Periodontal (gum) diseases, including gingivitis and periodontitis, are serious infections that if left untreated, can lead to tooth loss. The word periodontal literally means “around the tooth.” Periodontal disease is a chronic bacterial infection that affects the gums and the bone supporting the teeth. Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) causes the gums to become inflamed. While bacteria are the main cause for periodontal infection, other factors are considered as contributing and accelerating factors: Smoking or Tobacco Use, Stress, Genetics, Pregnancy, Medications, Diabetes, and Poor Nutrition. Periodontal disease comes in many forms. GINGIVITIS is perhaps the mildest form of gum disease. While the gums become red, swollen and bleed easily, there is very little to no discomfort associated at this stage of the disease. Through a good oral hygiene regimen and treatment from your dentist, the results of gingivitis can be reversed.
Periodontitis is another form of periodontal disease and can be aggressive or chronic. Aggressive periodontitis displays rapid bone destruction and attachment loss in clinically healthy patients. Chronic periodontitis is one of the most common forms of periodontal disease and is frequently seen in adults. The stages progress slowly and can be recognized by gum recession and pocket formation. Aggressive periodontitis occurs in patients who are otherwise clinically healthy. Common features include rapid loss of gum tissue and severe bone destruction. This can often occur in very young patients. Chronic periodontitis results in inflammation within the supporting tissues of the teeth. This leads to loss of the periodontal attachment and underlying bone. This is the most frequently occurring form of periodontitis and is characterized by pocket formation and/or recession of the gingiva. It is prevalent in adults, but can occur at any age. Progression of attachment and bone loss usually occurs slowly, but periods of rapid progression can occur. Periodontitis as a manifestation of systemic diseases often begins at a young age. Systemic conditions such as heart disease, respiratory disease, and diabetes are associated with this form of periodontitis. There is growing evidence that connects periodontal disease to other systemic diseases. Bacteria present in the mouth can access to the blood stream through ulcers which are present in infected periodontal pockets. These bacteria can cause infection in blood vessels, heart and other organs. Furthermore, in response to periodontal infection, our body secretes inflammatory mediators, which are molecules that are intended to fight and contain the infection. These molecules, although protective in the site of infection, can cause harmful effects in other part of the body. Inflammatory response to bacteria in the mouth may be the cause behind the periodontal-systemic health link. Many of the diseases associated with periodontal disease are also considered to be systemic inflammatory disorders, including cardiovascular disease, diabetes, rheumatoid arthritis, chronic kidney disease and even certain forms of cancer. This suggests that inflammation itself may be the basis for the connection. Necrotizing periodontal disease is an infection characterized by necrosis of gingival tissues, periodontal ligaments and jawbone. These lesions are most commonly observed in individuals with systemic conditions such as HIV infection, malnutrition and immunosuppression.
Good oral hygiene and regular visits to your dentist can prevent periodontal disease. Daily brushing and flossing can keep plaque to a minimum and, in conjunction with professional cleanings 2-4 times a year, can keep your teeth healthy for life. Treatment of periodontal disease consists of non-surgical and surgical treatment. The first line of treatment is usually non-surgical. It is intended to remove bacteria by removing tartar deposits and to reduce gum inflammation. Surgical treatment is needed when the initial infection is in the jawbone and cannot be eliminated by non-surgical methods. Surgical treatment also allows regeneration of the bone that was lost as a result of the infection.
Even when periodontal disease is in a fairly advanced stage, it is possible to improve or even reverse the condition with non-surgical procedures. Depending on the type of disease and its severity, one of these approaches may be suggested by your doctor.
This process can be done above or below the gum line and involves the scraping and removal of plaque and calculus (tartar) from the tooth. Scaling done at regular teeth cleanings usually involves the crown of the tooth. However, in more extreme circumstances, it is necessary to go further below the gum line to thoroughly remove disease causing bacteria and their by-products (toxins) on the root surface. In very advanced cases, flap surgery or gingivectomy may be necessary to allow the doctor free access to the infected tooth root.
After the thorough cleaning of the tooth surface has been completed above and below the gum line, the root of the tooth undergoes a process called planing. This is a process of smoothing the root of the tooth so that any remaining tartar is removed. This also serves two other purposes: it clears away any rough areas that bacteria below the gum line thrive in, and it makes it much easier for the gingival (gum) tissue to re-attach itself to the tooth, effectively reducing the size of the pockets that the plaque and bacteria hide in. This re-growth of tissue is a key in stopping a recurrence of gum disease and happens very quickly once the calculus has been removed.
When non-surgical treatment does not improve one’s periodontal health, periodontal surgery is recommended to treat the disease. The following procedures may be advised: osseous surgery, bone graft, and bone regeneration. If a tooth has been lost due to periodontal disease, dental implants are always an option for permanent tooth replacement. Bone and gum tissue should be firmly attached to the teeth. When one has periodontal disease, the supporting tissue of the teeth and bone is destroyed, forming “pockets” around the teeth. Over time, these pockets become deeper, providing a larger space for bacteria to live. As bacteria develop around the teeth, it accumulates and advances deeper under the gum tissue. Bone is lost, gums bleed, and teeth become mobile. Surgical intervention may be needed.
Osseous surgery is recommended when the pockets are too deep to be treated non-surgically. During the procedure, the periodontist folds back the gum tissue to remove the disease-causing bacteria before securing the tissue into place. In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. This allows the gum tissue to better reattach to healthy bone.
When the bone supporting the teeth has been destroyed, bone graft and bone regeneration procedures are recommend in addition to the osseous surgery. This procedure can reverse some of the damage. Membranes (filters) and bone grafts or tissue-stimulating proteins are used to encourage your body’s natural ability to regenerate bone and tissue.
Elimination of the existing bacteria, pocket reduction and bone and tissue regeneration are important steps to reverse the damage caused by the progression of periodontal disease and to prevent the disease recurrence. More information on periodontal disease and periodontal – systemic health can be found on the web site of The American Academy of Periodontology.