Periodontal disease is an infection that occurs in the crevice between your teeth and gums (called a “sulcus”) and affects the tissues and bone that support your teeth. When the tissues are damaged, the sulcus develops into a pocket, which in severe cases can lead to bone loss around the teeth. This disease is caused by plaque-forming bacteria on your teeth that produce byproducts that irritate the gum tissues and damage the attachment of the gums, periodontal ligament, and bone to your teeth.
Types of Periodontal Diseases
The two major stages of the disease are gingivitis and periodontitis:
Gingivitis: Gingivitis is a milder and reversible form of periodontal disease that only affects the gums. It develops as toxins in plaque irritates gums, making them red, tender, swollen, and likely to bleed easily. Gingivitis can usually be treated by regular dental cleanings, combined with daily brushing, and cleaning between your teeth.
Periodontitis: This is a more destructive form of periodontal disease, with the most common being chronic adult periodontitis. This happens when toxins, enzymes, and other plaque by-products destroy the tissues that anchor teeth into the bone. The gum line recedes, which can expose the tooth’s root. Exposed roots can become susceptible to decay and sensitive to cold and touch.
The sulcus deepens into a pocket in the early stage of periodontal disease, and when the plaque that collects in these pockets it becomes very difficult to remove during regular brushing and interdental cleaning. Byproducts from the plaque will continue to damage the gums, periodontal ligament, and bone. In some cases, so much ligament and bone are destroyed that the tooth loosens. Even at this stage, our doctors may still be able to treat the disease during a visit or multiple visits. But, in the worst of cases, a loose tooth may need to be extracted.
The first step in treatment is a thorough deep cleaning that includes scaling to remove plaque and tartar deposits. The tooth roots also may be planed to smooth the root surface, allowing the gum tissue to heal and reattach to the tooth. In some cases, the occlusion, or bite, may require adjustment.
In certain instances we may also recommend local delivery of antibiotics to help control infection, pain, and to promote healing. This medication is placed directly in the periodontal pocket after scaling and root planing.
In more severe cases, when very deep pockets between teeth and gums are present, it may be too difficult for the doctors to completely remove the plaque and tartar, and likewise, you may have trouble keeping these pockets clean going forward. If the pockets do not heal after scaling and root planing, periodontal surgery may be required to access hard-to-reach areas that require the removal of tartar and plaque. The tooth root is also cleaned and smoothed, and the bone around the tooth is also sometimes smoothed to help remove these pockets. The gums then are sutured back into place or into a new position that will be easier to keep clean at home.
Bone surgery may be used to rebuild or reshape bone that has been destroyed. Grafts of the patients bone or artificial bone may be used, as well as special membranes. Splints, bite guards, or other appliances are used to stabilize loose teeth and to aid the regeneration of tissue during healing. If excessive gum tissue has been lost from the tooth root (gum recession), a gum graft may be performed. After surgery, a protective dressing over teeth and gums is usually applied. An antibiotic and mild pain reliever may be prescribed.
Increased Risk Factors
Certain factors increase your risk of developing Periodontal Disease, such as:
- Smoking or chewing tobacco
- Certain medications, such as steroids, some types of anti-epilepsy drugs, cancer therapy drugs can affect the gums
- Some systemic diseases, like diabetes, can lower your body’s resistance to infection, making periodontal disease more severe
- Crowns and bridges that no longer fit properly, crooked teeth, or fillings that have become defective can contribute to plaque retention and increase your risk or developing periodontal disease
- Pregnancy or use of oral contraceptives increases hormone levels that can cause gum tissue to be more sensitive to the toxins and enzymes produced by plaque and can accelerate growth of some bacteria
How do I prevent periodontal disease from recurring?
With good oral hygiene at home and regular dental visits, you should be able to avoid periodontal disease. If you begin to show signs of disease, we may request that you schedule more frequent visits than you have in the past so we an treat it before it worsens. Brush, clean between your teeth, eat a balanced diet, and schedule regular dental visits for healthy oral care.
If you do suspect you may have periodontal disease, contact us right away for an appointment.