What is Periodontitis?
Untreated gingivitis can advance to periodontitis. This causes gums to separate from the teeth, forming pockets that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed.
Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.
There are many forms of periodontitis. The most common ones include the following:
- Aggressive periodontitis occurs in patients who are otherwise clinically healthy. Common features include rapid attachment loss and bone destruction and familial aggregation.
- Chronic periodontitis results in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss. This is the most frequently occurring form of periodontitis and is characterized by pocket formation and/or recession of the gingiva. It is prevalent in adults, but can occur at any age. Progression of attachment loss usually occurs slowly, but periods of rapid progression can occur.
- Periodontitis as a manifestation of systemic diseases often begins at a young age. Systemic conditions such as heart disease, respiratory disease, and diabetes are associated with this form of periodontitis.
- Necrotizing periodontal disease is an infection characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions such as HIV infection, malnutrition and immunosuppression.
Are You at Risk?
Your risk for periodontal disease may increase depending on:
- Your age
- Bleeding gums
- Tobacco use
- Family history of gum disease
To find out if you may be at risk, take the American Academy of Periodontology’s risk assessment here. The assessment will let you know if you are at low, moderate, or high risk for periodontal disease. Or schedule an appointment with our office and we will be happy to evaluate you and discuss your results with you.
Risk Factors, Symptoms & Prevention
The main cause of periodontal (gum) disease is plaque, but other factors affect the health of your gums.
Periodontal Disease and Treating It
Miracle cures, or quick fixes, have been around for centuries; certain foods, ointments, or potions have claimed to cure everything from hair loss to cancer. Marketed as quick, easy, and painless, these miracle cures often are not backed by science or approved by the Food and Drug Administration (FDA), which means that they may do more harm than good. Similar quick fixes that claim to treat periodontal disease are no different. Though elements of these quick and easy periodontal “cures” may be FDA approved, there may be little or no scientific proof that they are effective in the prevention and treatment of periodontal diseases. In fact, periodontal “miracle cures” may actually harm your oral health. Periodontal disease is a chronic inflammatory disease that affects the gums and bone supporting the teeth, and has been associated with the progression of other diseases such as cardiovascular disease and diabetes. If you opt for a treatment for periodontal disease that has not been backed by scientific evidence, it’s possible that the treatment won’t effectively treat (or could even worsen) your condition. Just because a treatment is deemed “new” or “innovative” doesn’t mean that it works properly or better than more traditional treatments. By choosing the quick fix route first, your oral health may remain in poor condition and you may require additional treatment.
Instead, a better idea is to schedule an appointment with a periodontist when you notice signs of periodontal disease (red, swollen or tender gums; bleeding while brushing or flossing; gums that are receding or pulling away from the teeth; loose or separating teeth). A periodontist is a dentist who specializes in the prevention, diagnosis and treatment of periodontal disease and in the placement of dental implants. Periodontists receive extensive training in these areas, including three additional years of education beyond dental school. They are familiar with the latest techniques for diagnosing and treating periodontal disease, and their education and experience allow them to effectively treat periodontal disease using clinically proven treatments such as scaling and root planing, soft tissue grafts and regenerative procedures. A periodontist will evaluate your unique condition, and offer the treatment that is best for you; one that is supported by both science and experience. Your periodontist can also answer any questions that you may have about alternate treatment options.
Your oral health is invaluable. While quick fixes for periodontal disease may seem like a good option, it’s a better idea to research treatment options and discuss them with a periodontist first. The discussion has the possibility of saving you time and money in the long-run!
So you have periodontal disease, what next?
If you’ve recently been diagnosed with periodontal disease, you probably have some questions about your treatment. Be assured that periodontists believe that periodontal therapy should be achieved in the least invasive and most cost-effective way possible; this includes nonsurgical therapy.
Remember that the first step toward good oral health begins with proper oral hygiene. This includes brushing your teeth at least twice each day and flossing at least once each day. Good oral hygiene along with regular visits to a dental professional, such as a periodontist, can go a long way toward preventing certain forms of periodontal disease and reversing gingivitis, an early stage of periodontal disease.
If you have more significant disease, you may require an in-depth cleaning called scaling and root planing (SRP). SRP is a careful cleaning of the tooth root surfaces to remove plaque from pockets and to remove bacteria and toxins from the tooth root. Research has consistently shown that SRP reduces inflammation of the gums and reduces the amount of bacteria associated with periodontal disease. Due to these positive findings, SRP is usually the first mode of treatment recommended for most patients. In fact, many people do not require any further active treatment after SRP.
