The term “periodontal”means “around the tooth.”  Periodontal disease (also known as periodontitis and gum disease) is a common inflammatory condition which affects the supporting and surrounding soft tissues of the tooth; also the jawbone itself when in its most advanced stages.

Periodontal disease is most often preceded by gingivitis which is a bacterial infection of the gum tissue.  A bacterial infection affects the gums when the toxins contained in plaque begin to irritate and inflame the gum tissues.  Once this bacterial infection colonizes in the gum pockets between the teeth, it becomes much more difficult to remove and 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, gingivitis (mild gum inflammation) can spread to below the gum line.  When 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.

Here are some of the most common types of periodontal disease:

  • Chronic periodontitis – Inflammation within supporting tissues cause deep pockets and gum recession.  It may appear the teeth are lengthening, but in actuality, the gums (gingiva) are receding.  This is the most common form of periodontal disease and is characterized by progressive loss of attachment, interspersed with periods of rapid progression.
  • Aggressive periodontitis – This form of gum disease occurs in an otherwise clinically 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.  Necrosis (tissue death) occurs in the periodontal ligament, alveolar bone, and gingival tissues.
  • 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.

Treatment for Periodontal Disease

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 for periodontal disease:

  • Scaling and root planing – In order to preserve the health of the gum tissue, the bacteria 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.  A prescription mouthwash may be incorporated into daily cleaning routines.
  • Tissue regeneration – When the bone and gum tissues have been destroyed, regrowth can be actively encouraged using grafting procedures.  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.  Surgery on the jawbone is another option which serves to eliminate indentations in the bone which foster the colonization of bacteria.
  • Dental implants – When teeth have been lost due to periodontal disease, the aesthetics and functionality of the mouth can be restored by implanting prosthetic teeth into the jawbone.  Tissue regeneration procedures may be required prior to the placement of a dental implant in order to strengthen the bone.

Ask your dentist if you have questions or concerns about periodontal disease, periodontal treatment, or dental implants.

FAQs

Q: How can I tell if I have gingivitis or periodontitis (gum disease)?

Four out of five people have periodontal disease and don’t know it!  Most people are not aware of it because the disease is usually painless in the early stages.  Unlike tooth decay, which often causes discomfort, it is possible to have periodontal disease without noticeable symptoms.  Having regular dental check-ups and periodontal examinations are very important and will help detect if periodontal problems exist.

Periodontal disease begins when plaque, a sticky, colorless, film of bacteria, food debris, and saliva, is left on the teeth and gums.  The bacteria produce toxins (acids) that inflame the gums and slowly destroy the bone.  Brushing and flossing regularly and properly will ensure that plaque is not left behind to do its damage.

Other than poor oral hygiene, there are several other factors that may increase the risk of developing periodontal disease:

  • Smoking or chewing tobacco – Tobacco users are more likely than nonusers to form plaque and tartar on their teeth.
  • Certain tooth or appliance conditions – Bridges that no longer fit properly, crowded teeth, or defective fillings that may trap plaque and bacteria.
  • Many medications – Steroids, cancer therapy drugs, blood pressure meds, oral contraceptives.  Some medications have side affects that reduce saliva, making the mouth dry and plaque easier to adhere to the teeth and gums.
  • Pregnancy, oral contraceptives, and puberty – Can cause changes in hormone levels, causing gum tissue to become more sensitive to bacteria toxins.
  • Systemic diseases – Diabetes, blood cell disorders, HIV / AIDS, etc.
  • Genetics may play role – Some patients may be predisposed to a more aggressive type of periodontitis.  Patients with a family history of tooth loss should pay particular attention to their gums.

Signs and Symptoms of Periodontal Disease

  • Red and puffy gums – Gums should never be red or swollen.
  • Bleeding gums – Gums should never bleed, even when you brush vigorously or use dental floss.
  • Persistent bad breath – Caused by bacteria in the mouth.
  • New spacing between teeth – Caused by bone loss.
  • Loose teeth – Also caused by bone loss or weakened periodontal fibers (fibers that support the tooth to the bone).
  • Pus around the teeth and gums – Sign that there is an infection present.
  • Receding gums – Loss of gum around a tooth.
  • Tenderness or Discomfort – Plaque, calculus, and bacteria irritate the gums and teeth.

Good oral hygiene, a balanced diet, and regular dental visits can help reduce your risk of developing periodontal disease.