Periodontal Diseases

Periodontal diseases are caused by bacterial infections that attack gums, ligaments and bone. Although the body has some natural defenses that resist bacterial attacks, these may not fully protect gum and bone tissues from inflammation and infection.

There are several kinds of periodontal disease. Often painless, these diseases may develop slowly or progress quite rapidly, and they can occur at any age. Unless you have regular dental checkups, including a periodontal exam, you may not be aware you have a problem until your gums and bone have been seriously compromised.

What Causes Periodontal Disease?

The mouth contains a large number and variety of bacteria that form a sticky film called plaque.

In this film, the bacteria that cause periodontal diseases create toxins (poison), which irritate the gums and bone. Even if you brush and clean between your teeth every day, you may not completely remove plaque, especially around the gum line.

Plaque that is not removed can harden into a rough, porous deposit called calculus, or tartar. Tartar can only be removed when your teeth are cleaned in the dental office.

Although tartar that forms above the gum line has not been shown to cause periodontal disease, tartar on teeth below (under) the gum line makes it more difficult to remove plaque. This can create conditions that lead to chronic inflammation and infection.

The Warning Signs

If you notice any of the following signs, see your dentist immediately:

Gums that bleed easily.
Red, swollen or tender gums.
Gums that have pulled away from the teeth.
Pus between the teeth and gums when the gums are pressed.
Persistent bad breath or bad taste.
Permanent teeth that are loose or separating.
Any change in the way your teeth fit together when you bite.
Any changes in the fit of partial dentures.

It's possible to have periodontal disease and not have warning signs. That's why regular dental checkups and periodontal examinations are important.

Types of Periodontal Diseases

At the very edge of the gum line, gum tissue is not attached to each tooth. Instead, there is a very shallow, v-shaped groove called the sulcus between the tooth and gums. The normal space between teeth and healthy gums should be three millimeters or less. With periodontal diseases, this tiny space develops into a pocket. Generally, the more severe the disease, the greater the depth of the pockets.

Gingivitis is a mild, often reversible form of periodontal disease. It develops as toxins in plaque irritate the gums, making them red, tender, swollen and likely to bleed easily. It can usually be eliminated by daily brushing, cleaning between teeth, and regular dental cleanings and checkups.

Gingivitis may lead to more serious, destructive forms of periodontal disease, called Periodontitis. This occurs when toxins destroy the tissues that anchor teeth into bone. The gums detach from teeth and form pockets. Exposed tooth roots become susceptible to decay and sensitive to cold and touch. Tartar that forms below the gums inhibits the reattachment of gum tissue to the teeth. It creates conditions that contribute to delayed healing and inflammation.

In some cases, so much ligament and bone are destroyed that the tooth, no longer stable, becomes loose in its socket. It may eventually fall out, or require extraction.

The Progress of Periodontal Disease

	Healthy gingiva (gum tissue) and bone anchor teeth firmly in place.
	Gingivitis develops as toxins in plaque irritate the gums, making them red, tender, swollen, and likely to bleed easily.
	Periodontitis occurs when toxins destroy the tissues that anchor teeth in the bone. As gums detach from teeth, pockets form and fill with plaque. Tooth roots are exposed and become susceptible to decay and sensitive to cold and touch.
	Advanced periodontitis is present when the teeth continue to lose their attachment and the supporting bone is destroyed. Unless treated, the affected teeth frequently become loose and may fall out or require removal by a dentist. Go back

Factors That Can Increase Your Risk

Other factors can increase the risk, severity and speed at which periodontal diseases develop. If one or more of these applies to you, you may still have good oral health by following your dentist's advice and practicing good oral hygiene.

People who smoke or chew tobacco are more likely to have periodontal disease. And, it's likely to be more severe than those who do not use any tobacco.

Bridges that no longer fit properly, malocclusion (misaligned teeth) or fillings that have become defective can contribute to plaque retention and increase your risk of developing periodontal disease.

Clenching or grinding your teeth may also contribute to the rate at which supporting bone is lost.

Poor diet may cause periodontal disease to progress more rapidly or increase the severity of the condition, according to some research. There is some evidence that an inadequate diet makes mouth tissues less resistant to infection.

Pregnancy or use of oral contraceptives increases hormone levels which can cause gum tissue to be more sensitive to the toxins in plaque and accelerate growth of some bacteria. The gums are more likely to become red, tender and swollen, and bleed easily.

Systemic diseases, such as AIDS or diabetes, can lower resistance to infection, making periodontal disease more severe.

Many medications, such as steroids, some types of antiepilepsy drugs, cancer therapy drugs, some calcium channel blockers, and oral contraceptives can affect the gums. Let your dentist know about your medications and update your medical history files at the dental office when any changes occur.

Preventing Periodontal Diseases

Here's how you can keep your teeth and gums healthy:

Brush your teeth thoroughly twice a day with a fluoride toothpaste. This removes plaque from the outer, inner and chewing surfaces of the teeth. Choose a soft-bristled toothbrush and replace it every three to four months. A worn, frayed or hard-bristled brush can injure the gums. Choose products that carry the American Dental Association Seal of Acceptance. The ADA Seal is an assurance of safety and effectiveness.

