Periodontal (Gum) Disease

Picture of periodontal disease

What is the medical definition of periodontal disease?

• Periodontal disease is a chronic inflammatory disease that destroys bone and gum tissues that support the teeth.
• Periodontal disease affects many Americans and is the major cause of adult tooth loss.
• Teeth are supported by the gums, or gingiva and bone.
• A tooth's root is anchored to the bone within its socket by fibers called periodontal ligaments.
• The gums do not attach to the teeth as firmly as one might think. A shallow, V-shaped gap called a sulcus exists between the teeth and the gums. Periodontal disease affects this gap and more.

What happens if periodontal disease goes untreated?

• Eventually, in periodontal disease, the tissues supporting the tooth break down.
• If only the superficial gums are involved in this breakdown, the disease is referred to as gingivitis. If it is more advanced and involves the connecting tissues and bone, then it is called periodontitis.

Plaque is a sticky film of bacteria that clings to the surface of teeth and gums. Brushing and flossing every day may not completely remove all the plaque, especially around the gum line. The bacteria in the plaque produce toxins that may injure the gums and supporting tissues.

Plaque that is not completely removed within 48 hours hardens into a rough deposit called tartar or calculus. Once tartar develops, the only way to remove it is by having the teeth professionally cleaned. Tartar below the gum line causes inflammation and infection. Because this process is often painless, a person may be unaware a problem exists.

Causes or factors that worsen gum disease include the following:

• Inherited factors (genetics)
• Infrequent dental care
• Insufficient calcium intake
• Inflammatory response by the body occurs that creates further problems.
• Because of a dulled immune response and less oxygen in the mouth, smokers are two to seven times more likely to develop periodontitis than nonsmokers.
• Diabetes worsens periodontal disease. If a person's blood sugar level is poorly controlled, a worse infection, poor healing, and a greater loss of bone and connective tissue are likely.
• Sjögren's syndrome causes decreased saliva production that can lead to periodontal disease.
• Stress increases certain hormones that make a person more susceptible to infection. Pregnancy and birth control pills can also increase hormone levels.
• Steroids, antiseizure medicines, cancer medicines, and blood pressure medicines can all affect the gums. Some drugs decrease the flow of saliva, irritating the mouth and making it prone to infection.

• Gingivitis
  • Gingivitis includes swelling and bleeding of the gums, bad breath, or a bad taste in your mouth. Good toothbrushing and flossing can reverse the affects of gingivitis.
  • Acute necrotizing ulcerative gingivitis (ANUG) is an advanced and invasive form of gingivitis that causes sore gums and a whitish membrane on the gums. It requires antibiotics as part of the treatment.
• Periodontitis
  • Periodontitis occurs when bacterial toxins and enzymes destroy the connective tissue and bone.
  • The gums draw back, and the roots of the teeth are exposed. The teeth may become very sensitive to temperature changes, or new cavities can develop.
  • The pocket between the tooth and the gums deepens; plaque in this area is very difficult to remove. Bacteria invade the surrounding structures.
  • When the gums pull away from the teeth, pus develops between the teeth and the gums or the permanent teeth become loose in their sockets. Only a dentist can decide whether the teeth can be saved.

A dentist provides major care for diseases of the teeth and gums.

A person should visit his or her dentist for the following concerns:

• Gums start to bleed.
• Gums are swollen and sore.
• Bad-smelling breath or a bad taste develops in the mouth.
• Gums become very red or very pale.
• Teeth are painful.
• Teeth are loose in their sockets.

If any of the above symptoms are present, plus fever, sweats, chills, or face swelling, go to a hospital's emergency department.

Other reasons to go to an emergency department include the following:

• The tongue feels swollen or pushes up from the floor of the mouth.
• Swelling develops below the chin, especially if it is red, tender, and warm.

During any routine dental examination, a dentist will do a periodontal exam of the gums.

• The dentist may use a probe to measure the depth of the pocket between the teeth and the gums.
• Special X-ray films may be used to evaluate the teeth, the bones supporting the teeth, and other mouth structures.
• If periodontal disease is present, the dentist will make recommendations or refer the person to a specialist (periodontist).

Good oral hygiene prevents periodontal disease.

• Brush the teeth at least twice every day. Brushing removes plaque from the inner, outer, and chewing surfaces of each tooth. A dental hygienist can demonstrate the proper technique.
• Get a new toothbrush every three months or replace the head of electric brushes every three months or sooner based on wear from the indicator bristles. Some electric tooth brushes have been proven to reduce the risk of periodontal disease.
• Use a toothpaste that contains fluoride and xylitol.
• Floss every day. Flossing removes plaque between the teeth that a toothbrush cannot reach.
• Use a mouthwash that kills bacteria.
• Eat a well-balanced diet; avoid too many sweets and processed carbohydrates.

If the dentist diagnoses periodontal disease, the first treatment will probably include scaling and root planing. More than one visit may be needed for this treatment. Scaling removes plaque and tartar from below the gum line down to the bottom of each pocket.

• A local anesthetic (lidocaine) may be needed to reduce discomfort.
• The roots of the teeth are smoothed. Smoothing allows the gums to reattach to their roots.
• The use of lasers, antibiotics, special mouth rinses, and various probiotics for the mouth may be needed.
• If pockets are still present after scaling and planing, surgery may be needed.

Regular visits to the dentist for cleaning and X-ray films helps prevent periodontal disease. Inform the dentist of any health problems or current medications being taken. Teeth do not have to be lost to periodontal disease. With proper care, a person's teeth should last a lifetime.