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Periodontal disease is a slow, progressive disease that can destroy you oral and systemic health. Many of the hallmark symptoms of periodontal disease sneak up on us and are often ignored at least initially. It is important not to ignore these signs and symptoms as periodontal disease is the #1 cause of tooth loss. Periodontal disease comes in many different forms including aggressive, chronic, necrotizing periodontitis, and periodontitis associated with systemic diseases.  Each of these types of periodontal disease has its own distinct characteristics and symptoms, and all require prompt treatment by a dentist to help halt subsequent bone and gum tissue loss. Risk of periodontal disease increases with age. For younger people, dental caries are a more important risk for tooth loss, while for older people, periodontal disease is the more important risk factor.

Risk Factors Of Periodontal Disease

-Age. Studies have shown that over 70% of all Americans aged 65 and older have some form of periodontal disease.

-Tobacco Use (including smoking). We are well aware of the health effects of smoking on our overall health. These diseases include various types of cancer, lung disease, and cardiovascular (heart) disease. Research has also shown that tobacco use also increases a persons risk for periodontal disease.

-Family History (Genetics). Some people are more susceptible to periodontal disease than others. This is because of our genetic makeup.

-Stress. Studies have shown that stress can make it more difficult for the body to fight off infection, this includes periodontal diseases.

Prescription Drugs (Medications). Some drugs, such as oral contraceptives, anti-depressants, and certain heart medicines, can affect your oral health. Just as you notify your pharmacist and other health care providers of all medicines you are taking and any changes in your overall health, you should also inform your dentist.

-Bruxism (Teeth Grinding). Bruxism can put excess force on the supporting tissues of the teeth and could speed up the rate at which these periodontal tissues are destroyed.

-Presence Of Systemic Disease. Many systemic diseases can interfere with the inflammatory process. These include cardiovascular (heart) disease, diabetes, and rheumatoid arthritis.

-Poor Diet/ Nutrition. A diet low in important, essential nutrients can compromise the body’s immune system and make it harder for the body to fight off infection. Because periodontal disease begins as an infection, poor nutrition can worsen the condition of your gums.

Periodontal Disease Signs And Symptoms

Bleeding Upon Brushing, Flossing, Or Even Eating. This is one of the most common signs that periodontal disease is active. It is often overlooked as not a big deal. Periodontal disease is an inflammatory disease. As the bacteria and toxins build up in the mouth, the body responds by activating the inflammatory process, rushing our cells to stop the attack. This will cause the gum tissues to become inflamed and red. It is important to also note that bleeding gums can also be the sign of something more sinister like leukemia and blood platelet disorders.

Unexplained Pain Or Swelling. Periodontal infections present in this manner. When an oral infection occurs, it is essential that you get to a dentist as soon as possible for evaluation and treatment. If the infection is left unchecked it will cause damage to the gum tissues and the bone supporting your teeth. It can also be carried to other parts of the body through the blood stream affecting your overall health.

-Persistent Halitosis (Bad Breath). Bad breath can occur from many things but peristent bad breath can mean progressive periodontal disease . As the gum tissues are destroyed, the areas where the oral bacteria can flourish will increase causing a foul odor in the mouth. There are other causes of chronic halitosis that should also be ruled out by your dentist prior to treatment.

-Change In Your Smile Or Loose Teeth. As periodontal disease progresses, your teeth will loosen and move out of position. This will effect the way your teeth fit together and even alter your smile.

-Teeth Become Longer In Appearance. As periodontal disease progresses it will lead to destruction of the bone and gum tissues. This will show up as gum recession. Once the gum tissues pull back they expose more of the tooth and root, making them appear longer than before.

Pus Drainage. This goes along with the periodontal infection mentioned previously. An active periodontal infection will create pus which can ooze out from between the teeth and gums causing a bad taste and bad breath (malodor).

Periodontal Disease Prevention

Dental and Periodontal Examinations

Your dentist will complete a thorough examination with x-rays and periodontal charting. Notations about the visual condition of the gum tissue will also be recorded. In its earliest stages the gum tissue is usually red, puffy, and painless or slightly tender at this point. Plaque and tartar will more than likely be present to some degree. A periodontal probe will be used to measure around the teeth to see if your periodontal disease has progressed and to what degree. It is important to note that once bone loss has occurred you now have a more advanced form of periodontal disease.

