What Is Periodontal (Gum) Disease?
The term “periodontal” means “around the tooth.” Periodontal disease (also known as periodontitis
and gum disease) is a common inflammatory condition that affects the supporting and
surrounding soft tissues of the tooth, eventually affecting the jawbone itself in the disease’s most
advanced stages.
Periodontal disease is most often preceded by gingivitis, a bacterial infection of the gum tissue.
A bacterial infection affects the gums when the toxins contained in plaque begin to irritate and
inflame the gum tissues.
Once this bacterial infection colonizes in the gum pockets
between the teeth, it becomes much more difficult to remove
and treat. Periodontal disease is a progressive condition that
eventually leads to the destruction of the connective tissue and
jawbone. If left untreated, it can cause shifting teeth, loose teeth,
and eventually tooth loss.
Periodontal disease is the leading cause of tooth loss
among adults in the developed world and should always
be promptly treated.
Types of Periodontal Disease
When left untreated, gingivitis (mild gum inflammation) can spread below the gum line. When the
gums become irritated by the toxins contained in plaque, a chronic inflammatory response causes
the body to break down and destroy its own bone and soft tissue. There may be little or no symptoms
as periodontal disease causes the teeth to separate from the infected gum tissue. Deepening
pockets between the gums and teeth generally indicate that soft tissue and bone are being
destroyed by periodontal disease.
Here are some of the most common types of periodontal disease:
• Chronic periodontitis – Inflammation within supporting tissues causes deep pockets and gum
recession. It may appear the teeth are lengthening. Yet, in actuality, the gums (gingiva) are
receding. This is the most common form of periodontal disease and is characterized by
progressive loss of attachment, interspersed with periods of rapid progression.
• Aggressive periodontitis – This form of gum disease occurs in an otherwise clinically healthy
individual. It is characterized by rapid loss of gum attachment, chronic bone destruction, and
familial aggregation.
• Necrotizing periodontitis – This form of periodontal disease most often occurs in individuals
suffering from systemic conditions such as HIV, immunosuppression, and malnutrition. Necrosis
(tissue death) occurs in the periodontal ligament, alveolar bone, and gingival tissues.
• Periodontitis caused by systemic disease – This form of gum disease often begins at an
early age. Medical conditions such as respiratory disease, diabetes, and heart disease are
common cofactors.
Treatment for Periodontal Disease
There are many surgical and nonsurgical treatments the periodontist may choose to perform,
depending on the exact condition of the teeth, gums, and jawbone. A complete periodontal exam of
the mouth will be done before any treatment is performed or recommended.
Here are some of the more common treatments for periodontal disease:
• Scaling and root planing – To preserve the gum tissue's health, the bacteria
and calculus (tartar) that initially caused the infection must be removed. The gum pockets will
be cleaned and treated with antibiotics as necessary to help alleviate the infection. A
prescription mouthwash may be incorporated into daily cleaning routines.
• Tissue regeneration – When the bone and gum tissues have been destroyed, regrowth can
be actively encouraged using grafting procedures. A membrane may be inserted into the
affected areas to assist in the regeneration process.
• Pocket elimination surgery – Pocket elimination surgery (also known as flap surgery) is a
surgical treatment that can be performed to reduce the pocket size between the teeth and
gums. Surgery on the jawbone is another option that serves to eliminate indentations in the
bone, which foster the colonization of bacteria.
• Dental implants – When teeth have been lost due to periodontal disease, the aesthetics and
the functionality of the mouth can be restored by implanting prosthetic teeth into the jawbone.
Tissue regeneration procedures may be required before the placement of a dental implant in
order to strengthen the bone.
Diagnosis
Periodontal disease is diagnosed by your dentist or dental hygienist during a periodontal
examination. This type of exam should always be part of your regular dental checkup.
A periodontal probe (a small dental instrument) is gently used to measure the sulcus (pocket or
space) between the tooth and the gums. The depth of healthy sulcus measures three millimetres
or less and does not bleed. The periodontal probe helps indicate if pockets are deeper than three
millimetres. As periodontal disease progresses, the pockets usually get deeper.
Your dentist or hygienist will use pocket depths, amount of bleeding, inflammation, tooth
mobility, etc., to make a diagnosis that will fall into a category below:
Gingivitis
Gingivitis is the first stage of periodontal disease. Plaque and its toxin by-products irritate
the gums, making them tender, inflamed, and likely to bleed.
Periodontitis
Plaque hardens into calculus (tartar). As calculus and plaque build-up, the
gums begin to recede from the teeth. Deeper pockets form between the gums and teeth
and become filled with bacteria and pus. The gums become very irritated, inflamed, and
bleed easily. Slight to moderate bone loss may be present.
Advanced Periodontitis
The teeth lose more support as the gums, bone, and periodontal ligament continues 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.
Treatment
Periodontal treatment methods depend on the type and severity of the disease. Your dentist and
dental hygienist will evaluate for periodontal disease and recommend the appropriate treatment.
Periodontal disease progresses as the sulcus (pocket
or space) between the tooth and gums gets filled with
bacteria, plaque, and tartar, causing irritation to the
surrounding tissues. When these irritants remain in the
pocket space, they can cause damage to the gums and, eventually, the bone that supports the teeth!
If the disease is caught in the early stages of gingivitis, no damage has been done. One to two regular cleanings
will be recommended. You will also be given instructions
to improve your daily oral hygiene habits and have
regular dental cleanings.
If the disease has progressed to more advanced stages, a special periodontal cleaning called scaling, and root planing (deep cleaning) will be recommended. It is usually done one quadrant
of the mouth at a time while the area is numb. In this procedure, tartar, plaque, and toxins are
removed from above and below the gum line (scaling), and rough spots on root surfaces are made
smooth (planing). This procedure helps gum tissue to heal and pockets to shrink. Medications,
special medicated mouth rinses, and an electric toothbrush may be recommended to help control
infection and healing.
If the pockets do not heal after scaling and root planing, periodontal surgery may be needed to
reduce pocket depths, making teeth easier to clean. Your dentist may also recommend that you
see a periodontist (specialist of the gums and supporting bone).
Maintenance
It only takes 24 hours for plaque not removed from your teeth to turn into calculus
(tartar)! Daily home cleaning helps control plaque and tartar formation, but those hard to
reach areas will always need special attention.
Once your periodontal treatment has been completed, your dentist and dental hygienist will
recommend that you have regular maintenance cleanings (periodontal cleanings), usually four
times a year. At these cleaning appointments, the pocket depths will be carefully checked to ensure
that they are healthy. Plaque and calculus that are difficult for you to remove daily will be
removed from above and below the gum line.
In addition to your periodontal cleaning and evaluation, your appointment will usually include:
• Examination of diagnostic x-rays (radiographs): Essential for detecting decay, tumours,
cysts, and bone loss, X-rays also help determine tooth and root positions.
• Examination of existing restorations: Check current fillings, crowns, etc.
• Examination of tooth decay: Check all tooth surfaces for decay.
• Oral cancer screening: Check the face, neck, lips, tongue, throat, cheek tissues, and gums
for any signs of oral cancer.
• Oral hygiene recommendations: Review and recommend oral hygiene aids as needed.
(electric toothbrushes, special periodontal brushes, fluorides, rinses, etc.)
• Teeth polishing: Remove stain and plaque that is not otherwise removed during tooth
brushing and scaling.
Good oral hygiene practices and periodontal cleanings are essential in maintaining dental
health and keeping periodontal disease under control!