Periodontal Disease & Treatments
Q1: What is periodontal disease?
Q2: Signs and symptoms of periodontal disease
Q3: When to see a dentist
Q4: Causes of periodontal disease
Q5: Risk Factors that increase the risk of periodontal disease
Q6: Types of periodontal disease
Q7: Complications of Periodontal Disease
Q8: Periodontal disease and diabetes
Q9: Periodontal disease, heart disease and stroke
Q10: Periodontal disease and hormones
Q11: Periodontal disease and osteoporosis
Q12: Periodontal disease and respiratory disease
Q15: Lifestyles and Home Remedies
1. What is 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 supporting and surrounding soft tissue 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.
2. Signs and symptoms of periodontal disease:
Bright red or purplish gums
Gums that feel tender when touched
Gums that pull away from your teeth (recede), making your teeth look longer than normal
New spaces developing between your teeth
Pus between your teeth and gums
Bad taste in your mouth
A change in the way your teeth fit together when you bite (shifting)
3. When to see a dentist
Health gums are firm and pale pink. If your gums are puffy, dusky red and bleed easily, or show other signs or symptoms of periodontitis, see your dentist soon. The sooner you seek care, the better chances of reversing damage from periodontitis and preventing other serious health problems.
4. Causes of periodontal disease
It’s thought that periodontitis begins with plaque. This sticky film is composed mainly of bacteria. Plaque forms on your teeth when starches and sugars in food interact with bacteria normally found in your mouth. Brushing your teeth removes plaque. But plaque re-forms quickly, usually within 24 hours.
Plaque that stays on your teeth longer than two or three days can harden under your gum line into tartar (calculus). Tartar makes plaque more difficult to remove and acts as a reservoir for bacteria. What's more, you usually can't get rid of tartar by brushing and flossing — you need a professional dental cleaning to remove it.
The longer plaque and tartar remain on your teeth, the more damage they can do. Initially, they may simply irritate and inflame the gingiva, the part of your gum around the base of your teeth. This is called gingivitis, the mildest form of periodontal disease. But ongoing inflammation eventually causes pockets to develop between your gums and teeth that fill with plaque, tartar and bacteria. In time, these pockets become deeper and more bacteria accumulate, eventually advancing under your gum tissue. These deep infections cause a loss of tissue and bone. If too much bone is destroyed, you may lose one or more teeth.
5. Risk Factors that increase the risk of periodontal disease
Poor Oral Health Habits
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 bacteria 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.
Research has indicated 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 significant bone loss.
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. Genetic tests can be used to determine susceptibility with early intervention being performed to keep the oral cavity healthy.
Hormonal changes, such as those related to pregnancy or menopause, experienced by the body can cause the gum tissue to become more sensitive, rendering them more susceptible to gum disease.
Chronic Stress and Poor Nutrition
Stress lowers the ability of the immune system to fight off disease, which means bacterial infections may possible 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 Other 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.
The clenching and 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.
Many drugs, including oral contraceptive pills, heart medicines, antidepressants, 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.
Decreased Immunity, Such as that Occurring with Leukemia, HIV/AIDS, or Chemotherapy
Ill-Fitting Dental Restorations
6. Types of periodontal disease
There are many different varieties of periodontal disease, and many ways in which these variations manifest themselves. All require immediate treatment to halt the progression and save the gum tissue and bone.
Here are some of the most common types of periodontal disease along with the treatments typically performed to correct them:
Gingivitis is the mildest and most common form of periodontitis. It is caused by the toxins in plaque and leads to periodontal disease. People at increased risk of developing gingivitis include pregnant women, women taking birth control pills, people with uncontrolled diabetes, steroid users, and people who control seizures and blood pressure using medication.
Treatment for gingivitis is easily reversible using a solid combination of home care and professional cleaning. The dentist may perform root planing and deep scaling procedures to cleanse the pockets of debris. A combination of antibiotics and medicated mouthwashes may be used to kill any remaining bacteria and promote the good healing of the pockets.
Chronic Periodontal Disease
Chronic periodontal disease is the most common form of the disease, and occurs much more frequently in people over 45 years of age. Chronic periodontal disease is characterized by inflammation below the gum line and the progressive destruction of the gingival and bone tissue. It may appear that the teeth are gradually growing in length, but in actuality, the gums are gradually recessing.
