Periodontal Disease

What is periodontal disease?

Periodontal disease is a disease affecting the tissues that support the teeth, including gum tissue and bone. The most common periodontal diseases are gingivitis and periodontitis. Gingivitis is inflammation of the gums. Periodontitis is a more serious disease that affects the underlying bone structure of the teeth.

Periodontal disease is the leading cause of tooth loss in adults over 40. However, early diagnosis and treatment can usually prevent tooth loss.

How does it occur?

The most common cause of periodontal disease is long-term neglect of oral health. Other causes of periodontal disease may include:

• vitamin deficiency, especially vitamin C deficiency
• diseases such as diabetes, thyroid disorders, and disorders of the immune system
• drugs that cause your mouth to be dry or change the development of the gums
• pregnancy
• smoking or chewing tobacco.

Also, mental or physical stress can make the disease more severe and harder to fight.

The first stage of periodontal disease is gingivitis, which is most often caused by bacteria found in plaque. Plaque is a sticky material made of mucus and saliva, food particles, and bacteria that live in the mouth. Chemicals produced by the bacteria in plaque inflame the gum tissue, causing it to swell and become tender.

Over time, if untreated, the inflammation becomes worse as bacteria begin to attack the underlying, supporting tissues of the teeth, which include bone and the ligaments that attach the bone, teeth, and gums. In periodontitis, the supporting tissues are slowly destroyed and the teeth can become loose and eventually may need to be pulled.

What are the symptoms?

Symptoms of periodontal disease include:

• bad breath
• a bad taste in the mouth
• red, tender, swollen gums that bleed easily and ache deep into the bone
• permanent teeth that are loose or moving apart from one another
• sensitivity of teeth to hot and cold temperatures or to sweet foods
• pus seen between the teeth when the gums are pressed
• a change in the way the teeth fit together when you bite
• a change in the fit of partial dentures.

How is it diagnosed?

Your dentist will examine your gums and teeth. You may have X-rays taken of your mouth. Your dentist may use a probe that can make measurements to see if there is any bone loss around the teeth.

How is it treated?

The most common treatment of periodontal disease is a thorough dental cleaning, which includes:

• removing tartar and plaque deposits from above and below the gum tissue (tartar is plaque that has absorbed minerals from the saliva and calcified)
• removing hard deposits from the roots (this is called scaling and root planing)
• removing all diseased tissue lining the spaces between the teeth
• polishing the teeth to remove stain.

Once this is done, your gums can begin to heal. In some cases, you may also need antibiotics or further surgical treatment to reshape the gum tissue for easier self-cleaning. For severe periodontal disease, your dentist may refer you to a specialist.

Other treatments may include:

• antibacterial mouth rinses, either prescribed or nonprescription
• daily use of special dental tools to help you clean areas that are hard to reach
• reshaping your bite by grinding tooth surfaces
• orthodontics
• splinting teeth together to stabilize loose teeth
• gum or bone surgery
• daily prescription medicine that will control the growth of the disease-causing bacteria.

Managing periodontal disease includes a commitment to excellent, daily oral hygiene to remove plaque from your teeth. In addition, it is important to receive regular and more frequent professional dental care.

How long will the effects last?

If periodontal disease is not treated, it may cause permanent damage to the supporting structures of your teeth. However, proper oral hygiene and good professional care can stop the disease and prevent more damage.

How can I take care of myself?

To soothe the tissue and reduce swelling, rinse your mouth with warm salt water. Take a nonprescription pain medicine to reduce the tenderness until the tissue begins to heal.

The most important thing to do is to practice good oral hygiene, which includes the following:

• Brush your teeth correctly for at least 2 minutes at least twice a day with a soft bristled brush. The most important time to brush is before you go to sleep. It is also a good idea to brush or rinse after meals.
• Floss between your teeth once a day.
• Gently massage your gums with a soft toothbrush.
• Have your teeth professionally cleaned twice a year. Ask your dentist or hygienist to demonstrate proper techniques for brushing and flossing.
• Use a water pick to help flush out food that is between the teeth.
• Eat healthy foods. Avoid highly sugared, sticky foods. If you have deep gum pockets, avoid nuts and seeds.

How can I help prevent periodontal disease?

To prevent periodontal disease, practice good dental hygiene. This includes thorough home care and getting dental care and professional cleanings as often as your dentist recommends.