Periodontal (Gum) Disease

The term "periodontal" means "around the tooth." Periodontal disease is an infection that affects the gums and the bone supporting the teeth. It begins with plaque—a sticky film of food debris, bacteria, and saliva. If not removed, plaque hardens into tartar (calculus), which can destroy gum tissue and bone over time. The condition is commonly identified by red, swollen, and bleeding gums.

Did You Know?

4 out of 5 people have periodontal disease and don’t realize it!
It is usually painless in its early stages, which makes it difficult to detect without professional dental care.
Periodontal disease is the leading cause of tooth loss.

Research suggests that periodontal disease may be connected to several systemic conditions, including:

Stroke
Bacterial pneumonia
Diabetes
Cardiovascular disease
Complications during pregnancy
Inflammation and bacteria associated with periodontal disease may play a role in worsening these conditions. Additionally, smoking significantly increases the risk of developing periodontal disease.

Maintaining good oral hygiene, eating a balanced diet, and scheduling regular dental visits are essential to lowering your risk.

What is Periodontal Disease?

The term “periodontal” means "around the tooth." Periodontal disease, also known as periodontitis or gum disease, is a common inflammatory condition that affects the supporting tissues of the teeth and, in advanced stages, the jawbone.

Periodontal disease often starts with gingivitis, a bacterial infection of the gum tissue. Plaque buildup irritates and inflames the gums. If left untreated, the bacteria from plaque invade the gum pockets between the teeth, making the infection harder to treat. As the disease progresses, it can destroy the connective tissue and jawbone, leading to shifting, loose teeth, and even tooth loss.

Periodontal disease is the leading cause of tooth loss in adults in developed countries and requires prompt treatment.

Types of Periodontal Disease

If gingivitis is left untreated, it can progress to more severe forms of periodontal disease, often with little to no symptoms in the early stages. As the disease advances, the gums begin to recede, and the pockets between the teeth and gums deepen, indicating the destruction of soft tissue and bone.

Here are some of the most common types of periodontal disease:

Chronic Periodontitis: This is the most common form of gum disease. It causes deep gum pockets and gum recession, making teeth appear longer as the gums recede. The disease progresses with intermittent periods of rapid attachment loss.
Aggressive Periodontitis: Occurs in otherwise healthy individuals and leads to rapid loss of gum attachment and chronic bone destruction. It often runs in families.
Necrotizing Periodontitis: Typically affects individuals with weakened immune systems due to conditions like HIV, malnutrition, or immunosuppression. It involves tissue death (necrosis) in the periodontal ligament, bone, and gingiva.
Periodontitis Caused by Systemic Disease: Often begins at an early age, with medical conditions such as respiratory disease, diabetes, and heart disease contributing to its development.

Signs and Symptoms of Periodontal Disease

Be alert for the following warning signs:

Bleeding gums: Healthy gums should not bleed, even during vigorous brushing or flossing.
Loose teeth: A result of bone loss or weakened periodontal fibers that hold teeth in place.
New gaps between teeth: Often caused by bone loss.
Persistent bad breath: Caused by bacterial buildup in the mouth.
Pus around teeth and gums: A clear sign of infection.
Receding gums: Loss of gum tissue around the teeth.
Red and swollen gums: Healthy gums should appear firm and pink.
Tenderness or discomfort: Caused by plaque, tartar, and bacterial irritation.

If you notice any of these symptoms, consult your dentist immediately. Early detection and treatment are key to preventing the progression of periodontal disease and protecting your overall health.

Treatment for Periodontal Disease

Treatment for periodontal disease depends on the type and severity of the condition. A full periodontal examination will determine the best course of action.

Early Stage (Gingivitis)

If periodontal disease is caught early, in the gingivitis stage, and no damage has occurred, treatment typically includes:
- Regular Cleanings: One to two professional cleanings to remove plaque and tartar buildup.
- Oral Hygiene Guidance: Education on improving daily oral care habits and the importance of regular dental cleanings.

