The term “periodontal” means “around the tooth.”  Periodontal disease (also known as periodontitis and gum disease) is a common inflammatory condition that affects the supporting and surrounding soft tissues of the tooth, eventually affecting the jawbone itself in the disease’s most advanced stages.

Periodontal disease is most often preceded by gingivitis which is a bacterial infection of the gum tissue.  A bacterial infection affects the gums when the toxins contained in plaque begin to irritate and inflame the gum tissues.  Once this bacterial infection colonizes in the gum pockets between the teeth, it becomes much more difficult to remove and treat.  Periodontal disease is a progressive condition that eventually leads to the destruction of the connective tissue and jawbone.  If left untreated, it can cause shifting teeth, loose teeth, and eventually tooth loss. 

Periodontal disease is the leading cause of tooth loss among adults in the developed world and should always be promptly treated.

The bacterial infection colonizes in the gingival tissue, and deep pockets form between the teeth and the gums.  If treated promptly by a periodontist, the effects of mild inflammation (known as gingivitis) are completely reversible.  However, if the bacterial infection is allowed to progress, periodontal disease begins to destroy the gums and the underlying jawbone, promoting tooth loss.  In some cases, the bacteria from this infection can travel to other areas of the body via the bloodstream.

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 affect 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.

Types of Periodontal Disease

When left untreated, gingivitis (mild gum inflammation) can spread below the gum line.  When the gums become irritated by the toxins contained in plaque, a chronic inflammatory response causes the body to break down and destroy its own bone and soft tissue.  There may be little or no symptoms as periodontal disease causes the teeth to separate from the infected gum tissue.  Deepening pockets between the gums and teeth are generally indicative that soft tissue and bone are being destroyed by periodontal disease.

Here are some of the most common types of periodontal disease:

• Chronic periodontitis – Inflammation within supporting tissues causes deep pockets and gum recession.  It may appear the teeth are lengthening, but in actuality, the gums (gingiva) are receding.  This is the most common form of periodontal disease and is characterized by progressive loss of attachment, interspersed with periods of rapid progression.
  
  
• Aggressive periodontitis – This form of gum disease occurs in an otherwise clinically healthy individual.  It is characterized by rapid loss of gum attachment, chronic bone destruction, and familial aggregation.
  
  
• Necrotizing periodontitis – This form of periodontal disease most often occurs in individuals suffering from systemic conditions such as HIV, immunosuppression, and malnutrition.  Necrosis (tissue death) occurs in the periodontal ligament, alveolar bone, and gingival tissues.
  
  
• Periodontitis caused by systemic disease – This form of gum disease often begins at an early age.  Medical conditions such as respiratory disease, diabetes, and heart disease are common cofactors.

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 a 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.

Treatment for Periodontal Disease

There are many surgical and nonsurgical treatments the periodontist may choose to perform, depending upon the exact condition of the teeth, gums, and jawbone.  A complete periodontal exam of the mouth will be done before any treatment is performed or recommended.

Here are some of the more common treatments for periodontal disease:

• Scaling and root planing – In order to preserve the health of the gum tissue, the bacteria and calculus (tartar) which initially caused the infection, must be removed.  The gum pockets will be cleaned and treated with antibiotics as necessary to help alleviate the infection.  A prescription mouthwash may be incorporated into daily cleaning routines.
  
  
• Tissue regeneration – When the bone and gum tissues have been destroyed, regrowth can be actively encouraged using grafting procedures.  A membrane may be inserted into the affected areas to assist in the regeneration process.
  
  
• Pocket elimination surgery – Pocket elimination surgery (also known as flap surgery) is a surgical treatment that can be performed to reduce the pocket size between the teeth and gums.  Surgery on the jawbone is another option that serves to eliminate indentations in the bone which foster the colonization of bacteria.
  
  
• Dental implants – When teeth have been lost due to periodontal disease, the aesthetics and functionality of the mouth can be restored by implanting prosthetic teeth into the jawbone.  Tissue regeneration procedures may be required prior to the placement of a dental implant in order to strengthen the bone.

Please contact our office if you have questions or concerns about periodontal disease, periodontal treatment, or dental implants.