Periodontal disease

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Periodontal Disease is one of the leading causes of tooth loss. Gum disease if diagnosed and treated in the first stage, the condition can be reversed and tooth loss can usually be prevented. In order to prevent gum disease, practice good oral hygiene and visit your dentist for cleanings and check-ups twice a year.

If gum disease is detected during your visit, dentists will instruct you on steps regarding improved home care and recommend specialized treatment options in dental office to eliminate the disease.

Stages of Periodontal Disease

Periodontal disease is broken up into four separate stages: gingivitis, slight periodontal disease, moderate periodontal disease, and advanced periodontal disease.

Healthy Gums

Healthy Gums

Firm, pink, gums attached to the teeth and supported by firm dense bone are the indicators of healthy gums and teeth that have the strong support they need.

Gingivitis

Gingivitis

Gingivitis is the only stage of periodontal disease that is reversible as it has not yet had time to attack the bones. It is the result of a buildup of plaque around the teeth. There are only a few signs at this stage and most are painless. This is what makes periodontal disease so common and so concerning. It is silent until it is not. Periodontal disease does not typically break its “silence” until the fourth and final stage. Beginning signs to watch out for include bad breath on occasion, swelling and redness of the gums, and bleeding when brushing or flossing. Good overall oral hygiene and regular checkups can treat and reverse gingivitis.

Slight Periodontal Disease

Slight Periodontal Disease

Slight periodontal disease is the second stage of periodontal disease. It is not reversible, but it is manageable. Once a patient reaches stage two, the infection has spread to the bone and begins its bone-destroying process. The bacteria evolves and becomes more aggressive, which is what causes the additional bone loss. Simple oral hygiene will no longer cut it. Signs include increased swelling or redness of the gums, bad breath, bleeding during brushing or flossing, and probing depths that are between four and five millimeters.

Moderate Periodontal Disease

Moderate Periodontal Disease

Like slight periodontal disease, the third stage of periodontal disease cannot be reversed. At stage three, the same symptoms as stage two occur but probing depths are greater at six to seven millimeters which allows for even more bacteria to attack, not only your bones, but

your blood stream and immune system as well. Treatment for stage two and stage three periodontal disease consists of scaling and root planing. Scaling and root planing are forms of deep cleaning that remove the deposits of bacteria that are deeply rooted in your gums. If left untreated, these stages can progress to bone and tooth loss, gum sensitivity, increased bleeding, and the shifting of teeth.

Advanced Periodontal Disease

Advanced Periodontal Disease

The final stage of periodontal disease occurs when the infection deepens even further and the bacteria, once again, evolves into disease-causing bacteria. You are now at a 50% – 90% risk of bone loss. In addition to bone loss, advanced periodontal disease causes red, swollen gums that ooze pus, cold sensitivity, further loosening of teeth, painful chewing, and severe halitosis. This stage requires periodontal surgery or periodontal laser therapy in order to clean the deep bacteria-filled pockets that have formed. If left untreated, stage four periodontal disease leads to spacing or gaps between the teeth, gum recession, patients needing dentures, and other overall health problems that can be serious.

Common Causes of Gum Disease

Common Causes of Gum Disease

There are genetic and environmental factors involved in the onset of gum disease, and in many cases, the risk of developing periodontitis can be significantly lowered by taking preventative measures.

Here are some of the most common causes of gum disease:

Poor dental hygiene

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 preserve the natural dentition and support of bony structures.  When bacteria and calculus (tartar) are not removed, the gums and bone around the teeth become affected by bacterial toxins and can cause gingivitis or periodontitis, which ultimately lead to tooth loss.

Tobacco use

Research has indicated that smoking and tobacco use are some 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.

Genetic predisposition

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 and early intervention can be performed to keep the oral cavity healthy.

Pregnancy and menopause

During pregnancy, regular brushing and flossing is critical. Hormonal changes experienced by the body can cause the gum tissue to become more sensitive, rendering them more susceptible to gum disease.

Chronic stress and poor diet

Stress lowers the ability of the immune system to fight off disease which means bacterial infection can 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 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.

Grinding teeth

The clenching or grinding of 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.

Medication

Many drugs including oral contraceptive pills, heart medicines, anti-depressants, 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.

What are the signs and symptoms of periodontal disease?

What are the signs and symptoms of periodontal disease

These are the most common signs and symptoms of gum disease:

  • Red, swollen, tender gums
  • Bleeding while brushing and/or flossing
  • Receding gums (gums that pull away from the teeth)
  • Loose or separating teeth
  • Persistent bad breath (halitosis)
  • Partial dentures that no longer fit
  • Pus between the teeth and gums
  • A change in bite and jaw alignment

The signs and symptoms of gum disease may look like other conditions or medical problems. See a dentist or other oral health specialist for a diagnosis.

DIAGNOSING PERIODONTAL DISEASE

Periodontists typically rely on a visual assessment of the patient’s overall oral condition in addition to charting pocket depths with a periodontal probe. This visual/mechanical method of assessing periodontal disease status can only tell whether or not disease is present. There are other tests currently available that go beyond basic and subjective visual assessment to provide dental professionals with the detailed genetic and biological information required to better determine the appropriate treatment regimen for each individual patient. This information includes evaluating the inflammatory burden that is causing periodontal disease, as well as looking at the patient’s unique genetic susceptibility to periodontal disease.

What are the treatments for periodontal disease?

Treating periodontal disease quickly is of the utmost importance. Scheduling regular check-ups and cleanings and practicing good, daily oral hygiene habits can keep one from suffering from periodontal disease and/or can help halt the progression of periodontal disease. Periodontists offer a wide range of treatments, such as scaling and root planning (in which the infected surface of the root is cleaned) or root surface debridement. They can also treat patients using a range of surgical procedures, for both the treatment of severe periodontal disease and for cosmetic purposes. In addition, periodontists are specially trained in the placement and repair of dental implants. Treatment may include any, or a combination of, the following:

Tartar (calculus) and plaque removal beneath the gums

Tartar (calculus) and plaque removal beneath the gums

 Deep cleaning (also called scaling and root planning) can help remove tartar beneath the gums and infected tissue in the early stages of the disease. It also smoothes the damaged root surfaces of the teeth. The gums can then reattach to the teeth.

Medicine

Antibacterial medicines may be placed topically in the periodontal pockets or taken orally.

Surgery

 When the disease is advanced, the infected areas under the gums will be cleaned, and the tissues will then be reshaped or replaced. Types of surgeries include:

  • Pocket reduction
  • A regeneration procedure
  • A soft tissue graft
  • Crown lengthening