Treatment for chronic periodontal disease, unlike gingivitis, unfortunately cannot be completely cured because the supportive tissue cannot be rebuilt. However, the dentist can halt the progression of the disease using scaling and root planing procedures in combination with antimicrobial treatments. If necessary, surgical treatments can be performed, such as pocket reduction surgery and tissue grafts to strengthen the bone and improve the aesthetic appearance of the oral cavity.
Treatments for aggressive periodontal disease are the same as those for chronic periodontal disease, but aggressive periodontal disease sufferers are far more likely to require a surgical intervention. This form of the disease is harder to halt and treat, but the dentist will perform scaling, root planing, antimicrobial, and in some cases, laser procedures, in an attempt to save valuable tissue and bone.
Aggressive Periodontal Disease
Aggressive periodontal disease is characterized by the rapid loss of gum attachment, the rapid loss of bone tissue and familial aggregation. The disease itself is essentially the same as chronic periodontitis, but the progression is much faster. Smokers and those with a family history of this disease are at an increased risk of developing aggressive periodontitis.
Periodontal Disease Relating to Systemic Conditions
Periodontal disease can be a symptom of a disease or condition affecting the rest of the body. Depending on the underlying condition, the disease can behave like aggressive periodontal disease, working quickly to destroy tissue. Heart disease, diabetes, and respiratory disease are the most common cofactors, though there are many others. Even in cases where little plaque coats the teeth, many medical conditions intensify and accelerate the progression of periodontal disease.
Initially, the medical condition which caused the onset of periodontal disease must be controlled. The dentist will halt the progression of the disease using the same treatments used for controlling aggressive and chronic periodontal disease.
Necrotizing Periodontal Disease
This form of the disease rapidly worsens and is more prevalent among people who suffer from HIV, immunosuppression, malnutrition, chronic stress, or choose to smoke. Tissue death (necrosis) frequently affects the periodontal ligament, gingival tissues, and alveolar bone.
Treatment for Necrotizing Periodontal Disease is extremely rare. Because it may be associated with HIV or another serious medical condition, it is likely the dentist will consult with a physician before commencing treatment. Scaling, root planing, antibiotic pills, medicated mouth wash and fungicidal medicines are generally used to treat this form of the disease.
7. Complications of Periodontal Disease
Coronary artery disease
Low birth weight babies
Poorly controlled diabetes
Research suggests that the bacteria responsible for periodontitis can be inhaled or enter your bloodstream through your gum tissue, affecting your lungs, heart and other parts of your body. For instance, bacteria may travel to the arteries in your heart, where they can trigger a cycle of inflammation and arterial narrowing that contributes to heart attacks.
8. Periodontal disease and diabetes
People who have diabetes know the disease can harm the eyes, nerves, kidneys, heart and other important systems in the body. Did you know diabetes can also cause problems in your mouth? People with diabetes are more likely to have periodontal disease than people without diabetes, probably because people with diabetes are more susceptible to contracting infections. In fact, periodontal disease is often considered a complication of diabetes. Those people who don't have their diabetes under control are especially at risk.
Research has suggested that the relationship between diabetes and periodontal disease goes both ways - periodontal disease may make it more difficult for people who have diabetes to control their blood sugar.
Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. This puts people with diabetes at increased risk for diabetic complications.
Periodontal disease can lead to painful chewing difficulties and even tooth loss. Dry mouth, often a symptom of undetected diabetes, can cause soreness, ulcers, infections, and tooth decay. Smoking makes these problems worse.
9. Periodontal disease, heart disease and stroke
Several studies have shown that periodontal disease is associated with heart disease. While a cause-and-effect relationship has not yet been proven, research has indicated that periodontal disease increases the risk of heart disease.
Scientists believe that inflammation caused by periodontal disease may be responsible for the association.
Periodontal disease can also exacerbate existing heart conditions. Patients at risk for infective endocarditis may require antibiotics prior to dental procedures. Your periodontist and cardiologist will be able to determine if your heart condition requires use of antibiotics prior to dental procedures.
Additional studies have pointed to a relationship between periodontal disease and stroke. In one study that looked at the causal relationship of oral infection as a risk factor for stroke, people diagnosed with acute cerebrovascular ischemia were found more likely to have an oral infection when compared to those in the control group.
