Periodontal disease (also known as gum disease) occurs when plaque bacteria below the gum line irritate the gums and trigger an inflammatory response characterized by reddened tissue, swelling, and bleeding. In severe cases of periodontal disease, bacteria erode gum and supporting bone tissue, causing gum recession, spaces between the teeth and gums, loosening and shifting teeth, and eventually tooth loss.
Types of Periodontal Disease
Gingivitis: The mildest form of periodontal disease, gingivitis causes redness, swelling, and bleeding of the gums. It usually can be reversed by daily brushing, flossing, and regular cleanings by a dental professional. If left untreated, gingivitis can advance into periodontitis, which is more severe.
Periodontitis: As plaque accumulates below the gum line, gums can separate from teeth, creating gaps (known as pockets) that may become infected. These pockets can deepen, often resulting in destroyed gum tissue and bone as well as loosening teeth that may have to be removed.
Types of periodontitis include the following:
Chronic periodontitis, which often progresses slowly, is the most common form and is most prevalent in adults
Aggressive periodontitis, which is characterized by rapid detachment of gums to teeth and rapid bone loss. This form is likely to appear in smokers and in those with a family history of periodontitis
Necrotizing periodontal disease, in which necrosis (the death of tissue) affects gums, bone tissue, and the fiber connecting teeth to the bone. This extremely rare form of periodontitis is prevalent in those who suffer from human immunodeficiency virus (HIV), immunosuppression, or malnutrition. In some cases, periodontitis is associated with systemic disease affecting other parts of the body. Conditions like diabetes are associated with this form of periodontal disease.
Poor Oral Health Habits: Without twice-daily brushing and regular flossing, there is an increased likelihood of plaque buildup.
Age: Adults age 65 and over have higher incidences of periodontal disease, according to data from the Centers for Disease Control and Prevention.
Medications: Certain drugs can reduce the flow of saliva. Without adequate saliva production, the mouth can become a breeding ground for bacteria.
Tobacco Use: Users of cigarettes and chewing tobacco are at an increased risk of periodontal disease. Tobacco use is said to be one of the most significant risk factors in the development and progression of periodontal disease.
Genetic Predisposition: Research has found some individuals may be genetically susceptible to periodontal disease.
The first step to preventing periodontal disease is by brushing at least twice a day and flossing once a day to remove plaque and debris from between the teeth and below the gum line. The AAP also recommends that all adults receive a comprehensive periodontal evaluation annually.
If periodontal disease is suspected, the next best step is to seek the counsel of a periodontist, a dental specialist uniquely trained in the treatment of periodontal disease. Depending on the severity of disease, a periodontist may recommend a number of treatments ranging from deep cleaning, medication, or surgery. There are also a number of procedures to restore aesthetics and function in the event of tooth loss. Treatment may also include a care routine and the avoidance of certain habits like smoking.
If you’ve recently been diagnosed with periodontal disease, you probably have some questions about your treatment. Be assured that Dr. Baxter believes that periodontal therapy, including non-surgical treatment, should be achieved in the least invasive and most cost-effective way possible.
Remember that the first step toward good periodontal health begins with proper oral hygiene, which can go a long way toward preventing certain forms of periodontal disease and reversing gingivitis, an early stage of periodontal disease. Good oral hygiene includes brushing your teeth at least twice each day, flossing at least once each day, and seeing a periodontist annually for a comprehensive periodontal evaluation.
If you are diagnosed with periodontal disease, common treatments include the following:
Scaling and Root Planing
Scaling and root planing also known as a deep cleaning, is a non-invasive measure of preventing the progression of periodontal disease. A deep cleaning goes beneath the gum line to remove plaque, bacteria, and other toxins from areas that brushing and flossing cannot reach, reducing the risk of disease advancement. A routine cleaning does not require the dentist or hygienist to go below the gum line; therefore, the procedure does not eliminate the cause of disease if it is present.
Oral antibiotics as well as anti-microbial mouth rinses can be prescribed short-term to control bacteria and treat acute periodontal infection. Other medicinal treatments include antibiotic gels, slow-release antiseptic chips, microspheres, and enzyme suppressants used after scaling and root planing procedures.
If inflammation and deep pockets are present after deep cleaning and medication, Dr. Baxter may perform flap surgery to minimize the depth of the pocket. The surgery consists of plaque removal below the gum line and then closure of the gums so that they fit snugly against the tooth. A bone and tissue graft procedure helps to regenerate any tissue or bone lost to periodontal disease through the placement of natural or synthetic bone material to promote bone growth. A soft tissue graft uses synthetic material or tissue from the mouth to cover tooth roots that have been exposed.
After a period of healing, your periodontist will evaluate your condition to determine if further treatment is necessary. If additional treatment is required, your periodontist will develop a treatment plan to help restore your smile to a state of health. If you don’t require further treatment, you’ll enter a maintenance phase, and thorough checkups on your teeth and gums will occur every few months or so.