C. The Cause of Gum Disease
In order to understand the treatment of gum disease, you must come to know what occurs when the gums become infected. A pregnant woman has such alterations in her hormonal status that these hormonal changes can influence the health of her gums as an additional consideration to the normal causes of gum disease.
1. The Cause

Gum disease is caused by the bacteria that are normally in the mouth. The types of bacteria may vary with some patients having more types that are associated with aggressive gum disease. The bacteria then accumulate where the gums meet the teeth. The gums normally form a "ditch" or "sulcus" that goes completely around the tooth like a "cuff on a shirt goes around your wrist". Once the bacteria cause the gums to become infected, the gums detach from the teeth.

When the gums are healthy, the normal depth of the "sulcus" is 1-3 millimeters. When the gums detach fron the teeth as a result of the gum disease, a diseased "sulcus" is called a "pocket" and the "pocket" has a depth deeper than the 1-3 millimeters of the "sulcus".

This deeper depth of the "pocket" then prevents the patient from treating their own gum disease since a patient can not clean into a "pocket" and eliminate the excess bacteria when the pocket depth is deeper than 3 millimeters. The untreatable gum disease then spreads into the underlying bone which supports the teeth. This causes loosening of the teeth.

If the gum disease is not treated early enough, the patient will lose their teeth and their body will have been flooded by diseased products (biological molecules) which were generated by the diseased gum tissues

2. The Risk Factors

Aside from the bacteria that cause gum disease, there are other considerations which can modify the course or aggressiveness of the disease. These are called "risk factors" and are:

a. Hormonal Changes Related to the Pregnancy.
The alterations in a pregnant woman's hormone levels can increase her chance of getting gum disease. The milder form of gum disease which is frequently called "pregnancy gingivitis" is readily controlled and in all likelihood would only be a minor contributory factor in pre-term low birth weights, if any factor at all.

b. Genetically-Reduced Resistance to Gum Disease.
There are genetic considerations which predispose patients towards severe gum disease. While genetic testing is not routinely done, if you are concerned with the degree of severity of your problem you really must see a periodontist in order to discuss:
(1.) Genetic testing for low gum disease resistance.
(2.) Family profiling to reconstruct a history of gum disease resistance.
(3.) A Clinical Disease-Severity Aggressiveness Projection.

c. Smoking.
While smoking may be a risk factor for premature births, a smoking pregnant woman can further risk her pregnancy if by smoking she also increases the amount of gum disease that she has.

d. Presence of Diabetes or a Family History of Diabetes.
Diabetes can influence gum disease and there is some research that gum disease can influence diabetes. The diabetic pregnant woman should consider seeing a periodontist for a thorough exam.

e. The Type of Bacteria that are Present in a Patient's Mouth.
There are different types of bacteria that are associated with gingivitis, mild periodontitis and more severe periodontitis. It is not known why some patients have more aggressive bacteria in their mouths.

*** Important: It has been shown that patients can transmit gum disease bacteria to their spouses, and that when the spouses have gum disease, the other spouse is more likely to have gum disease. If you are shown to have a more serious type of gum disease, it is important to check the gum health of your spouse. Check the website www.periotrans.com for more information about gum disease transmissibility.
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