The Dental Blog

Periodontal Disease 101

Don’t Wait Till It Hurts

Your teeth are intended to last a lifetime-and they can, with proper care. This means thorough daily brushing, cleaning between the teeth, and regular professional cleanings to avoid periodontal diseases. Advanced periodontal diseases are a major cause of tooth loss in adults. But they can be prevented.

There are several types of periodontal diseases. All are started by a bacterial infection which attacks the gums, bone and ligaments that support the teeth and hold them in the jaw. Periodontal diseases are usually painless, and may develop slowly or progress quite rapidly. Unless you have regular dental checkups, you may not be aware you have a periodontal disease until your gums and bone have been so seriously damaged that tooth loss is inevitable.

More than half of all people over age 18 have at least the early stage of some type of periodontal disease. After age 35, about three out of four adults are affected by some form of gum disease. However, periodontal diseases can occur at any age. Even children as young as five or six can have signs of some of these diseases.

Causes of Periodontal Diseases

Periodontal diseases are caused by certain types of bacteria in plaque, the sticky, colorless film of bacteria that constantly forms on teeth. These bacteria create toxins (poisons) which irritate the gums and result in a break-down of the attachment of gum tissues to teeth. Over time, these toxins can destroy gum tissues, allowing the infection to progress to bone loss.

In addition, plaque that is not removed can combine with other materials and harden into a rough, porous deposit called calculus (tartar). Calculus on the root surface, below the gums, makes removal of new plaque and bacteria more difficult. Unlike plaque, which you can remove, only a dentist or dental hygienist can remove calculus.

Types of Periodontal Diseases

While there are many forms of gingival and periodontal diseases, the two most common types are gingivitis and adult periodontitis:

• Gingivitis is the earliest stage, and affects only the gum tissue. At this stage, the disease is still reversible.
• Periodontitis is the more advanced stage of periodontal diseases. The gums, bone and other structures that support the teeth become damaged. Teeth can become loose and fall out – or may have to be removed. At this stage, the disease may require more complex treatment to prevent tooth loss.

Here is a step-by-step illustration of the progress of gingivitis and periodontitis:

Healthy gingiva

Gingivitis

Periodontitis

Advanced Periodontitis

1. Healthy gingiva (gum tissue) and bone anchor the teeth firmly in place.
2. Gingivitis develops as toxins in plaque irritate the gums, making them red, tender, swollen and likely to bleed easily.
3. Periodontitis occurs when toxins destroy the tissues that anchor the teeth in the bone. Gums become detached from the teeth, forming pockets that fill with more plaque. Tooth roots are exposed to plaque and become susceptible to decay and sensitive to cold and touch.
4. Advanced periodontitis is present when the teeth lose more attachment because the supporting bone is destroyed. Unless treated, the affected teeth frequently becomes loose, may fall out or require removal by a dentist

Other Factors Contributing to Periodontal Disease

Although periodontal diseases are caused by plaque, a number of other factors can increase the risk, severity and speed of development of the condition.

• People who smoke or chew tobacco are more likely to have periodontal diseases.
• Poorly fitting bridges, malocclusion (badly aligned teeth or defective restorations (fillings), can all contribute to plaque retention and increase the risk of developing periodontal diseases.
• Excessive biting forces on your teeth, such as clenching or grinding, may also accelerate the rate at which supporting bone is lost.
• Poor diet may cause periodontal diseases to progress more rapidly.
• Pregnancy or use of oral contraceptives increases hormone levels which can cause gum tissues to react more sensitively to the toxins in plaque and accelerate growth of certain bacteria. The gums are more likely to become red, tender and swollen and to bleed easily.
• Systemic diseases, such as AIDS or diabetes, can lower the tissues’ resistance to infection, making periodontal diseases more severe.
• Medications – steroids, some types of drugs, cancer therapy drugs, some calcium channel blockers and many others – affect the gums.

Most people don’t experience any pain due to periodontal diseases so it is important to have regular checkups including a periodontal exam. In addition, professional cleaning is essential to preventing periodontal diseases. If you notice any of the following signs, see your dentist immediately:

• Gums that bleed easily.
• Red, swollen or tender gums.
• Gums that have pulled away from the teeth.
• Pus between the teeth and gums when the gums are pressed.
• Persistent bad breath or bad taste.
• Permanent teeth that are loose or separating.
• Any change in the way your teeth fit together when you bite.
• Any changes in the fit of partial dentures.

Diagnosing Periodontal Diseases

With regular dental visits, dentists can detect developing periodontal diseases early, before the gums and the bone around your teeth are irreversibly damaged. So don’t wait till it hurts!

During checkups, your dentist will examine your gums for periodontal problems. An instrument called a periodontal probe will be used to determine if there is any breakdown in the gum tissue attachment or development of pockets between your gums and teeth. The depth of pockets can be measured with the instrument you see in the picture to the left.  Your dentist may also need to take X-rays to determine if any bone has been destroyed.

Treating Forms of Periodontitis

The method of treatment of periodontal diseases depends upon the type of disease and how far the condition has progressed. The first step is usually a thorough cleaning which may include scaling to remove plaque and calculus deposits beneath the gumline. In some cases, the occlusion (bite) also may require adjustment.

1. Presurgical bony defect

Surgery may be required when deeper pockets (over 4 to 6 mm) are found. Patients can seldom, if ever, keep them clean and free of plaque. Allowing pockets to remain may invite infection and bone destruction.

2. Flap incision allows gingival tissue to be retracted

When pockets are deep and bone has been destroyed, flap surgery may be necessary to allow the dentist to get access to the roots of the teeth in order to thoroughly remove calculus, plaque and any diseased tissue.

3. Gingival tissue is sutured into a new position

Osseous (bone) surgery sometimes accompanies flap surgery. In osseous surgery, some of the bone around the tooth is reshaped. In certain cases, a bone area may be employed to replace lost bone. Splints or other appliances may be used to stabilize loose teeth temporarily and may be necessary after completion of periodontal therapy as well.

Other effective procedures are also available for replacing gum tissue and bone destroyed in advanced stages of the disease. These procedures are used for specific periodontal problems. Talk with us about the treatments that may be right for you.