Advanced Stages (Periodontitis)

As the disease progresses, the sulcus (pocket) between the teeth and gums becomes filled with bacteria, plaque, and tartar, leading to tissue and bone damage. Treatments for advanced stages include:
- Scaling and Root Planing (Deep Cleaning):
  - Scaling: Removal of tartar, plaque, and toxins from above and below the gum line.
  - Root Planing: Smoothing rough spots on the root surfaces to promote gum healing and pocket shrinkage.
  - Medications, medicated mouth rinses, or an electric toothbrush may also be recommended to control infection and encourage healing.
- Surgical Treatment:
  - If pockets do not heal after scaling and root planing, periodontal surgery may be necessary to reduce pocket depths, making it easier to clean teeth.
  - Your dentist may refer you to a periodontist (a gum and bone health specialist) for further treatment.

Additional Treatments for Advanced Cases

Tissue Regeneration:
- For cases where bone and gum tissue have been lost, regenerative procedures can stimulate tissue regrowth.
- This may involve grafting or using a membrane to promote healing.
Pocket Elimination Surgery:
- A surgical procedure to reduce the size of gum pockets and remove bacteria from deep areas.
- Jawbone reshaping may also be performed to prevent further bacterial buildup.
Dental Implants:
- If teeth are lost due to periodontal disease, dental implants can restore appearance and function.
- Tissue regeneration may be required before implant placement to ensure a strong bone structure.

Next Steps

If you have concerns or questions about periodontal disease or treatment options, consult your dentist. They will evaluate your condition and recommend the most appropriate course of action to preserve your oral health.

Diagnosis of Periodontal Disease

Periodontal disease is diagnosed by your dentist or dental hygienist during a periodontal examination, which should be part of your regular dental check-up.

A periodontal probe (a small dental instrument) is gently used to measure the sulcus (the space or pocket) between the tooth and the gums. In a healthy mouth, the sulcus measures three millimeters or less and does not bleed. If the pockets are deeper than three millimeters, it may indicate the presence of periodontal disease. As the disease progresses, these pockets typically get deeper.

Your dentist or hygienist will assess the following to make a diagnosis:

Pocket depths
Amount of bleeding
Inflammation
Tooth mobility

Based on these factors, your diagnosis may fall into one of the following categories:

Gingivitis
- Gingivitis is the earliest stage of periodontal disease. It occurs when plaque and its toxin by-products irritate the gums, causing them to become inflamed, tender, and prone to bleeding.
Periodontitis
- As the plaque hardens into calculus (tartar), the gums begin to recede from the teeth. Deeper pockets form between the gums and teeth, which can become filled with bacteria and pus. The gums become very irritated and inflamed, often bleeding easily. Slight to moderate bone loss may also be present at this stage.

Advanced Periodontitis
- In this stage, the teeth lose support as the gums, bone, and periodontal ligament continue to be destroyed. Without treatment, the affected teeth will become loose and may eventually be lost. Generalized moderate to severe bone loss is common at this stage.

Maintenance of Periodontal Disease

It only takes 24 hours for plaque that is not removed from your teeth to turn into calculus (tartar). While daily home cleaning helps control plaque and tartar formation, there will always be hard-to-reach areas that need special attention.

Once your periodontal treatment is complete, your dentist and dental hygienist will recommend regular maintenance cleanings (periodontal cleanings), typically four times a year. During these cleanings, the pocket depths will be carefully checked to ensure they are healthy. Plaque and calculus that are difficult to remove with regular brushing will be cleaned from above and below the gum line.

What to Expect During Your Maintenance Appointments:

Examination of diagnostic x-rays (radiographs): Essential for detecting decay, tumors, cysts, and bone loss. X-rays also help determine tooth and root positions.
Examination of existing restorations: Check the condition of fillings, crowns, etc.
Examination for tooth decay: Check all tooth surfaces for signs of decay.
Oral cancer screening: Examine the face, neck, lips, tongue, throat, cheek tissues, and gums for any signs of oral cancer.
Oral hygiene recommendations: Review and recommend any necessary oral hygiene aids, such as electric toothbrushes, special periodontal brushes, fluoride treatments, and rinses.
Teeth polishing: Remove stains and plaque that are not otherwise removed during brushing and scaling.

Good oral hygiene practices, combined with regular periodontal cleanings, are essential for maintaining dental health and keeping periodontal disease under control!

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