In some cases, systemic antibiotics (antibiotics that are taken by mouth) are prescribed at the time of SRP to help control bacteria levels. However, each time you take an antibiotic you increase your chance of developing drug resistant bacteria. Therefore, it is very important to take antibiotics only when necessary. Instead of a systemic antibiotic, your periodontist may prescribe a local delivery antimicrobial, medication that is delivered directly into periodontal pockets to control or kill periodontal bacteria. In general, local delivery antimicrobials do not lead to antibiotic resistance.
When tooth surfaces are not in harmony between the upper and lower teeth, an occlusal adjustment may be necessary. This is because teeth that do not properly fit together can affect the rate of progression of periodontal disease. During this procedure, your periodontist may take a mold of your teeth to determine the areas of concern, which will be adjusted. You may also need to wear an occlusal guard or night guard to be worn at certain times of the day to minimize the effects of teeth grinding.
Following adequate time to respond to your treatment, you will be asked to return to your periodontist to determine if further treatment is necessary. If you need further treatment, your periodontist, in collaboration with your general dentist will develop a treatment plan to help restore your smile to a state of health. If you don’t need further treatment, you’ll enter into a maintenance phase. These appointments are usually more thorough than traditional six-month cleanings and may occur more often, which will help protect the health of your teeth and gums.
Your bone and gum tissue should fit snugly around your teeth like a turtleneck around your neck. When you have periodontal disease, this supporting tissue and bone can be destroyed, leading to pockets. Eventually, too much bone can be lost, leading to teeth falling out or needing to be extracted. To fix this, your periodontist may recommend a regenerative procedure that will reverse some of the damage by regenerating lost bone and tissue with the help of bone grafts. Tissue grafts, procedures that place gum tissue in places where it has receded (such as exposed tooth roots), may also be utilized in regeneration procedures.
Your Gums and Your Smile
A smile is one of the most universally recognizable expressions. Smiling can demonstrate a person’s happiness, confidence, attractiveness, sociability, and sincerity. However, the effects of gum disease or other oral tissue disorders cannot only be dangerous to your health and well-being, but can also have the potential to ruin your smile. Luckily, periodontists are the experts in treating the tissues around the teeth. They have the know-how to treat the effects of gum disease or other oral tissue disorders and help improve your smile. There are a variety of periodontal cosmetic procedures that can improve and enhance the overall artwork of your smile.
Gum disease is one of the leading causes of tooth loss in adults. In the past, the only options for disguising tooth loss were dentures and bridges. Nowadays, dental implants are a more natural looking option because implants look and feel just like real teeth. They also allow the patient to speak and eat with comfort and confidence. During this procedure, a dental implant is attached to the root and after a healing period, an artificial tooth is attached. The result is a permanent replacement tooth that blends right in with the rest. Root Coverage Gum recession as a result of gum disease causes the tooth root to become exposed, which can make teeth look long and can prematurely age a person. In fact, the phrase “long in the tooth”, used to describe the elderly, is derived from this very reason. A periodontist can fix this problem with a procedure called root coverage. During this procedure, tissue from the mouth’s palate, or other synthetic materials, are used to facilitate coverage of the exposed root. Gummy Smile Periodontists also have the ability to fix a “gummy smile” when a person’s teeth appear too short. The teeth may actually be the proper length, but they’re covered with too much gum tissue. Your periodontist can correct this by performing a procedure called crown lengthening. During this procedure, excess gum and bone tissue is reshaped to expose more of the natural tooth. Think of it like pushing back the cuticles on a fingernail. The outcome is longer looking teeth and a winning smile. Your gums are an important part of your smile. They frame the teeth and play an integral role in the overall aesthetics of your everyday appearance. While taking care of them by brushing and flossing daily is the best way to maintain a healthy mouth, talk to your periodontist about the procedures available to maximize the potential of your smile.
Other Linked Diseases
You may have seen stories in the news about the connection between periodontal disease and heart disease, stroke, and diabetes. However, those aren’t the only health conditions that are related to periodontal disease. Research has shown that having periodontal disease can put you at risk for a few surprising conditions including rheumatoid arthritis, certain cancers, and even kidney disease. Click on the item in the boxes below to learn more.