Periodontal diseases are infections of the structures around the teeth, which include the gums, periodontal ligament and alveolar bone. “Perio” means around and “dontal” means the teeth. Periodontitis is a pathological inflammatory condition of the gum and bone support surrounding the teeth.
In the earliest stage of periodontal disease called –gingivitis, the infection affects the gums. It is characterised by redness of the gum margins, swelling and bleeding on brushing. Swollen and bleeding gums are early signs that your gums are infected with bacteria. Gingivitis occurs in both chronic and acute forms. Acute gingivitis is usually associated with specific infections, micro-organisms, or trauma. Chronic inflammation of the gum tissue surrounding the teeth is associated with the bacterial biofilm (plaque) that covers the teeth and gums. Gingivitis can be reversed by effective personal oral hygiene practice. If left ignored and untreated gingivitis can spread to the surrounding periodontal ligament and alveolar bone
In the early stages, periodontitis has very few symptoms, and in many individuals the disease has progressed significantly before they seek treatment.
Symptoms may include:
- Gum swelling that keeps recurring
- Spitting out blood after brushing teeth
- Halitosis (bad breath)
- Metallic taste in the mouth
- Gingival recession, resulting in apparent lengthening of teeth. This increases the sensitivity as the root portion of the teeth gets exposed.
- Deep pockets between the teeth and the gums –Pockets are sites where the attachment has been destroyed over a period of time by collagen-destroying enzymes, known as “collagenases”
- Loose teeth, in the later stages
Cause of Periodontal Disease
Periodontal disease is caused by the bacteria in dental plaque, the sticky substance that forms on the teeth a couple of hours after brushing. It is the body’s response to the bacterial infection that causes most of the problems. In an effort to eliminate the bacteria, the cells of the immune system release substances that cause inflammation and destruction of the gums, periodontal ligament or alveolar bone. The build-up of plaque below the gum line leads to inflammation of the gums. As the gum tissues become more swollen, they detach from the tooth forming a space, or “pocket,” between the tooth and gums. These pockets encourage further plaque accumulation. If left untreated, the inflammatory response to the plaque bacteria may spread to the periodontal ligament and alveolar bone, causing these structures to be destroyed. If plaque is allowed to build up on teeth, over time it becomes calcified and hardened, and turns into calculus (commonly called tartar). Since calculus is rougher than tooth enamel or the layer that covers the tooth root even more plaque attaches to it, continuing this degenerative process.
Risk factors for periodontal disease
- Smoking and tobacco use- Smoking increases the risk of periodontal disease. If periodontal disease is present, smoking makes it more severe. Smokers collect more tartar on their teeth, develop deeper periodontal pockets once they have gum disease and are likely to lose more bone as the disease progresses. Quitting smoking can play a major role in bringing periodontal disease under control.
- Genetics- Researchers believe up to 30% of the population may have a genetic susceptibility to periodontal disease. Even people who are highly prone to periodontal disease because of their genetic make-up can prevent or control the disease with good oral care.
- Misaligned or crowded teeth, braces or bridgework- Anything that makes it more difficult to brush or floss your teeth is likely to enhance plaque and tartar formation above and below the gum line, which increases your chance of developing gum disease.
- Grinding or clenching of teeth- These habits won’t cause periodontal disease, but they can lead to more severe disease if inflammation is already present. The excessive force exerted on the teeth by these habits appears to speed up the breakdown of the periodontal ligament and bone.
- Stress – Stress weakens your body’s immune system, which makes it harder for your body to fight off infection, including periodontal disease.
- Fluctuating hormones – Puberty and pregnancy can temporarily increase the risk and severity of gum disease, as can menopause.
- Medications- Several types of medications can cause dry mouth (Xerostomia) including antidepressants, diuretics and high blood-pressure medications. Few medications may cause the gums to enlarge, which in turn makes them more likely to trap plaque. These medications include phenytoin, cyclosporine and other calcium channel blockers.
- Diseases – People with diabetes are more likely to get periodontitis, than people without diabetes and it’s likely to be more severe. Other diseases, such as leukaemia, inflammatory bowel disease and HIV infection, also can increase the risk.
- Poor nutrition – Nutrition is important for overall good health, including a working immune system and healthy gums and mouth.
The cornerstone of successful periodontal treatment starts with establishing excellent oral hygiene. This includes twice-daily brushing with daily flossing. The use of an interdental brush is helpful if there are gaps between the teeth. For smaller spaces, products such as narrow picks with soft rubber bristles provide excellent manual cleaning. A lifelong regimen of excellent hygiene and professional maintenance care with a dentist/hygienist or periodontist is required to maintain affected teeth.
Initial therapy involves removal of microbial plaque and calculus to re-establish periodontal health. The first step in the treatment of periodontitis involves nonsurgical cleaning below the gum line with a procedure called scaling and debridement. In addition to the initial scaling and root planing, it may also be necessary to adjust the bite to prevent excessive force on teeth that have reduced bone support.
If nonsurgical therapy is found to have been unsuccessful in managing signs of disease activity, periodontal surgery may be needed to stop progressive bone loss and regenerate lost bone where possible. The goal of periodontal surgery is access for definitive calculus removal and surgical management of bony irregularities which have resulted from the disease process to reduce pockets as much as possible.
Periodontal maintenance involves regular check-ups and detailed cleanings every three months to prevent repopulation of periodontitis-causing microorganisms, and to closely monitor affected teeth so early treatment can be rendered if the disease recurs.