Board Certified Periodontist

58 – Thoughts & Ideas of One Periodontist

Hi and welcome to another installment of The Perio Patient Podcast.

Thank you for listening. I know you have choices and, for whatever reason, you have chosen to listen a moment to what I have to share. I will try to make it both informative and brief.

If you have accepted my earlier premise about needing routines, then good for you.

And if you are like me, routines are always sort of a work in progress. This is to say we are not so settled that we can’t find new and better ways to do things. Or as is often the case, we are bombarded by new ideas all the time, even that flossing is irrelevant and does’t work, that we need to continually review and strengthen our resolve.

Just this morning I had trouble getting out of bed. I set the alarm last night. I knew what I planned to do, what I at that time, wanted to do, but when the alarm went off, I was in the middle of some weird dream. I used this as an excuse in the moment to tell myself that I needed to continue sleeping in order to find out how the dream turns out. Well, that never works. So I tried sleeping longer, and succeeded at this for a few minutes until I just gave up and got out of bed.

Life is a battle between our comforts and our purposes. If we are not constantly working to live a purposeful life, then —I don’t know about you, but — it’s easy for me to just curl up and sleep a little longer.

Recently, I came across a Zen Proverb and it goes like this:

“If you understand, things are just as they are; if you do not understand, things are just as they are.”

At first you might think that what it is saying is that it doesn’t matter if you understand things, but actually it is just an acknowledgment that there is a reality that exists outside of our imaginations and even control, whether we know or like it. However, working toward understanding allows us to better manage the reality as it is. I hope I’m being clear here.

A tooth has four parts for everyone. And even though I need to know a lot more about this subject than you do, we both need to know enough to be able to take good care of ourselves. My approach to communicating to you what I think should be the bare minimum that someone needs to know, I have put into my explanation.

It begins with the title statement, A tooth has four parts. Then I tell you that you already know three of the four parts. You have likely heard the words enamel, dentin and pulp before. But there is one part I’m pretty sure you have not heard before seeing me — unless you have some education involving the anatomy of animals.

I then give you what for many is a new word, “Cementum.” I explain why it is likely new — it’s microscopic. You can’t see it with the naked eye. It surrounds the dentin which is everything on the outside of the tooth except the enamel. It is like a coating over the root structure. And when you look at it under a microscope you will see that it looks a lot like bone. Why it is not bone is due to the fact that there is a space between the bone and cementum where little fibers exist and attache the bone to the cementum. For this reason, cementum is definitely part of the tooth.

The space with the fibers that attach teeth to the rest of the body has a name and that name is the name of my particular specialty, periodontics. They are called periodontal fibers.

The word comes from Greek and breaks into Peri and Odont. Peri means “around” like perimeter, and periscope. Odont is the root word for tooth. Around the Tooth fibers. Odont also is the root word for dentist by the way.

It is this fiber attachment and the blood supply that nourishes it that are affected by periodontal disease.

Periodontal disease is an inflammatory response to hordes of bacteria that continually and rapidly grow in our mouths and congregate around the teeth in a film we call either plaque or biofilm.

My original explanation simply states that the cause of periodontal disease is by bacteria. This is partly true and really comes out of information that is now a bit dated. In other words, in the time of my career, our understanding of periodontal disease has shifted in actually some quite dramatic ways. Initially we were looking for the culprit, the bacterium that was responsible for the disease that was lurking in the middle of all the other organisms. What we found was that it is more complicated than this. It involves a number of organisms interacting with each other and emitting chemical signals that turn on the body’s immune response. This immune response with it’s killer cells and chemicals engage the battle with the plaque with the net result of destruction to the tissues around the tooth. Fibers are destroyed along with the bone near the fibers and the cementum, for the first time since it was formed is exposed and contaminated by the toxic products of some of the bacteria types.

Now if you want to hear the full presentation A Tooth Has Four Parts, its found on the homepage of my website: The other day I had a patient come in who was returning from another office. The concern by this other office had to do with bleeding and pocket depths in a particular area no resolving. When someone returns to me after active therapy has been completed it is important to figure out where they are now. Did everything get worse than before?

In her particular case the probing depths were still fairly stable — and I will get into a review about pocket depth numbers in another episode — but her bleeding index shot up. Her mouth was more inflamed than when she left. So I asked her, “How often are you flossing?”

She responded with not as often as she should.

To which I responded that flossing, if it is not accomplished daily, is not flossing. The reason I say this is because flossing prevents but doesn’t cure. In other words, if you get into trouble with bleeding gums, flossing more is now no longer the solution.

I know it’s hard to accept that you need to see a dentist, but if your gums are bleeding — and even if after flossing — they stop bleeding — it doesn’t mean that problem went away. All that went away was a symptom. Those of you who have seen me know that I obtain a bleeding index from probing around your gums that has really nothing to do with whether or not you are experiencing bleeding at home. My assessment has to do with the pockets around the teeth and whether or not there is any bleeding coming from this space — not your mouth in general. I am looking at bleeding coming from the area of injury or weakness.

But back to flossing not curing anything. Floss disrupts the bacterial colonies, the plaque or biofilm, so that it can’t organize or mature enough to emit the toxic chemicals that cause the immune response. But this requires a daily activity — not a once in a while activity. Once the inflammatory response occurs it has the potential of taking on a life of its own. If you want more information about flossing, you can read my little book, The Joy of Flossing, it’s a Kindle download on Amazon, or you can listen to me read you the book which is found on my website.

Thanks for listening and have a great day. You have been listening to The Perio Patient Podcast and I am Dr. Ben Young, a periodontist in San Antonio Texas. The podcast is primarily produced for my patients, my former patients and anyone else who cares to listen.