Periodontitis or gum disease is an infection that starts around the gums that can damage the soft tissue and can destroy the bone that supports your teeth. Without treatment, the disease can worsen and cause teeth to loosen or lead to tooth loss.
Periodontitis is fairly common, especially as we get older, but is largely preventable. It's usually the result of poor oral hygiene. Brushing at least twice a day, flossing daily and getting regular dental checkups can greatly improve your chances of successful prevention and treatment for gum disease.
Symptoms
Healthy gums are usually firm and pale pink around teeth. Signs and symptoms of gum disease can include:
Swollen or puffy gums
Bright red, dusky red or purplish gums
Gums that feel tender when touched
Gums that bleed easily
Pink-tinged toothbrush after brushing
Spitting out blood when brushing or flossing your teeth
Bad breath
Pus between your teeth and gums
Loose teeth or loss of teeth
Painful chewing
New spaces developing between your teeth
Gums that pull away from your teeth (recede), making your teeth look longer than normal
A change in the way your teeth fit together when you bite
Causes
The development of gum disease starts with bacteria. Bad bacteria accumulate in the mouth, on the tooth, and around and under the gums to form plaque. The bacteria creates plaque and tartar/calculus on the tooth over time that further irritates the gums, surrounding tissues, and eventually the underlying bone underneath the gums. If left untreated, here's how plaque can eventually advance to periodontitis:
Plaque forms on your teeth when starches and sugars in food interact with bacteria normally found in your mouth. Brushing your teeth twice a day and flossing once a day removes plaque, but plaque re-forms quickly.
Plaque can harden under your gumline into tartar (calculus) if it stays on your teeth. Tartar is more difficult to remove and it's filled with bacteria. The longer plaque and tartar remain on your teeth, the more damage they can do. You can't get rid of tartar by brushing and flossing — you need a professional dental cleaning to remove it.
Plaque can cause gingivitis, the mildest form of gum disease. Gingivitis is irritation and inflammation of the part of your gum tissue around the base of your teeth (gingiva). Gingivitis can be reversed with professional treatment and good home oral care.
Ongoing gum inflammation can cause periodontitis, eventually causing pockets to develop between your gums and teeth that fill with plaque, tartar and bacteria. In time, these pockets become deeper, filling with more bacteria. If not treated, these deep infections cause a loss of tissue and bone, and ultimately you may lose one or more teeth. Also, ongoing chronic inflammation can put a strain on your immune system.
Risk factors
Factors that can increase your risk of periodontitis include:
Gingivitis
Poor oral health habits
Smoking or chewing tobacco
Hormonal changes, such as those related to pregnancy or menopause
Recreational drug use, such as smoking marijuana or vaping
Obesity
Inadequate nutrition, including vitamin C deficiency
Genetics
Certain medications that cause dry mouth or gum changes
Conditions that cause decreased immunity, such as leukemia, HIV/AIDS and cancer treatment
Certain diseases, such as diabetes, rheumatoid arthritis and Crohn's disease
Complications
Periodontitis and gum disease can not only irritate the gum tissues, it can also lead to tooth loss. Also, the bacteria and tartar build up in the mouth can enter your bloodstream through gum tissue and vessels. It is the same kind of plaque build up that can clog your arteries and cause heart and other systemic diseases. For instance, periodontitis is linked with respiratory disease, rheumatoid arthritis, coronary artery disease and problems controlling blood sugar in diabetes.
Prevention
The best way to prevent periodontitis is to have good oral hygiene routine, one that you begin early and practice consistently throughout life.
Good oral hygiene. That means brushing your teeth for two minutes at least twice daily — in the morning and before going to bed — and flossing at least once a day. Flossing before you brush allows you to clean away the loosened food particles and bacteria. Good oral hygiene prevents the development of an environment around your teeth that is favorable to specific bacteria that cause periodontal disease.
Regular dental visits. See your dentist or dental hygienist regularly for cleanings, usually every three to six months. If you have risk factors that increase your chance of developing periodontitis — such as having dry mouth, taking certain medications or smoking — you may need professional cleaning more often.
Diagnosis
Your dentist will conduct a thorough examination of your periodontal and overall health and make recommendations accordingly.
Review your medical history to identify any factors that could be contributing to your symptoms, such as smoking or taking certain medications that cause dry mouth.
Examine your mouth to look for plaque and tartar buildup and check for easy bleeding.
Measure the pocket depth of the groove between your gums and teeth by placing a dental probe beside your tooth beneath your gumline, usually at several sites throughout your mouth. In a healthy mouth, the pocket depth is usually between 1 and 3 millimeters (mm). Pockets deeper than 4 mm may indicate periodontitis. Pockets deeper than 5 mm cannot be cleaned well.
Take dental X-rays to check for bone loss in areas where your dentist observes deeper pocket depths.
Treatment
The goal of treatment is to thoroughly clean the pockets around and underneath the gums to prevent further damage to surrounding bone and allow for the gum tissues to re-attach to the tooth surfaces.
Nonsurgical treatments If the gum disease is not as advanced, treatment may involve less invasive procedures such as:
Scaling. Scaling removes tartar and bacteria from your tooth surfaces and beneath your gums. It may be performed using instruments, a laser or an ultrasonic device.
Root planing. Root planing smooths the root surfaces, discouraging further buildup of tartar and bacteria, and removes bacterial byproducts that contribute to inflammation and delay healing or reattachment of the gum to the tooth surfaces.
Antibiotics. Topical or oral antibiotics can help control bacterial infection. Topical antibiotics can include antibiotic mouth rinses or insertion of gels containing antibiotics in the space between your teeth and gums or into pockets after deep cleaning. However, oral antibiotics may be necessary to completely eliminate infection-causing bacteria.
Surgical treatments If you have advanced periodontitis, treatment may require dental surgery, such as:
Flap surgery (pocket reduction surgery). Your periodontist makes tiny incisions in your gum so that a section of gum tissue can be lifted back, exposing the roots for more effective scaling and root planing. Because periodontitis often causes bone loss, the underlying bone may be recontoured before the gum tissue is sutured back in place. After you heal, it's easier to clean these areas and maintain healthy gum tissue.
Soft tissue grafts. When you lose gum tissue, your gumline recedes. You may need to have some of the damaged soft tissue reinforced. This is usually done by removing a small amount of tissue from the roof of your mouth (palate) or using tissue from another donor source and attaching it to the affected site. This can help reduce further gum recession, cover exposed roots and give your teeth a more pleasing appearance.
Bone grafting. This procedure is performed when periodontitis has destroyed the bone surrounding your tooth root. The graft may be composed of small fragments of your own bone, or the bone may be synthetic or donated. The bone graft helps prevent tooth loss by holding your tooth in place. It also serves as a platform for the regrowth of natural bone.
Guided tissue regeneration. This allows the regrowth of bone that was destroyed by bacteria. In one approach, your dentist places a special piece of biocompatible fabric between existing bone and your tooth. The material prevents unwanted tissue from entering the healing area, allowing bone to grow back instead.
Tissue-stimulating proteins. Another technique involves applying a special formulas/solutions to a diseased tooth root. This solution contains the same proteins and growth factors found in developing tooth enamel and stimulates the growth of healthy bone and tissue.
Please schedule an appointment at Smiles Beyond Dentistry and consult with our dentist about your oral health!
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