10. Periodontal disease and hormones
During puberty, an increased level of hormones, such as progesterone and possibly estrogen, causes increased blood circulation to the gums. This may cause an increase in the gum's sensitivity and lead to a greater reaction to any irritation, including food particles and plaque. During this time, the gums may become swollen, turn red and feel tender.
Occasionally, some women experience menstruation gingivitis. Women with this condition may experience bleeding gums, bright red and swollen gums and sores on the inside of the cheek. Menstruation gingivitis typically occurs right before a woman's period and clears up once her period has started.
Some studies have suggested the possibility of an additional risk factor – periodontal disease. Pregnant women who have periodontal disease may be more likely to have a baby that is born too early and too small. However, more research is needed to confirm how periodontal disease may affect pregnancy outcomes.
All infections are cause for concern among pregnant women because they pose a risk to the health of the baby. The Academy recommends that women considering pregnancy have a periodontal evaluation.
Menopause and Post-Menopause
Women who are menopausal or post-menopausal may experience changes in their mouths. They may notice discomfort in the mouth, including dry mouth, pain and burning sensations in the gum tissue and altered taste, especially salty, peppery or sour.
In addition, menopausal gingivostomatitis affects a small percentage of women. Gums that look dry or shiny, bleed easily, and range from abnormally pale to deep red mark this condition. Most women find that estrogen supplements help to relieve these symptoms.
11. Periodontal disease and osteoporosis
Osteoporosis is a disease that has garnered a bit of attention just by the severity of the results of later stages of the disease. It is characterized by the later stages, as in these stages the bones have become thin and porous and pose more and more risk over time as they become more fragile.
This condition is estimated to be affecting 2 million men and 6 million women of the United States alone, and is very hard to detect in the early stages as it shows little to no symptoms. Often the only time a person is even suspected to have this disease is the first time that person fractures a bone, as that can be the first sign of the bones having been weakened by the disease.
With this in mind, there is good news emerging as some believe we may soon be able to diagnose osteoporosis earlier in a person by looking inside their mouth. This is because being able to identify the quality of bone strength in the mouth is showing to be a reliable indicator of the bone strength elsewhere in the body. This is in part due to more scientists studying the link between osteoporosis and periodontal disease of the mouth in which the bones of the mouth have been determined to be susceptible to the same conditions the bones of the rest of the body.
Periodontal disease itself is caused by infection and inflammation inside the mouth after plaque has been left on the teeth far too long than what is healthy. When the bacteria in the plaque have dissolved the surrounding gums and begin to do the same to the bone, it weakens the surrounding bones of the mouth and jaw. While this disease, commonly called gum disease, is not caused by osteoporosis it is complicated when it is present. This is because osteoporosis working in connection with periodontal disease will make the bone degradation of the mouth much more severe. The severity of the effect of gum disease is becoming a strong indicator for the presence of osteoporosis elsewhere in the body. Being able to catch this early in a person allows for better treatment of osteoporosis before it can have the chance to cause debilitating fractures.
12. Periodontal disease and respiratory disease
Periodontal disease (also called periodontitis and gum disease) has been linked to respiratory disease through recent research studies. Researchers have concluded that periodontal disease can worsen conditions such as chronic obstructive pulmonary disease (COPD) and may actually play a causal role in the contraction of pneumonia, bronchitis and emphysema.
Periodontal disease is a progressive condition which generally begins with a bacterial infection. The bacteria found in plaque begin to colonize in gingival tissue, causing an inflammatory response in which the body destroys both gum and bone tissue. The sufferer may notice the teeth “lengthening” as the gums recede while the disease progresses. If left untreated, erosion of the bone tissue brings about a less stable base for the teeth, meaning loose, shifting or complete tooth loss.
There are a number of different respiratory diseases linked to periodontal disease. Pneumonia, COPD, and bronchitis are among the most common. Generally, bacterial respiratory infections occur due to the inhalation of fine droplets from the mouth into the lungs. COPD is a leading cause of death and should be taken very seriously.
Diagnosis is of periodontitis is generally simple. Diagnosis is based on your description of symptoms and an exam of your mouth. Your dentist will look for plaque and tartar buildup and check for easy bleeding.