Following the examination, your dentist will recommend a course of treatment for your periodontal disease. This will include a professional cleaning along with extra home care instructions. The goal in treatment is to reduce the inflammation and not allow progression of the disease. An antibacterial rinse (example, Listerine) may also be recommended for at home use. Your dentist may also recommend repair of misaligned or crooked teeth to aid you in your home care efforts. Your dentist may also recommend a more frequent schedule(every 4-6 months) to control your periodontal disease.

Following removal of plaque and tartar, bleeding and tenderness of the gums should begin to subside within 1-2 weeks after professional cleaning and careful dental hygiene. Warm salt water or antibacterial rinses can also reduce gum inflammation. Taking an over the counter anti inflammatory medication can also aid in pain and inflammation reduction.

Healthy gums should look pink and firm with no bleeding upon brushing, flossing, or eating. Good oral hygiene must be maintained for your whole life, or periodontal disease will come back and possibly advance past the gingivitis form into advanced periodontal disease (also called periodontitis).

Steps to prevent periodontal disease should include:

-Routine dental visits. Usually recommended every 3- 6 months for examination and professional cleaning.

-Maintain At Home Dental Care. Brushing after every meal and flossing at least once a day.

-Rinsing with an antiseptic rinse as recommended by your dentist. Choose one with the American Dental Association (ADA) seal of approval.

Consult your physician if the bleeding is severe or chronic, gums continue to bleed even after dental treatment, or you have other unexplained symptoms along with the bleeding from your gums. These could all be the sign of a more serious condition than periodontal disease and should be checked out as soon as possible.

Conclusion

Preventing periodontal disease is up to the patient. Luckily, it is preventable with diligence and effort. Maintaining good dental hygiene and seeing your dentist regularly will lead to a lifetime of healthy smiles.



Periodontal disease (or commonly called gum disease) is a very serious and chronic dental infection of the periodontal tissues that can result in the breakdown of the tissue as well as the loss of bone that surrounds and supports your teeth. This dental infection disease begins when bacteria and plaque form a sticky bio film on your teeth and causes inflammation of the periodontal tissue.  Periodontal disease will continue a downward progression if this is not resolved by maintaining proper dental care and hygiene. Periodontal disease is the leading cause of tooth loss in adults. Scientific studies show that somewhere between 75% and 95% of all adults are suffering from some stage of periodontal disease.

Periodontal disease and tooth decay (cavities) are caused by different types of bacteria, and are considered to be two separate and distinct conditions, however, you can suffer from both issues. Poor oral hygiene promotes the risk of both cavities and periodontal disease. Swollen and receding gums open up the more vulnerable areas of the tooth…The root areas, which, are not protected by enamel and can break down quickly to form root decay.  On the flip side, in patients with significant tooth decay, the broken down teeth allow for food trap areas which keep periodontal tissue chronically inflamed.

Gingivitis

Periodontitis

Stages of Periodontal Disease

The earliest stage of periodontal disease is gingivitis (or simply inflammation of the gum tissues). This is the most mild form of periodontal disease. Symptoms include red, swollen (or puffy) and inflamed gums due to plaque-bacteria build-up. The gums may also bleed easily during brushing or eating of hard foods. During the earliest of stages the periodontal disease process it can be reversed thru proper brushing, flossing and professional dental care to remove the excess bacterial plaque. If the required oral hygiene does not occur, the periodontal disease then progresses  to the next stage. The majority of people with this early form of periodontal disease, do not even know a dental problem exists. This is a crucial period for the patient, as the condition can be reversed (since the bone and connective tissue that hold the teeth in place have not yet been adversely affected) at this point if it is recognized, diagnosed, and properly treated by a dental professional. Gingivitis is commonly seen during puberty, pregnancy, times of high stress, and menopause, as raging hormones can make you more prone to inflammation. As for the rest of the population, poor dental hygiene is generally the most common cause, followed by medication and certain medical conditions.

Periodontitis

As the periodontal disease progresses it is now becoming harder to treat and control. The difference between gingivitis and periodontitis is that gingivitis only infects the gum tissue that surrounds the teeth while the periodontal disease process also invades the bone that provides support and stability for the teeth. The bacteria eventually invades past the initial the gum line area and destruction begins to the point that gums may begin to separate or pull away from the teeth (taking away support and connective fibers with it). What results are called periodontal pockets. These pockets allow for bacteria to invade below the gum line.  They eventually become loaded with toxic plaque and bacteria that moves and works its way deeper. It begins to erode the bone below the gum line. A patient’s bite will be affected (as the teeth shift or loosen) by the lost support which then affects chewing and other daily functions.

