PERIODONTAL DISEASE

Periodontal disease, or gum disease, is the name for any disease that affects the tissues that support your teeth. These tissues include bone, gums, and the ligaments that attach the teeth to the bone.

What causes periodontal disease

Bacteria that are found in your mouth cause periodontal disease. These bacteria form a sticky white substance when combined with food debris that is known as plaque. Plaque must be removed from your teeth on a daily basis to prevent it from sticking to your teeth and creating calculus. Calculus is also known as tartar, which is a hard, mineral-like substance that can only be removed from your teeth during a professional cleaning. Calculus that forms above the gum line has not been shown to cause periodontal disease, but large deposits make it very difficult for you to remove the plaque that forms below it. The calculus that forms beneath your gum line contributes to periodontal disease by irritating the gum tissue and allowing bacteria to live undisturbed beneath your gums. This situation can create chronic inflammation and infection, which in turn can lead to tooth loss.

Factors that may increase the risk or severity of periodontal disease include:

  • Smoking. It has been shown that 100% of smokers have some form of periodontal disease. Smoking will also increase the likelihood of a post-treatment recurrence of periodontitis or a failure of treatment.
  • Dental restorations that no longer fit properly. When a bridge, partial denture or filling no longer fits as it originally did, it can create areas that attract plaque, increasing the risk of periodontal disease.
  • Poor Diet. Without proper nutrition it is difficult for you body to defend itself from infection and disease. It is also very hard for your body to repair any tissue damaged by disease without a healthy diet. Eating a diet with adequate amounts of fruits and vegetables will greatly increase your body’s ability to battle disease.
  • Systemic Disease. Diseases such as diabetes and AIDS have been shown to lower the body’s resistance to infection, including periodontal disease.
  • Certain Medications. Some medications, including steroids, anti-epilepsy drugs, cancer therapy treatments, some calcium channel blockers, and hormone therapies, can affect the gums and their resistance to disease.

    Types of periodontal disease

There are several types of gum disease. The mildest form of periodontal disease is known as gingivitis. Gingivitis is an early, generally reversible disease. It is caused by the toxins that bacteria found in plaque secrete when left undisturbed in the mouth for any period of time. The gums become red, swollen, irritated and bleed easily. Regular dental cleanings and proper oral hygiene at home can eliminate gingivitis in most cases. On occasion, the gingivitis is severe enough that it requires more than one dental appointment to restore the gum tissue to a healthy state. Untreated gingivitis may lead to a more serious and destructive form of gum disease called periodontitis. Periodontitis occurs when the bacterial toxins begin to destroy the tissues that hold the teeth into the bone of the jaw. This destruction includes the bone around the teeth, causing teeth to become loose. If periodontitis is not treated and maintained, the bone and ligament destruction can progress to the point that the teeth are no longer stable, requiring extraction.

Checking for periodontal disease

During your check-up, the dentist will examine your gums. This examination includes evaluation of the color, texture and bleeding of the gums. The most valuable portion of the exam is the periodontal probing and charting. An instrument called a periodontal probe is used to gently measure the space [or pocket] between the tooth and gums. This depth is measured in millimeters, and is a gauge of the presence and severity of gum disease. Measurements between one and three millimeters are generally considered healthy unless gum recession is present. As a general rule, the greater the pocket depth, the more severe the disease.

Dental x-rays may be taken to evaluate the bone supporting the teeth as well as evaluate other conditions that may be contributing to periodontal disease. These conditions include defective or ill-fitting restorations, tooth decay below the gums and dental anatomy.

Treating periodontal disease

The primary treatment for adult periodontitis consists of a procedure called scaling and root planing and increased oral hygiene at home. Scaling and Root Planing has been referred to as "deep cleaning" by some patients. The procedure is fairly straightforward. First, the gums and teeth in the affected area are numbed with anesthetic to provide the patient with an increased level of comfort. Second, an instrument called an ultrasonic scaler is used to remove the built up deposits of tartar from above and especially below the gum line. Hand instruments are then used to smooth [or plane] the surfaces of the roots to allow the gums to reattach to the tooth during healing. After the root planing, the areas which were treated are rinsed below the gum line with an antimicrobial solution to help decrease bacteria levels.

When the pocket depths that are found in a periodontal examination exceed six millimeters, it is very difficult to successfully treat periodontal disease without surgical intervention. Using various surgical techniques, it is possible to enhance the removal of calculus and bacterial deposits on the tooth surface and allow increased healing of the oral tissues. Surgery involving the bone may be used to reshape or even regenerate bone that has been destroyed by periodontal disease.

There are very few adverse reactions to the treatment of periodontal disease, but they include gum recession during healing, increased sensitivity to cold and slight tenderness of the gums immediately following treatment.

It must be pointed out that the failure to maintain proper oral hygiene at home and not following a periodontal maintenance schedule as recommended will compromise your treatment, possibly to the point of failure.

In order to arrest the disease process, treatment is recommended prior to beginning any extensive definitive restorative dentistry.

In addition, please note that smoking will adversely affect the outcome, and possibly cause the failure of your periodontal treatment. There is a 100% correlation between gum disease and cigarette smoking that has been shown in dental research.

Treatment alternatives are few, and they include non-treatment or delayed treatment, and extraction of the affected teeth. The extraction of teeth may lead to many potential complications including bone loss, shifting of teeth in both upper and lower jaws, loss of chewing ability, loss of support of facial muscles and structures [leading to a "sunken" facial appearance], and difficulty in speaking. The replacement of teeth lost to periodontal disease is complicated by the bone loss that is caused by the disease process, as this weakens the support for the remaining teeth. Non-treatment may result in the progression of the disease, with further bone loss, the loosening of teeth, bleeding gums, pus coming from the gums, periodontal abscesses, pain, bad breath and tooth loss. Delaying treatment may also cause progression of the disease, with further bone loss, the loosening of teeth, bleeding gums, pus coming from the gums, periodontal abscesses, pain, bad breath and tooth loss, but the progression of the disease may result in the need for more extensive treatment in the future. These treatment needs may include extraction of untreatable teeth, referral to a periodontist [gum specialist] and periodontal [gum flap] surgery with possible bone grafts to retain teeth.

Preventing periodontal disease

Proper oral hygiene and maintaining a regular schedule of professional examinations and cleanings is the key to the prevention of periodontal disease.

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