Gum Disease in Younger Patients

 

Last week a new patient, in his early 20s came in for assessment and treatment.  After x-rays and periodontal charting, I determined that he had periodontal disease, in its early stages. Deep cleanings can go far in resolving such a situation and this is what I recommended.  His pocketing is 5 mm in the molar areas with red bleeding gums and bad breath all due to the accumulation of plaque and the response of the gum tissues to this irritant. In this particular case, a full mouth treatment of 1.5 to 2 hours is recommended. The cause of this is the lack of home care, plus the patient’s chemistry which makes plaque accumulation conducive to the growth. I noted that he is on some psychiatric medicine, but I cannot say for sure that there is a contribution from that.

Less extreme is gingivitis. This is found in patients of all ages. It is similar to periodontal disease as far as the red, swollen and irritated gums. In this case there is no bone loss, especially between the teeth. The treatment usually consists of a good cleaning and hygiene instruction so that the patient can maintain healthy gums between cleaning appointments.

There is an aggressive form of periodontitis that is seen in juveniles and adolescents. This usually causes extreme bone loss on first molars (which come in around age 6) along with the incisors. The result is frequently tooth loss due to the response of the bone and different bacteria than one would normally find in that area. Treatment to save these teeth consists of both major debridement of the area, plus antibiotic therapy. I usually refer these cases to the periodontist, although I do not see very many of these patients in my practice.

One difficulty in the dental profession is to convince parents that their children can have periodontal disease at such early ages. Although it is true we see more periodontal problems in our middle age population, gum problems do exist in the younger population and should be treated as early as possible so that they do not need gum surgery or even worse, experience tooth loss.