Carefully clean between teeth with dental floss or other interdental cleaners to remove plaque from areas your toothbrush can't reach. It takes only a few minutes each day. A lifelong healthy smile is worth your time

If you need extra help in controlling gingivitis and plaque that forms above the gum line, your dentist may recommend using an ADA accepted antimicrobial mouth rinse as an effective addition to your daily oral hygiene routine.

Eat a balanced diet for good general health. Schedule regular dental checkups.

Checking for Periodontal Diseases

During your checkup, the dentist will examine your gums. This is called a periodontal examination. An instrument called a periodontal probe is used to gently measure the pocket space between each tooth and gum. This will determine the depth of periodontal pockets. A pocket size of three millimeters is considered normal unless gum recession is present. Generally the more severe the disease, the greater the pocket depth.

Your dentist may examine your gums using a method called Periodontal Screening and Recording' (PSR). Using this simple test, the dentist gently moves the probe around the gum line to track pocket depths. The dentist can determine how healthy your gums are and whether or not you need a more complete periodontal examination.

Dental x-rays may be taken to evaluate bone supporting the teeth and to detect other problems not visible during the clinical examination. If periodontal disease is diagnosed, the dentist may provide treatment or may refer you to a periodontist, a dentist who specializes in the diagnosis and treatment of periodontal diseases.

Treating Periodontal Diseases

Treatment methods depend upon the type of disease and how far the condition has progressed.

The first step is usually a thorough cleaning that may include scaling to remove plaque and tartar deposits beneath the gum line. The tooth roots may also be planed to smooth the root surface allowing the gum tissue to heal and reattach to the tooth. In some cases, the occlusion (bite) may require adjustment. Antibiotics or irrigation with antimicrobials (chemical agents or mouth rinses) may be recommended to help control the growth of bacteria that create toxins and cause periodontitis. In some cases, the dentist may place antibiotic fibers in the periodontal pockets after scaling and planing. This may be done to control infection and to encourage normal healing.

When deep pockets between teeth and gums (4 to 6 mm or greater) are present, it is difficult for the dentist to thoroughly remove plaque and tartar. Patients can seldom, if ever, keep these pockets clean and free of plaque. Consequently, surgery may be needed to restore periodontal health. Using various surgical techniques, the dentist lifts the gum away to reach areas that require the removal of tartar and plaque, which cause chronic infection and delay healing. The tooth root is cleaned and smoothed. The gums are sutured back into place or into a new position that will be easier to keep clean at home.

Subgingival scaling. Cleaning the tooth below the gum.	X-ray of periodontal bone loss.	Subgingival scaling. Cleaning the tooth below the gum.	Root planing. Smoothing the tooth root.

Presurgical bony defect.	Flap incision accesses bone.	Bone is Contoured.	Gum is sutured.
Bone surgery may be used to rebuild or reshape bone that has been destroyed. Grafts of the patient's bone or artificial bone may be used, as well as the use of membranes. The dentist may use splints or other appliances to stabilize loose teeth and to guide the regeneration of tissue during healing. Go back
		Gum healed in new position.

Gum Disease May Relate to Heart Attack Risk

Previous studies have found the incidence of heart disease is about twice as high in people with periodontal (gum) disease, but until recently no plausible cause had been suggested. Now studies indicate that the most common strain of bacteria in dental plaque may cause blood clots. When blood clots escape into the bloodstream, there is a relation to increased risk of heart attacks and other heart illnesses.

People with periodontal disease (over one half the adult population) have an infection that causes chronic inflammation of the gums. Also, it is a path for these bacteria to enter the bloodstream.

A recent study describes the association between heart disease and gum disease to be at least as strong as the linkage of heart disease to cholesterol, body weight, or smoking.

Incidence of Periodontal Disease

Unlike most diseases that give us early warning signs, gum disease progresses silently, often without pain. It may develop slowly or progress quite rapidly. More than half of all people over 18 have at least the early stages of periodontal disease. Even more frightening, after the age of 35, three out of four people are affected to some degree. Periodontal disease is an infection that destroys the gum surrounding your teeth and also destroys the supporting bone that holds your teeth in place.

What Other Health Concerns Are Related To Gum Disease?

Bacteria in plaque have also been linked to:

Inflammation of the lining of the blood vessels that is known to lead to constriction in the arteries.
Infective endocarditis, a potentially fatal disease in which the inner lining of the heart becomes inflamed.
Lung infections in people with chronic lung diseases.
A weakened immune system can slow wound healing and diminish a person's response to hepatitis B and flu vaccines.
A higher risk of delivering premature, low birth weight infants.
Tooth loss.

Evidence is mounting relating gum disease to a variety of health concerns, some that are life threatening. By keeping regular re-care appointments with your dental team, you help increase your chances for a long and happy life.

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