Advanced Periodontitis

As the periodontal disease process advances further, the fibers and bone that provide support for the teeth are broken down and  destroyed. At least half (50%) of the bone support (if not more) will have broken down at this late stage of periodontal disease. It does not grow back naturally. Teeth may begin to loosen. Deep root cleanings and surgical intervention are typical at this stage. This may include cleaning with a periodontal microscope, (Perioscope), grafting of tissue, bone, placement of growth factors, (Emdogain), periodontal antibiotic regimen (Periostat), placement of antibiotics directly into pockets, (Arestin), open periodontal flap surgery, and, possibly even tooth removal.

How Do I Know If I Have Periodontal Disease?

Periodontal disease can happen to a person of any age. It is most common among adults. Remember, if periodontal disease is detected in its earliest stages it can be reversed so it is important to see your dentist right away if you notice any of the following symptoms:

-Gums that are red, puffy or inflamed, or tender.

Periodontitis

X-Ray showing Periodontal Disease Progression

-Gums that bleed easily during routine brushing or flossing.

-Teeth that appear longer due to recession of gum tissue.

-Changes in the way your teeth fit together when you bite or chew.

-Pus coming from between your teeth and gums

-Bad breath odor or bad taste in your mouth.

Treatment of Periodontal Disease

Periodontal Disease

Arestin use in Periodontal Disease

The earliest stages of periodontal disease are reversible. This is accomplished thru proper brushing, flossing, and maintaining a regular schedule with your dentist. A professional cleaning by your dentist or hygienist is the only way to remove plaque and tartar especially below the gum line. The hygienist will clean (also called scaling) your teeth to remove the tartar and plaque buildup from above and below the gum line. If the periodontal disease condition worsens, then a root planing procedure may be necessary. Root planing helps smooth irregularities on the roots to make it more difficult for plaque to deposit and stick there. Also makes it easier for you to keep your teeth clean at home. Treatment may also include use of antibiotics.

If you have advanced periodontitis, your gum tissue may not respond to nonsurgical treatments and good oral hygiene. In that case, your periodontitis treatment may require dental surgery. This surgical intervention may include:

-Pocket Reduction Surgery (also called Flap surgery). In this procedure, your periodontist makes tiny incisions in your gum so that a section of gum tissue can be lifted back, exposing the roots for more effective scaling and planing. Because periodontitis often causes bone loss, the underlying bone may be recontoured before the gum tissue is sutured back in place. The procedure generally takes from one to three hours and is performed under local anesthesia.

Soft tissue grafts. Gum tissue is often lost as part of the periodontal disease process making your teeth appear longer than normal. You may need to have damaged tissue replaced to return your cosmetic appearance back to normal. This procedure can help reduce further gum recession, cover exposed roots and give your teeth a more cosmetically pleasing appearance.

Bone graft. This procedure is needed when periodontitis has destroyed the bone surrounding your tooth. The bone graft helps prevent tooth loss by holding your tooth in place. It also serves as a platform for the regrowth of natural bone.

-Antibiotics and medicaments – A wide array of antibacterial rinses(Peridex), antibiotics taken in pill form, (Periostat) or localized placement directly into the affected pockets(Arestin), can aide in and promote healing of the affected gum tissue.

-Guided tissue regeneration. This allows the regrowth of bone that was destroyed by bacteria. In one approach, your dentist places a special piece of biocompatible fabric between existing bone and your tooth. The material prevents unwanted tissue from entering the healing area, allowing bone to grow back instead.

-Enamel matrix derivative application. Another technique involves the application of a specialized gel to a diseased tooth root. This gel contains the same proteins found in developing tooth enamel and stimulates the growth of healthy bone and tissue. An example of this is the use of emdogain.

To ensure a successful result following periodontal therapy, patient cooperation in maintaining excellent oral hygiene is essential. More frequent professional cleanings can help reduce the likelihood of the periodontal disease ever returning.

By scheduling regular checkups, early stage periodontal disease can be treated before it leads to a much more serious condition. If your periodontal disease is more advanced, treatment in the dental office will be required. Periodontal disease can be managed and controlled for most patients. Following a regular routine of brushing, flossing, and seeing your dentist should be enough for most to keep periodontal disease at bay.