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.
Not only is it the number one reason for tooth loss, but research also suggests that there may be a link between periodontal disease and other diseases such as stroke, bacterial pneumonia, diabetes, cardiovascular disease, and increased risk during pregnancy. Researchers are determining if inflammation and bacteria associated with periodontal disease affect these systemic diseases and conditions. Smoking also increases the risk of periodontal disease. Please click here for a full breakdown of periodontal disease's connection to the rest of your body.
Good oral hygiene, a balanced diet, and regular dental visits can help reduce your risk of developing periodontal 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 ensure and preserve the natural dentition and supporting bony structures. When bacteria and calculus (tartar) are not removed, the gums and bone around the teeth become affected by bacteria toxins and can cause gingivitis or periodontitis, which can lead to tooth loss.
Tobacco use – Research has indicated that smoking and tobacco use is one 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 are 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 infections may possibly 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 the 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.
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.
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.
A periodontal probe (small dental instrument) is gently used to measure the sulcus (pocket or space) between the tooth and the gums. The depth of healthy sulcus measures three millimeters or less and does not bleed. The periodontal probe helps indicate if pockets are deeper than three millimeters. As periodontal disease progresses, the pockets usually get deeper.
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- 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 continues 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.
Treatments Performed by a Periodontist
A periodontist is a dentist who specializes in the soft tissues of the mouth and the underlying jawbone which supports the teeth. A periodontist is able to perform a wide range of treatments to halt the progression of gum disease, replace missing teeth, and make the appearance of the smile more aesthetically pleasing.
Here are some of the treatments commonly performed by the periodontist:
Implant placement – When a tooth or several teeth are missing, the periodontist is able to create a natural-looking replacement by anchoring a prosthetic tooth to the jawbone.
Osteoplasty (hard tissue recontouring) – Once periodontitis has been treated, the periodontist can recontour the hard tissue to make the smile both natural-looking and aesthetically pleasing.
Gingivoplasty (soft tissue recontouring) – As gums recede due to periodontitis, the teeth may appear longer; causing a “toothy" smile. The periodontist can remove tissues or straighten the gum line to make the teeth look more even.
Bone grafting – Dental implants can only be positioned if there is sufficient bone to attach the prosthetic tooth to. If bone loss has occurred, bone grafting is an excellent way to add or “grow” bone so that an implant may be properly secured.
Deep pocket cleanings – As gingivitis and periodontitis progress, it becomes more difficult to cleanse the pockets between the soft tissues and the teeth. The periodontist can scale and root plane the teeth (sometimes under local anesthetic) to remove debris and infection-causing bacteria.
Crown lengthening – In order to expose more of the natural tooth, the periodontist can remove some of the surrounding gingival tissue.
Antibiotic treatments can be used in combination with scaling and root planning, curettage, surgery, or as a stand-alone treatment to help reduce bacteria before and/or after many common periodontal procedures. Antibiotic treatments come in several different types, including oral forms and topical gels which are applied directly into the gum pockets. Please click here for a full breakdown of the antibiotics we offer.
Once your periodontal treatment has been completed, your dentist and dental hygienist will recommend that you have regular maintenance cleanings (periodontal cleanings), usually four times a year. At these cleaning appointments, the pocket depths will be carefully checked to ensure that they are healthy. Plaque and calculus that is difficult for you to remove on a daily basis will be removed from above and below the gum line.
In addition to your periodontal cleaning and evaluation, your appointment will usually include:
Examination of diagnostic x-rays (radiographs): Essential for detection of decay, tumors, cysts, and bone loss.X-rays also help determine tooth and root positions.
Examination of existing restorations: Check current fillings, crowns, etc.
Examination of tooth decay: Check all tooth surfaces for decay.
Oral cancer screening: Check the face, neck, lips, tongue, throat, cheek tissues, and gums for any signs of oral cancer.
Oral hygiene recommendations: Review and recommend oral hygiene aids as needed. (Electric toothbrushes, special periodontal brushes, fluorides, rinses, etc.)
Teeth polishing: Remove stain and plaque that is not otherwise removed during tooth brushing and scaling.