Periodontal Disease: What you should know

Periodontal Disease is a bacterial infection of the gums, bone and ligaments that support the teeth and anchor them in the jaw. The bacteria are normal inhabitants of the mouth and form a film of dental plaque and calculus (tartar) which stick to the teeth. The bacteria produce poisonous toxins which stimulate the immune response to fight the infection. If the disease process is not stopped, the supporting structures of the teeth will continue to be destroyed. This eventually leads to tooth loss.

Periodontal disease can occur at any age. Over half of all people over the age of 18 have some form of the disease. After age 35, over 75% of all people are affected. Unfortunately, the disease process is usually asymptomatic and painless. The disease can be easily detected during regular dental examinations.

Common type of periodontal disease:

Gingivitis

Gingivitis is infection of the gingiva (gum tissue), and is the initial stage of the disease process. Gums become red, swollen and may bleed easily. Underlying bone levels are unaffected

Gingivitis

Periodontitis

Periodontitis is classified as being Mild, Moderate or Severe, depending upon the amount of destruction to the gums, ligaments and bone that surround teeth. As the disease progresses, gums separate from the teeth and form gum pockets.

Moderate Periodontitis

These pockets get deeper as more underlying bone is destroyed. Gum pockets will collect increasing amounts of bacterial plaque and calculus (tartar) as the disease process worsens. Teeth will loosen as more bone is lost.

Severe Periodontitis

Warning Signs of Periodontal Disease

• Bleeding gums
• Tenderness, swelling, red color
• Abscess (puss oozing from the gums)
• Foul odor
• Loose teeth
• Pain

Contributing Factors to Periodontal Disease

• Poorly fitting dental restorations
• Smoking
• Crowded teeth, improper bite alignment
• Clenching or grinding of teeth
• Hormonal changes, including pregnancy, menstruation and menopause
• Systemic diseases, including blood disorders and diabetes
• Medications, including calcium channel blockers and anti-convulsants

Treatment of Periodontal Disease

The main goal of periodontal treatment is eradication of the disease process from the gums, ligaments and bones that surround the teeth, and restoration of health that can be predictably maintained in the future. A periodontal probe, with ruled millimeter markings, is used to measure the depth of the space between the teeth and gums. Ideally, normal measurements range between 1 and 3 millimeters. Depths greater than this may signify the presence of periodontal pockets and associated gum disease

Periodontal Disease Phase I

Initial treatment involves educating patients in the proper methods of effective, daily plaque removal and oral hygiene. This is a critical component of successful therapy.

Subgingivial Scaling

Root Planning

Scaling and root planing are performed to clean the tooth structure and remove bacterial plaque and calculus deposits (the source of the infection) from the gum pockets. This may be the only treatment necessary in cases of gingivitis and very mild periodontitis

Periodontal Disease Phase II

In cases which demonstrate deeper gum pockets and underlying bone loss, it becomes necessary to eliminate the diseased gum pockets and bony destruction with osseous (bone) surgery.

As part of the Osseous surgery, the gum is "flapped" and retracted away from the teeth to expose the underlying roots and bone deformities. The bone is contoured to approximate a normal profile, and the gum is sutured back to place. When the gum heals, normal probing depth is re-established between the gum and tooth (ideally 1-3mm).

Sequence of steps in the surgery

1. Gum pocket and defect before surgery.	2. Gum is retracted for access to the bone and root.	3. Bone defects are removed.
4. Gum tissue is sutured back around the tooth.	5. After healing, the gum is tightly "sealed" around the tooth.

Additional treatment modalities may be necessary, such as

• Bone grafts for bone regeneration
• Gum grafts to treat gum recession and pathological root exposure
• Cosmetic plastic surgery of the gums to improve appearance
• Fabrication of night guards for bruxism ( tooth grinding )
• Splinting or bonding teeth together for increased strength and stability
• Orthodontics ( braces ) to straighten and realign teeth
• Removal of diseased roots on some types of molars
• Use of medications such as antibiotics, fluoride and antimicrobial rinses

Periodontal Disease Maintenance

Once the active phase of treatment is complete and health has been restored, it is extremely important that patients be seen by a hygienist for routine dental and periodontal cleaning on a regular basis. This regimen, along with diligent home care and oral hygiene, will give the best chance for preventing recurrence of disease and maintaining long term periodontal health.