What is periodontal disease, its causes, symptoms and treatment?
Our mouths are full of bacteria. Bacteria take any sugars we eat change the sugar into a soft, sticky, tooth colored carbohydrate called ‘plaque’. Plaque accumulated on the surfaces of the teeth, in-between the teeth, and under the gum. The more frequently a person eats sugar and refined carbohydrates the more plaque forms.
Brushing, flossing, and tongue cleaning for people with plaque coated tongues help get rid of plaque. Plaque that is not removed can harden and form bacteria-hiding "tartar" that brushing doesn't clean. Only a professional cleaning by a dentist or dental hygienist can remove tartar.
Gingivitis
The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called "gingivitis." In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.
Periodontitis
When gingivitis is not treated, it can advance to "periodontitis" (which means "inflammation around the tooth.") In periodontitis, gums pull away from the teeth and form "pockets" that are infected. The body's immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body's enzymes fighting the infection actually start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and connective tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.
Aggressive Periodontitis A form of periodontitis that occurs in patients who are otherwise clinically healthy. Common features include rapid attachment loss and bone destruction and familial aggregation.
Chronic Periodontitis
A form of periodontal disease resulting in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss and is characterized by pocket formation and/or recession of the gingiva. It is recognized as the most frequently occurring form of periodontitis. 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 Disease Periodontititis, often with onset at a young age, can result from several systemic diseases, such as diabetes and leukemia.
Some of the following information is from the American Academy Of Periodontology (AAP_ at http://www.perio.org/consumer/procedures.htm#1. Additional information is available at the AAP site.
Periodontitis as a Cause of Systemic Diseases While more research needs to be done to say definitively that people with periodontal disease are at higher risk for developing heart disease, stroke, uncontrolled diabetes, preterm births and respiratory disease, periodontists do know that periodontal disease has a strong inflammatory component which results from a bacterial infection, and both the infection and inflammation may be responsible for the following correlations.
Necrotizing Periodontal Diseases
An infection characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions including, but not limited to, HIV infection, malnutrition and immunosuppression.
Risk Factors Leading to Periodontal Disease
Smoking. Need another reason to quit smoking? Smoking is one of the most significant risk factors associated with the development of periodontitis. Additionally, smoking can lower the chances of success of some treatments.
Diet. Frequently eating refined carbohydrates or foods made with sugar allow barteria to form products from sugar which causes cavities, gum disease and bad taste or bad breath (halitosis) and give the teeth a dull appearance.
Poor home care. Not effectively removing plaque from the teeth or tongue
Hormonal changes in girls/women. These changes can make gums more sensitive and make it easier for gingivitis to develop.
Diabetes. People with diabetes are at higher risk for developing infections, including periodontal disease.
Stress. Research shows that stress can make it more difficult for our bodies to fight infection, including periodontal disease.
Medications. Some drugs, such as antidepressants and some heart medicines, can affect oral health because they lessen the flow of saliva. (Saliva has a protective effect on teeth and gums.)
Illnesses. Diseases like cancer or AIDS and their treatments can also affect the health of gums.
Genetic susceptibility. Some people are more prone to severe periodontal disease than others.
Treatment
Periodontal Procedures
Following are some of the procedures that periodontists use to treat patients diagnosed with a periodontal (gum) disease. The main cause of periodontal disease is bacteria in the form of a sticky, colorless plaque that constantly forms on your teeth; however, many other factors can cause periodontal (gum) disease or influence its progression.
Non-Surgical Treatments
AAP treatment guidelines stress that periodontal health should be achieved in the least invasive and most cost-effective manner. This is often accomplished through non-surgical periodontal treatment, including scaling and root planing (a careful cleaning of the root surfaces to remove plaque and calculus [tartar] from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins), followed by adjunctive therapy such as local delivery antimicrobials and host modulation, as needed on a case-by-case basis.
Most periodontists would agree that after scaling and root planing, many patients do not require any further active treatment, including surgical therapy. However, the majority of patients will require ongoing maintenance therapy to sustain health. Non-surgical therapy does have its limitations, however, and when it does not achieve periodontal health, surgery may be indicated to restore periodontal anatomy damaged by periodontal diseases and to facilitate oral hygiene practices.
Periodontal Surgery
If you're diagnosed with periodontal disease, your periodontist may recommend periodontal surgery. Periodontal surgery is necessary when your periodontist determines that the tissue around your teeth is unhealthy and cannot be repaired with non-surgical treatment. Following are the four types of surgical treatments most commonly prescribed:
The Use of Lasers in Periodontal Therapy
Limited research suggests that the use of lasers as an adjunct to scaling and root planing (SRP) may improve the effectiveness of this procedure. In addition, when the lasers are used properly during periodontal therapy there can be less bleeding, swelling and discomfort to the patient during surgery. However, each laser has different wavelengths and power levels that can be used safely during different periodontal procedures. Damage to periodontal tissues can result if an inappropriate wavelength and/or power level is used during a periodontal procedure.
If you've already lost a tooth to periodontal disease or other reasons, you may be interested in dental implants—the permanent tooth replacement option.
In addition to procedures to treat periodontal disease, many periodontists also perform cosmetic procedures to enhance your smile. Oftentimes, patients who pursue cosmetic procedures notice improved function as well. Cosmetic procedures include:
