because they have become inflamed. Once you have your teeth cleaned and are taught proper oral hygiene techniques, it takes about 2 weeks of bleeding gums before they heal and stop bleeding. You just have to put up with some soreness and tough it out to get results. Once your gums have healed you will be amazed how good they feel, and how the bleeding just stops.

Reasons For Gum Inflammation and Bleeding

Poor dental hygiene

-Open mouth breathing

Medication causing tissue overgrowth, or poor healing

-Acid reflux (GERD)

-Poor nutrition

-Systemic Disease

Other Factors That Cause Bleeding Gums


Chemotherapy has many side effects. One of those side effects can include painful, swollen, and bleeding gums. Another gum issue from chemotherapy is stomatitis. This

Bleeding Gums Marielaina Perrone DDS

causes the development of painful sores and ulcers on the gums and throughout the mouth.

Tobacco use

Smoking or using other tobacco products can be very damaging to your gum tissue, and people who smoke are much more likely to develop periodontal disease than those who do not. Smokers often find that their smoking habit gives you a number of gum problems from sensitive gums that bleed to painful sores in your mouth.

Hormone Irregularities

Some women find that they experience gum problems during menstruation or pregnancy (and even menopause). The hormonal increase during puberty can elevate blood flow to the gums, making them red, swollen, and sensitive. For women with menstrual gingivitis, the gums become red, swollen, and have an increased likelihood to bleed shortly before each menstrual period. These problems typically subside after menstruation begins. Pregnancy gingivitis typically starts in the second or third month of pregnancy and continues through the eighth month, causing sore, swollen, and bleeding gums. The use of birth control products (oral and injectables) may cause similar gum problems. Though uncommon, some women going through menopause may find that their gums become extremely dry and therefore sore and more likely to bleed.

 Gum Damage From Brushing and Flossing

The most common cause of bleeding gums is not following proper techniques when flossing and brushing. This allows harmful bacteria to accumulate, and can lead to damage to your gums. The gingival tissue in the mouth can be strengthened considerably with proper hygiene. Normal brushing and flossing of healthy, pink, firm gum tissue does not elicit bleeding.

Whether you choose a manual or electric toothbrush, choose one with soft nylon bristles that have blunted ends. Even though you can find brushes with medium or hard bristles, they may damage the enamel on your teeth or cause gum recession.

When you brush, make sure you use gentle, circular motions to massage and clean the teeth and gums. While many people use a back-and-forth motion, this motion canBleeding Gums Marielaina Perrone DDS actually irritate and damage your gums, making them sore and more likely to recede.

We all know the importance of flossing every day to help remove plaque from places where your toothbrush cannot reach. Make sure that you have been taught to properly floss and brush by a professional.Be gentle and thorough when you brush and when you floss. Floss between your teeth by carefully sliding it up and down, following the curve of each tooth, and do not use a shoeshine or slicing motion.

Stages Of Periodontal Disease

Recent studies show 50-75% of American adults over the age of 35 suffer from some form of periodontal disease. The majority with periodontal disease have the earliest form, called gingivitis (reversible with treatment), about 10-15% of the population has the much more advanced type of periodontal disease known as periodontitis (controllable but not reversible).

Poor oral hygiene leads to a build up of bacteria and plaque in the mouth around teeth. This build up of bacteria may cause your gums to become inflamed, which results in red, swollen, or bleeding gums. Most people with gingivitis do not notice any symptoms initially. If you diagnose gingivitis early, it can be reversed and healed with proper oral hygiene maintenance. Gingivitis, if left untreated, can and will progress, and ultimately lead to tooth loss.

Signs and Symptoms of Periodontal Disease

-Formation of deep pockets between teeth and gums

-Gums that bleed during and after toothbrushing or during flossing.

-Loose teeth

-Shifting of teeth or changes in the way your teeth bite together

-Persistent bad breath (halitosis) or a foul taste in the mouth

-Receding Gums

Bleeding Gums Marielaina Perrone DDS

-Red, swollen, or tender gums

As gingivitis progresses, it develops into periodontitis. This a condition in which the gums and bone that hold the teeth in place can begin to break down. The bacteria on the

teeth release toxic substances that harm your gums and cause them to become infected. The infection and the inflammation that result when your body attacks the bacteria can break down your gums and the bone in your jaw supporting the teeth. You may experience exceptionally swollen, painful gums that are likely to bleed. If left untreated, periodontitis can lead to tooth loss.

Tips To Prevent Bleeding Gums

Visit dentist regularly.  This should include dental examinations, x-rays, and professional cleanings.

-Brush Twice a Day and follow proper brushing technique. If you’re not sure what to do, ask your dentist or dental hygienist for a quick lesson at your next visit.

-Floss daily. Flossing takes but a minute or two a day to do but the effects are far reaching in terms of keeping you gums healthy.

-Eat a well-balanced nutritious diet.

-Stay Hydrated by Drinking plenty of water.

-Do Not Smoke!

-Relax. Being stressed out raises levels of the stress hormone cortisol, increasing the likelihood of inflammation throughout your body, including in your gums.


Maintaining healthy teeth and gums is not a difficult job. It just requires knowing the proper techniques, creating daily habits, and visiting your dentist on a regular basis for check ups and professional cleanings. In the long run it will be well worth it as you save your teeth for a lifetime!