The word periodontal means “around the tooth.” It has been estimated that 80% of the population has gum disease and does not know it because it is painless in the early stages. Periodontal disease, also called gum disease, attacks the gums and bone that support your teeth. Bacterial plaque is a sticky film that builds up daily on teeth and must be mechanically removed. Mechanical removal includes a tooth brush and more importantly, floss. If plaque is not removed, it becomes calcified to the teeth turning to calculus (tartar). The gums and bone around the teeth become destroyed if plaque and calculus are not removed on a daily basis. Periodontal disease is usually characterized by red, swollen, easily bleeding gums coupled with bone loss from around the teeth.
Research suggests that there may be a link between periodontal disease and diseases such as diabetes, stroke, bacterial pneumonia, cardiovascular disease and increased preterm births. It, not tooth decay, is the number one reason for tooth loss. Smoking also increases the risk of periodontal disease.
Eliminating unhealthy habits, practicing proper oral hygiene, eating a balanced diet and maintaining regular dental visits can help reduce your risk of developing periodontal disease.
SIGNS AND SYMPTOMS OF PERIODONTAL DISEASE
- Bleeding gums – A tooth brush and floss should not make gums bleed. Gums that bleed easily are the first sign that gums are under attack by bacteria.
- Loose teeth – Bone loss around the tooth provides for weakened periodontal tooth support resulting in loose teeth.
- New spacing between teeth – Increased triangular looking space between the teeth where bone and gums used to be but has been lost.
- Persistent bad breath – The result from increased presence of disease causing bacteria in the mouth.
- Pus around the teeth and gums – A sign that so much bacteria is present that infection has developed around the entire root structure of the tooth and is moving into the jawbone.
- Receding gums – An exposure of the root surfaces of the teeth which coincides with bone loss.
- Red and puffy gums – Inflammation is a clue from your body’s immune system that bacteria is beginning to attack the body in that area.
- Tenderness or discomfort – Excessive plaque, calculus and bacteria can eventually pinch and irritate loose gum tissue and/or the teeth.
Gum disease is diagnosed by your dentist during a regular dental exam. This type of exam should always be part of your regular dental check-up.
A periodontal exam is done using a small gum probing instrument which measures the depth, height, and random bleeding of the gums around each tooth in the mouth. The depth of a healthy gum pocket is three millimeters or less and does not bleed. As gum disease get worse, the pockets usually get deeper.
Gum pocket depths, amount of bleeding, inflammation, and tooth mobility are all used to make a diagnosis that will fall into one of three stages.
STAGES OF PERIODONTITIS
This is the first stage of periodontal disease. The presence of bacterial plaque and toxins irritate the gums, making them red and swollen, and likely to bleed easily. Again this is your immune system’s first reaction to the bacterial toxins that help prevent them from entering your body through the gums.
If plaque continues to build up and calculus begins to form due to lack of proper brushing and flossing, the gums begin to recede from the teeth. Deeper gum pockets begin to form where more bacteria, plaque and calculus begin accumulate. The gums become very irritated looking, inflamed and bleed very easily. Slight to moderate bone loss may be present.
Here, the teeth lose more periodontal support as the gums and bone around the teeth continue 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.
HOW PERIODONTITIS IS TREATED
Treatment of gum disease depends upon the type bacteria present and the severity of the disease. Your dentist and hygienist can recommend the appropriate treatment.
As periodontal disease progresses, the gum pockets become increasingly filled with bacteria, plaque and calculus, further destroying even more teeth supporting structures of the jaw. If these irritants remain in the pocket space, eventual teeth loss is an absolute.
A special periodontal cleaning called scaling and root planing, also called a deep cleaning, will be recommended if you become diagnosed with periodontis or advanced periodontitis. Gum pocket depths of 4-5 mm can be deep cleaned in our office. Patients with deeper probing depths are usually referred to a periodontist, who specializes in the treatment of advanced gum disease.
The scaling process removes calculus, plaque and bacterial toxins from above and below the gum line. Any rough spots on the root surface are made smooth by planing the root. The area being scaled and planed is usually numbed. Proper scaling and root planing helps shrink gum pockets and eliminate inflammation. Sometimes, localized antibiotic may be placed in the pockets by the periodontist to help the healing process. This antibiotic is slowly dissolved over time giving it the best chance to heal.
Medications, special prescription mouth rinses and an electric tooth brush may be recommended by dental professionals to help control infection and healing. Instructions on how to improve your daily oral hygiene habits will always be provided and a recommended dental cleaning frequency will be prescribed.
If the pockets do not heal after scaling and root planing, the periodontist may need to perform periodontal surgery. Here the gums are temporarily pulled away from tooth to provide better access for improved scaling and root planing.
After the initial periodontal treatment has been completed, your dentist and hygienist will recommend that you have regular maintenance cleanings. This can sometimes be up to three or four times a year. At these cleaning appointments, the gum pocket depths will be checked for gum disease recurrence. Your regular periodic dental exams will be part of two of these periodontal maintenance cleanings a year.
It takes twenty-four hours for plaque that is not removed from your teeth to turn into calculus, starting the sequence of events that lead up to gum disease. Once this plaque hardens, it can only be removed with specialized dental instruments. This is why proper at-home oral hygiene is a must. Good oral hygiene practices and periodontal cleanings are essential for maintaining dental health and keeping periodontal disease under control!