Periodontal Disease

The term “periodontal” means “around the tooth.” Periodontal disease (also known as periodontitis and gum disease) is a common inflammatory condition, which affects the soft tissue around the tooth and supporting bone.

Periodontal disease is most often preceded by gingivitis. Gingivitis occurs when plaque accumulates around the teeth irritating the gums. This causes the gums to become inflamed and bleed. Plaque that is not removed gets hard becoming tartar (calculus) that can form above and below the gums. Calculus that has formed under the gums becomes much more difficult to remove and to treat. Periodontal disease is a progressive condition that eventually leads to the destruction of the connective tissue and jawbone. If left untreated, it can lead to shifting teeth, loose teeth and eventually tooth loss.

Periodontal disease is the leading cause of tooth loss among adults in the developed world and should always be promptly treated.

Types of Periodontal Disease

When left untreated, the gums become irritated by the toxins contained in plaque, a chronic inflammatory response causes the body to break down and destroy its own bone and soft tissue. There may be little or no symptoms as periodontal disease causes the teeth to separate from the infected gum tissue. Deepening pockets between the gums and teeth are generally indicative that soft tissue and bone is being destroyed by periodontal disease.

THE FOLLOWING ARE THE MOST COMMON TYPES OF PERIODONTAL DISEASE:

• Chronic periodontitis – Is characterized by inflammation within supporting tissues causing deep pockets and gum recession. The teeth may appear longer as the gums are receding. Chronic periodontitis is the most common form of periodontal disease.
• Aggressive periodontitis – This form of gum disease typically occurs in an otherwise healthy individual. It is characterized by rapid loss of gum attachment, chronic bone destruction and familial aggregation.
• Necrotizing periodontitis - This form of periodontal disease most often occurs in individuals suffering from systemic conditions such as HIV, immunosuppression and malnutrition.

• Periodontitis caused by systemic disease – This form of gum disease often begins at an early age. Medical condition such as respiratory disease, diabetes and heart disease are common cofactors.

Common Causes of Gum Disease

There are genetic and environmental factors involved in the onset of gum disease, and in many cases the risk of developing periodontitis can be significantly lowered by taking preventative measures.

• Poor dental hygiene - Preventing dental disease starts at home with good oral hygiene and a balanced diet. Prevention also includes regular dental visits which include exams, cleanings, and x-rays. A combination of excellent home care and professional dental care will ensure and preserve the natural dentition and supporting bony structures. When plaque and calculus (tartar) are not removed, the gums and bone around the teeth become affected by bacteria toxins and can cause gingivitis or periodontitis, which can lead to tooth loss.
• Tobacco use – Research has shown that smoking and tobacco use is one of the most significant factors in the development and progression of gum disease. In addition to smokers experiencing a slower recovery and healing rate, smokers are far more likely to suffer from calculus (tartar) build up on teeth, deep pockets in the gingival tissue and more significant bone loss than non-smokers.
• Genetic predisposition – Despite practicing rigorous oral hygiene routines, as much as 30% of the population may have a strong genetic predisposition to gum disease. These individuals are six times more likely to develop periodontal disease than individuals with no genetic predisposition.
• Pregnancy and menopause – During pregnancy, regular brushing and flossing is critical. Hormonal changes experienced by the body can cause the gum tissue to become more sensitive, rendering them more susceptible to gum disease.
• Chronic stress and poor diet – Stress lowers the ability of the immune system to fight off disease, which means bacterial infections may possibly beat the body’s defense system. Poor diet or malnutrition can also lower the body’s ability to fight periodontal infections, as well as negatively affecting the health of the gums.
• Diabetes and underlying medical issues – Many medical conditions can intensify or accelerate the onset and progression of gum disease including respiratory disease, heart disease, arthritis and osteoporosis. Diabetes hinders the body’s ability to utilize insulin which makes the bacterial infection in the gums more difficult to control and cure.
• Grinding teeth – The clenching or grinding of the teeth can significantly damage the supporting tissue surrounding the teeth. Grinding one’s teeth is usually associated with a “bad bite” or the misalignment of the teeth. When an individual is suffering from gum disease, the additional destruction of gingival tissue due to grinding can accelerate the progression of the disease.
• Medication – Many drugs including oral contraceptive pills, heart medicines, anti-depressants and steroids affect the overall condition of teeth and gums; making them more susceptible to gum disease. Steroid use promotes gingival overgrowth, which makes swelling more commonplace and allows bacteria to colonize more readily in the gum tissue.

Symptoms of Periodontal disease:

• Red, swollen or tender gums or other pain in your mouth
• Bleeding while brushing, flossing, or eating hard food
• Gums that are receding or pulling away from the teeth, causing the teeth to look longer than before
• Loose or separating teeth
• Pus between your gums and teeth
• Sores in your mouth
• Persistent bad breath
• A change in the way your teeth fit together when you bite
• A change in the fit of partial dentures

Diagnosis

Periodontal disease is diagnosed by your dentist or dental hygienist during a periodontal examination. This type of exam should always be part of your regular dental check-up. A periodontal probe is gently used to measure the sulcus (pocket or space) between the top of the gum and the base where the tissue attaches to bone. The depth of a healthy sulcus measures 3 mm or less and does not bleed. The periodontal probe helps indicate the depth of the pocket. As periodontal disease progresses, the pockets usually get deeper.

Your dentist or hygienist will use pocket depths, amount of bleeding, inflammation, tooth mobility, etc., to make a diagnosis.

Treatment for Periodontal Disease

Periodontists specialize in the treatment of gum disease and the placement of dental implants. There are many surgical and nonsurgical treatments the periodontist may choose to perform, depending upon the exact condition of the teeth, gums and jawbone. A complete periodontal exam of the mouth will be done before any treatment is performed or recommended.

HERE ARE SOME OF THE MORE COMMON TREATMENTS OF PERIODONTAL DISEASE:

• Scaling and root planing –In order to preserve the health of the gum tissue, the bacterial plaque and calculus (tartar) which initially caused the infection, must be removed. The gum pockets will be cleaned and treated with antibiotics as necessary to help alleviate the infection.
• Tissue regeneration – When the bone and gum tissues have been destroyed, the periodontist may decide to re-growth lost bone. A membrane may be inserted into the affected areas to assist in the regeneration process.
• Pocket elimination surgery – Pocket elimination surgery (also known as flap surgery) is a surgical treatment which can be performed to reduce the pocket size between the teeth and gums allowing the patient to better clean their teeth.

Maintenance

Periodontal disease cannot be cured but it can be maintained in a stable state. This requires good home care and regular cleanings in your dental professionals office. Periodontal patients require cleanings four times a year, which is more frequent than the typical two times a year for non-periodontal patients.

Good oral hygiene home care and regular periodontal cleanings are necessary in maintaining dental health and keeping periodontal disease under control!