The word periodontal means “around the tooth”.  Periodontal disease attacks the gums and the bone that support the teeth.  Plaque is a sticky film of food debris, bacteria, and saliva.  If plaque is not removed, it turns into calculus (tartar).  When plaque and calculus are not removed, they begin to destroy the gums and bone.  Periodontal disease is characterized by red, swollen, and bleeding gums.

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. 

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 cause 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.

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

Signs and symptoms of periodontal disease:

• Bleeding gums – Gums should never bleed, even when you brush vigorously or use dental floss.

• Loose teeth – Also caused by bone loss or weakened periodontal fibers (fibers that support the tooth to the bone).

• New spacing between teeth – Caused by bone loss.

• Persistent bad breath – Caused by bacteria in the mouth.

• Pus around the teeth and gums – Sign that there is an infection present.

• Receding gums – Loss of gum around a tooth.

• Red and puffy gums – Gums should never be red or swollen.

• Tenderness or Discomfort – Plaque, calculus, and bacteria irritate the gums and teeth.

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.

Diagnosis

Periodontal disease is diagnosed by your dentist or dental hygienist during a periodontal examination.  This type of exam should always be part of your regular dental check-up. Your dentist or hygienist will use pocket depths, amount of bleeding, inflammation, tooth mobility, etc., to make a diagnosis that will fall into a category below:

Gingivitis is the first stage of periodontal disease. Plaque and its toxin by-products irritate the gums, making them tender, inflamed, and likely to bleed.

Periodontitis: Plaque hardens into calculus (tartar).  As calculus and plaque continue to build up, the gums begin to recede from the teeth.  Deeper pockets form between the gums and teeth and become filled with bacteria and pus.  The gums become very irritated, inflamed, and bleed easily.  Slight to moderate bone loss may be present.

Advanced Periodontitis: The teeth lose more support as the gums, bone, and periodontal ligament continue to be destroyed.  Unless treated, the affected teeth will become very loose and may be lost.  Generalized moderate to severe bone loss may be present.

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, and a complete periodontal exam of the mouth will be done before any treatment is performed or recommended. 

 If the disease is caught in the early stages of gingivitis, and no damage has been done, one to two regular cleanings will be recommended.  You will also be given instructions on improving your daily oral hygiene habits and having regular dental cleanings. If the disease has progressed to more advanced stages, 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.

Please contact our office if you have questions or concerns about periodontal disease, periodontal treatment, or dental implants.