Periodontal Disease

What Are Periodontal Diseases?

Periodontal diseases are infections of the gums, which gradually destroy the support of your natural teeth. The disease can take on different forms. The different types of the disease each require an accurate diagnosis and different treatment approaches.

The forms of the disease include the following:

  • Juvenile Periodontitis(children and adults)
  • Gingivitis
  • Adult Periodontitis
  • Rapidly Progressive Periodontitis
  • Refractory Periodontitis

Dental plaque (bacteria and their byproducts/toxins) is the primary cause of gum disease in genetically susceptible individuals. Daily brushing and flossing that is effective in removing plaque will prevent most periodontal conditions.

Why is Oral Hygiene so Important?

Adults past the age of 35 lose more teeth due to gum diseases (Periodontal Disease) as well as from cavities. Three out of four adults are affected at some time in their life with some form of periodontal problem. The best way to prevent cavities and Periodontal Diseases is when tooth brushing and flossing techniques are effectively performed daily.

Periodontal Disease and Decay are different diseases and are caused by different types of Bacterial Plaque. Plaque is a colorless invisible film, which sticks to your teeth and grows above, at and below the gum-line. Plaque consists of the living germs on your teeth. They begin to re-grow and multiply on the tooth within hours after being removed. With thorough and consistent daily plaque removal you can help prevent Periodontal Disease.

If the soft invisible plaque is not carefully and completely removed by daily brushing and flossing, plaque hardens into a rough, porous substance known as calculus (or tartar). Tartar is a hard substance that is firmly attached to the tooth and can only be removed with special instruments by the dentist or hygienist. In contrast, plaque is soft and can be removed by you (as long as you can get to it). The limitation of personal plaque removal is about 3mm (or about 1/16th of an inch) under the gum line.

Causes of Periodontal Disease

If left untreated, gingivitis can lead to periodontitis.

In general, periodontal disease involves the inflammation and destruction of tissues that surround and support the teeth, including the gums (gingiva) and supporting bone and fibers. The inflammation is caused by the bacteria found in plaque which produces toxins or poisons that irritate the gums. Oral health professionals make an important distinction between the two most common forms of periodontal disease: gingivitis and periodontitis. Gingivitis is an inflammation of the gums usually caused by the presence of bacteria in plaque, a sticky film that accumulates on teeth both above and below the gum-line. Gingivitis is reversible and does not cause destruction of the tissues that support the teeth. In contrast, periodontitis involves inflammation of the gums and a destruction of connective tissue and bone that is largely irreversible. If left untreated, gingivitis can lead to periodontitis.

In some, but not all cases of periodontitis, gums may turn red, swell and bleed easily. If this irritation is prolonged, the gums separate from the teeth, causing pockets (deep spaces under the gum line) with accompanying bone destruction around the tooth/teeth. As periodontal diseases progress, the supporting gum and the bone that holds teeth in place continues to dissolve. If left untreated, progressive bone loss leads to tooth loss.

Warning Signs of Periodontal Disease

  • Bleeding gums
  • Bad Breath
  • Red, Swollen, or tender gums
  • Loose teeth
  • Tooth drifting/migration, or a change in the bite
  • Pus that appears between the teeth and gums when the gums are compressed
  • A change in the fit of a partial denture
  • A receding gum line which has pulled away from the teeth
  • It is important to note that in many cases none of these warning signs are present. All too often, periodontitis is a silent destroyer of oral health because pain is absent unless an acute infection occurs. I have seen many cases of advanced bone loss with no signs of inflammation and where no pain was present for the patient.

The Goals of Periodontal Therapy

There are 4 main goals in periodontal therapy. They are as follows:

  1. Eliminate infection and inflammation
  2. Teach the patient self-care skills to maintain health and prevent reoccurrence of disease
  3. Correct any damage to the root, bone, gum and bite
  4. Establish an appropriate schedule of professional in-office maintenance

How We Diagnose Periodontal Disease

Before a diagnosis can be made an examination must first occur. The type of examination will be determined by the nature of the problem. A complete periodontal examination differs in scope from an examination for gum recession or for a broken tooth. A complete periodontal examination may include any or all of the following procedures:

  • Oral cancer screening exam of all hard and soft tissues
  • Check of the condition of the saliva
  • Charting of missing, shifted or impacted teeth
  • 6 pocket measurements on each tooth
  • Gum recession measurements on each tooth
  • Recording of the mobility (looseness) on each tooth
  • Evaluation for bone damage between the roots of multi-rooted teeth
  • Assessment of abrasion (wear) on exposed roots
  • Detection and recording of decay and defective or worn restorations (fillings)
  • Assessment and recording of sites with infection (pus) or bleeding
  • Bite exam and recording of bite function and movement
  • Evaluation of major muscle groups that relate to the bite and the jaws
  • Evaluation of the TMJ (jaw joint) function
  • Evaluation for bite trauma and tooth wear
  • Measurement of maximum bite opening
  • Photographs in the mouth and of the face
  • X-ray evaluation
  • Bacteriologic testing
  • Genetic susceptibility testing
  • Obtaining study models

Once the data has been collected an accurate diagnosis can be made. With an accurate diagnosis a proper treatment plan can be formulated based upon the findings as well as the needs, wants and desires of the patient.