Periodontal Disease

Periodontal disease or gum disease is the primary reason behind tooth loss. Periodontal means “around the tooth” and periodontal disease refers to infection that involves the gums and bones supporting our teeth.

Periodontal disease is quite common. In fact, four out of five individuals have the disease without knowing it. It is usually painless at its early stages and the first visible signs include red, swollen and bleeding gums.

Research has established a possible link between periodontal disease and other medical conditions such as diabetes, stroke, bacterial pneumonia, increased risk during pregnancy and cardiovascular disease. Studies are ongoing to determine if bacteria and inflammation associated with periodontal disease influence these systemic diseases and conditions. Smoking has also been determined to increase your risk of developing periodontal disease.

You can reduce your risk of developing periodontal disease by eating a well-balanced diet, embarking on a healthy lifestyle, practicing good oral hygiene, and seeing your dentist regularly.

The following are signs and symptoms of periodontal disease:

Diagnosis of Periodontal Disease

A periodontal examination forms part of your regular dental checkup. Your dentist or dental hygienist will do an examination to determine if you have periodontal disease.

Using a small dental instrument called the periodontal probe, your dentist will measure the gingival sulcus (pocket depths around the tooth) to determine that state of health of the tissues surrounding and supporting the teeth. Depth markings are inscribed on the head of the probe, and a healthy sulcus measures around 3 mm. Likewise, it does not bleed. Pocket depths of more than 3mm indicate periodontal disease, as the sulcus usually gets deeper with the progression of the disease.

There are several categories of periodontal disease and diagnosis is arrived at by measuring pocket depths, tooth mobility, as well as the amount of bleeding and level of inflammation.

Gingivitis

Gingivitis is first-stage periodontal disease characterized by tender and inflamed gums that are likely to bleed. This is due to gum irritation caused by plaque and its toxin by-products.

Periodontitis

Plaque that builds up along the gums and around the teeth needs to be removed. Otherwise, it can harden into calculus and cause the gums to recede. When the gums recede, deeper pockets form between them and the teeth and these pockets can collect pus and bacteria that will irritate or inflame the gums. This will cause the gums to bleed easily and there could also be slight to moderate bone loss.

Advanced Periodontitis

As the gums, bone and periodontal ligament are continually destroyed by the progression of periodontal disease, teeth will lose support and this can eventually lead to tooth loss. There could also be moderate to severe bone loss in advanced periodontitis.

Treatment of Periodontitis

The treatment of periodontitis will depend on an evaluation of the type and severity of the disease by your dentist and dental hygienist.

Periodontal disease progresses when the pockets between the teeth and gums accumulate plaque, tartar and bacteria. This will eventually irritate the surrounding tissues and cause damage to the gums and even the bone that supports your teeth.

Periodontal disease caught in the initial stages of gingivitis usually results to no damage. One to two regular dental cleanings should be able to address the problem at this point. Your dentist will also make recommendations on how to improve your daily oral care practices and have you come back for regular cleanings.

Periodontal disease in the more advanced stages will require scaling and root planing (deep cleaning), a special type of periodontal cleaning that involves one quadrant of the mouth at a time. A local anesthesia may be administered to keep the area numb during the procedure. Tartar, plaque and toxins that have built up above and below your gum line will be removed via scaling while rough sections on root surfaces are smoothened out by root planing. This specialized type of cleaning helps shrink the pockets and heal the gums. Your dentist will prescribe a medicated mouth rinse and some other medications and will often recommend the use of an electric toothbrush to speed up healing and control possible infection.

In some cases, pockets do not heal after the procedure and periodontal surgery may be required to reduce the depth of these pockets so teeth are easier to clean. Most dentists will recommend that you visit a periodontist for more serious gum issues. A periodontist is a gum and supporting bone specialist.

Maintenance

Did you know that it only takes 24 hours for plaque that isn’t removed from the teeth to turn into calculus or tartar? That is why it is vital that daily brushing and flossing are required to prevent and control plaque and tartar buildup.

Those hard to reach areas of the teeth and gums will require special attention and your dentist and dental hygienist will advise regular maintenance cleanings (periodontal cleanings) every quarter. They will check that the pocket depths between the teeth and gums are healthy and will remove any plaque and calculus from above and below your gum line.

Besides periodontal evaluation and cleaning, your regular appointments will normally include:

Diagnostic x-rays to detect any form of decay, the presence of cysts or tumors, and possible signs of bone loss. Tooth and root positions are also assessed with the help of these x-rays.

Good oral care and hygiene practices as well as regular periodontal cleanings are vital to the prevention or control of periodontal disease and the maintenance of optimum dental and oral health.