Periodontal Disease

Periodontitis, the more severe disease, is not reversible. It involved destruction of the bone supporting the teeth. There are different forms, and it is the #1 reason for tooth loss in the United States for adults.

What causes gum disease?

Most gum disease is started by dental plaque and your susceptibility to it. As it ages, if left on the teeth, it can harden into dental tartar or calculus. The plaque creates inflammation. It can be worsened by other factors such as smoking, hormonal issues and systemic diseases such as diabetes

What can it do?

Gingivitis, an earlier or less aggressive form of the disease, is reversible. It causes gingival swelling and bleeding. Often this is associated with blood on your toothbrush or something more serious.

What are periodontal diseases?

The word "periodontal" literally means "around the tooth." Periodontal diseases are bacterial gum infections that destroy the gums and supporting bone that hold your teeth in your mouth. Periodontal diseases can affect one tooth or many teeth.

The main cause of periodontal diseases is bacterial plaque, a sticky, colorless film that constantly forms on your teeth. If the plaque is not removed, it can turn into a hard substance called calculus or tartar in less than two days. Tartar is so hard it can only be removed by an oral health professional, such as a dentist or dental hygienist. The bacteria in plaque infect the gums, and release poisons that cause redness and inflammation (irritation). The inflammation and the poisons themselves cause destruction of the tissues that support the teeth, including the bone. When this happens, the gums separate microscopically from the teeth, forming pockets that fill with even more plaque causing even more infection.

Periodontal diseases are multi-factorial. This means that there is not just one cause of periodontal diseases but rather multiple factors that can affect the health of your gums.

• Tobacco use significantly increases the risk of developing periodontal diseases and can negatively affect treatment.
• Hormonal changes during pregnancy, puberty and menopause can cause the gums to become red, tender and bleed easily.
• Genetics and family history of periodontal diseases indicate a greater likelihood of developing these diseases.
• Stress can make it more difficult for the body to fight off infection, including periodontal diseases.
• Some medications such as oral contraceptives, antidepressants and certain heart medicine, can affect oral health.
• Destructive habits such as improper oral hygiene technique, oral piercing, drug or alcohol abuse can affect periodontal health.
• Poor nutrition can make it harder for the body to fight off infection.
• Systemic diseases that interfere with the body's immune system may worsen the condition of the gums and supporting bone.

Are all forms of periodontal diseases the same?

There are many types of periodontal diseases. The following is an overview of the most common:

Gingivitis

As the mildest form of the periodontal diseases, gingivitis causes the gums to become red, swollen, and bleed easily. There is usually no discomfort at this stage.

Chronic Periodontitis

Chronic periodontitis is a condition resulting in inflammation within the soft tissues surrounding the teeth causing progressive attachment and bone loss. It is diagnosed by bone loss on a dental X-ray, the formation of gum pockets and/or receding gums. It is most common in adults, but can occur at any age.

Aggressive Periodontitis

This form occurs in patients who are otherwise in good health. Common features include rapid attachment loss and bone destruction.

There are two forms of aggressive periodontitis:

1. Localized Aggressive Periodontitis - Most often occurs near puberty and usually involves attachment loss around first molars and/or front teeth but may involve one or two additional teeth.
2. Generalized Aggressive Periodontitis - Usually, but not always affects people under 30 years of age. It involves attachment loss on at least three permanent teeth in addition to first molars and incisors.

Periodontitis as a Manifestation of Systemic Disease

As the name indicates, the form is associated with one of several systemic diseases that are related to periodontitis, such as diabetes.

Necrotizing Periodontal Diseases

These types of periodontal diseases cause ulcers in the gums between the teeth and are most commonly observed in individuals with certain conditions including, but not limited to, HIV infection, malnutrition and immunosuppression. Stress, smoking, and poor oral hygiene sometimes can contribute to this problem.

What are the signs of periodontal diseases?

Periodontal diseases are often silent, meaning that symptoms may not materialize until significant bone loss has occurred. Some people may have periodontitis and not experience any symptoms and by unaware that they have disease. Common symptoms and signs of periodontal diseases include:

• Red, swollen or tender gums
• Bleeding while brushing or flossing
• Gums pulling away from the teeth making teeth appear longer
• Loose or separating teeth
• Pus between gum and tooth
• Persistent bad breath
• A change in the way your teeth fit together when you bite
• A change in the fit of your partial dentures

If you notice any of these symptoms, you should see a periodontist for a complete periodontal examination. A periodontist is a dentist who specializes in the prevention, diagnosis and treatment of tissues surrounding the teeth. In addition, periodontists are experts in the placement and maintenance of dental implants.

During a periodontal examination, the periodontist will gently place a small measuring instrument calling a periodontal probe in the pocket between the teeth and gums to measure pocket depths and help make a diagnosis. Probing depths measuring 1-3mm are usually considered healthy. Four to 5mm may indicate mild periodontitis, 5-6mm suggest moderate periodontitis, and 7mm or greater may indicate severe periodontitis. In addition to probing depth measurements, X-rays may be taken to evaluate the health of the bone supporting the teeth.
How are periodontal diseases treated?

Once your periodontal health has been evaluated, your periodontist will work with you to determine the best treatment options to control your disease and bring you back to health. Treatment can vary depending on how far the disease has progressed. If diagnosed and treated in the early stages, simple non-surgical periodontal therapy may be sufficient. If periodontitis has advanced to the point where the periodontal pockets are deep and significant amounts of bone lost, surgical therapy may be necessary.

Once periodontitis has been controlled, patients will require ongoing periodontal maintenance procedures to sustain health. This ongoing phase of treatment will allow your periodontist to assess your periodontal health and make sure that your infection stays under control or remains eliminated. During these re-evaluation appointments, your mouth will be examined, new calculus and plaque will be removed and, if necessary, your teeth will be polished and your bite will be checked. Periodontal diseases are chronic diseases, just like diabetes. Without careful, ongoing treatment, periodontal diseases can and often to recur.

How can the periodontal diseases be prevented?

Good oral hygiene and professional care are the keys to keeping your teeth for a lifetime. The best way to prevent periodontal diseases and tooth decay is to remove the bacterial plaque by thorough brushing and flossing every day. Good oral hygiene habits will help keep the formation of dental tartar to a minimum.

Regular dental visits that include a periodontal examination are also important to detect any changes in periodontal health and, if necessary, to remove hardened tartar in places that your toothbrush and floss may have missed. A professional cleaning (often called a prophylaxis) at least twice a year is recommended for patients with good periodontal health. If you have had any form of the periodontal diseases, you may need professional maintenance more frequently.

Congratulation on taking the first step to achieving periodontal health! Preventing and/or controlling periodontal diseases is a worthwhile commitment that will keep you smiling for life.

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