Periodontal Disease

The word periodontal means “around the tooth”. Periodontal disease attacks the gums and the bone that support the teeth. Plaque is a sticky film of food debris, bacteria, and saliva. If plaque is not removed, it turns into calculus or tartar. When plaque and calculus are not removed, they begin to destroy the gums and bone. Periodontal disease is characterized by red, swollen, and bleeding gums.

Four out of five people have periodontal disease and don’t know it! Most people are not aware of it because the disease is usually painless in the early stages.

Not only is it the number one reason for tooth loss, research suggests that there may be a link between periodontal disease and other diseases such as, stroke, bacterial pneumonia, diabetes, cardiovascular disease, and increased risk during pregnancy. Researchers are determining if inflammation and bacteria associated with periodontal disease affects these systemic diseases and conditions. Smoking also increases the risk of periodontal disease.

Good oral hygiene, a balanced diet, and regular dental visits can help reduce your risk of developing periodontal disease.

Signs and symptoms of periodontal disease:

• Bleeding gums – Gums should never bleed, even when you brush or use dental floss.
• Loose teeth – Also caused by bone loss or weakened periodontal fibers that support the tooth to the bone.
• New spacing between teeth – Caused by bone loss.
• Persistent bad breath – Caused by bacteria in the mouth.
• Pus around the teeth and gums – Sign that there is an infection present.
• Receding gums – Loss of gum around a tooth.
• Red and puffy gums – Gums should never be red or swollen.
• Tenderness or Discomfort – Plaque, calculus, and bacteria irritate the gums and teeth.

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 check-up.

A periodontal probe is gently used to measure the sulcus or pocket space between the tooth and the gums. The depth of a healthy sulcus measures three millimeters or less and does not bleed. The periodontal probe helps indicate if pockets are deeper than three millimeters. As periodontal disease progresses, the pockets usually get deeper.

Your dentist or hygienist will use pocket depths, amount of bleeding, inflammation, and tooth mobility to make a diagnosis that will fall into a category below:

• Gingivitis - Gingivitis is the first stage of periodontal disease. Plaque irritates the gums, making them tender, inflamed, and likely to bleed.
• Periodontitis - Plaque hardens into calculus or tartar. As calculus and plaque continue to build, the gums begin to recede from the teeth. Deeper pockets form between the gums and teeth filling with bacteria and pus. The gums become 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 continue 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

If the disease is caught in the early stages of ​gingivitis​, and no damage has been done, one to two regular cleanings will be recommended. You will also be given instructions on improving your daily oral hygiene habits and having regular dental cleanings.

If the disease has progressed to more advanced stages, a special periodontal cleaning called scaling and root planing or deep scalings will be recommended. In this procedure, tartar, plaque, and toxins are removed from above and below the gum line and rough spots on root surfaces are made smooth. 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, a specialist of the gums and supporting bone.

Maintenance

It only takes twenty four hours for plaque that is not removed from your teeth to turn into 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, 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 is difficult for you to remove on a daily basis 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 which are essential for detection of decay, tumors, cysts, and bone loss. Examination of existing teeth and restorations for tooth decay.
• Oral cancer screening of the neck, lips, tongue, throat, gums and all oral tissues.
• Oral hygiene recommendations reviewing and recommending oral hygiene aids such as electric toothbrushes, special periodontal brushes, fluorides, and mouth rinses.
• Teeth polishing to remove stain and plaque not 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!

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