To check the health of your gum tissue, your dentist may use a metal probe to measure the depth of the gingival sulcus, the groove between your gums and your teeth. The probe is inserted beside your tooth beneath your gum line, usually at several sites throughout your mouth. The measurements can help determine how severe your periodontitis is.
There are several ways to treat periodontitis, depending on its severity. The goal of periodontitis treatment is to thoroughly clean the pockets of bacteria and to prevent more damage. Treatment may be performed by a periodontist, a dentist or a dental hygienist. Treatment is most successful when you adopt a daily routine of good oral care.
If your periodontitis isn't advanced, treatment can include less invasive procedures, including:
Scaling - Scaling removes tartar and bacteria from your tooth surfaces and beneath your gums. It may be performed using instruments or an ultrasonic device.
Root planing - Root planing smoothes the root surfaces, discouraging further buildup of tartar.
Antibiotics - The use of antibiotics to treat periodontitis remains open to debate. Your periodontist or dentist may recommend using topical or oral antibiotics to help control bacterial infection. Topical antibiotics are generally the treatment of choice. They can include antibiotic mouth rinses or insertion of threads and gels containing antibiotics in the space between your teeth and gums or into pockets after deep cleaning. However, oral antibiotics may be necessary to completely eliminate infection-causing bacteria.
If you have advanced periodontitis, your gum tissue may not respond to nonsurgical treatments and good oral hygiene. In that case, your periodontitis treatment may require dental surgery, such as:
Flap surgery (pocket reduction surgery) - In this procedure, tiny incisions are made in your gum so that a section of gum tissue can be lifted back, exposing the roots for more effective scaling and planing. Because periodontitis often causes bone loss, the underlying bone may be recontoured before the gum tissue is sutured back in place. The procedure generally takes from one to three hours and is performed under local anesthesia.
Soft tissue grafts - When you lose gum tissue to periodontal disease, your gum line recedes, making your teeth appear longer than normal. You may need to have damaged tissue replaced. This is usually done by removing a small amount of tissue from the roof of your mouth (palate) or another donor source and attaching it to the affected site. This procedure can help reduce further gum recession, cover exposed roots and give your teeth a more cosmetically pleasing appearance.
Bone grafting - This procedure is performed when periodontitis has destroyed the bone surrounding your tooth root. The graft may be composed of small fragments of your own bone or the bone may be synthetic or donated. The bone graft helps prevent tooth loss by holding your tooth in place. It also serves as a platform for the regrowth of natural bone. Bone grafting may be performed during a technique called guided tissue regeneration.
Guided tissue regeneration - This allows the regrowth of bone that was destroyed by bacteria. In one approach, your dentist places a special piece of biocompatible fabric between existing bone and your tooth. The material prevents unwanted tissue from entering the healing area, allowing bone to grow back instead.
Enamel matrix derivative application - Another technique involves applying a specialized gel to a diseased tooth root. This gel contains the same proteins found in developing tooth enamel and stimulates the growth of healthy bone and tissue.
15. Lifestyles and Home Remedies
You can take steps at home to help reduce or prevent periodontitis, including:
Get regular professional dental cleanings, on a schedule recommended by your dentist
Use a soft toothbrush and replace it at least every three to four months
Consider using an electric toothbrush, which may be more effective at removing plaque and tartar
Brush your teeth twice a day or, better yet, after every meal or snack
Use a mouth rinse to help reduce plaque between your teeth
Supplement brushing and flossing with an interdental cleaner, such as a dental pick or dental stick specially designed to clean between your teeth
Don't rely on tartar-control toothpaste to do the job that brushing and flossing should
The best way to prevent periodontitis is to follow a program of good oral hygiene, one that you begin early and practice consistently throughout life. That means brushing your teeth at least twice daily - in the morning and before going to bed - and flossing at least once a day. Better yet, brush after every meal or snack or as your dentist recommends. A complete cleaning with a toothbrush and floss should take three to five minutes. Flossing before you brush allows you to clean away the loosened food particles and bacteria.
Also, see your dentist, or dental hygienist, regularly for cleanings, usually every 6 to 12 months. If you have risk factors that increase your chance of developing periodonititis, you may need professional tooth cleaning more often.
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