Periodontitis, The Leading Cause of Gum Disease
According to information from the American Dental Association, three out of four Americans over age 35 have some form of periodontal disease, the major cause of tooth loss and bad breath (halitosis) in adults. Gingivitis is the mildest form of periodontal disease that, if left untreated, can progress to periodontitis, the loss of bone and tissues that support the tooth.
Periodontal disease has three stages, categorized by the extent of bone loss: mild moderate, and advanced. If only one or a few teeth are effected, it is localized. If all the teeth are involved, it is generalized.
Bacteria that accumulate at and below the gum line cause periodontitis. The bacteria release toxic substances that trigger the breakdown of the gum and bone. The body responds with an inflammatory response in which it essentially turns on itself and destructs the bone and tissues around the teeth. This is the body's way of warding off infectious agents.
When this happens the gum separates from the teeth, forming a gap called a periodontal pocket. If left untreated, periodontitis can lead not only to tooth loss but can also aggravate systemic illnesses. The signs of periodontitis may include:
- Bleeding gums when brushing or flossing
- Red, tender or swollen gums
- Bad breath (halitosis) or bad taste
- Receding gums (gums that have pulled away from the teeth)
- Loose teeth
- Teeth that have migrated from their original positions
- Tooth loss
Very often, however, people are not aware that they should see a periodontics professional because gum disease can progress without pain. It is possible to not exhibit warning signs and still have periodontitis. That is why it is very important to have routine periodontal screenings so that the early signs of the disease can be detected and treated before it becomes a major problem.
Periodontal Treatment
Periodontitis is treated in three phases. The first phase involves stopping the disease activity and progression of bone loss. The bacterial deposits (plaque and tartar) that formed above and underneath the gums need to be removed and the root surfaces of the teeth smoothed to enhance healing and deter future plaque retention.
This periodontal treatment is called scaling and root planing. During this phase, a dentist will review the patient's oral hygiene techniques, and give them advice on how to modify certain risk factors associated with periodontal disease.
If the periodontal disease is more advanced, surgical treatment may be needed. The purpose of this phase of periodontal treatment is to create an environment that is more amenable to health and, if possible, bring back some of the bone that was lost to the disease. In some forms of periodontitis, antibiotic treatment may be used. If this is the case, a bacterial culture may be required to test for harmful bacteria and to establish what antibiotics they are susceptible to.
Periodontal disease is a chronic condition that, like many others, has to be closely monitored, even after active treatment.
The third (maintenance) phase is crucial to the success of any periodontal treatment. Daily brushing and flossing is essential in controlling ever-developing plaque and bad breath, as is periodic periodontal maintenance care with a professional scaling of the teeth. Periodontal status will be closely monitored, so that changes can be identified and treated as early as possible.
Everyone should be routinely screened for periodontitis. All dentists are qualified in detecting and treating the early stages of periodontitis, but if an individual suspects that they are at risk, or they know they have gingivitis, they may want to see a periodontist who has advanced training in the diagnosis and treatment of periodontal conditions.
By Laura Minsk, DMD
Gingivitis - Everything You Need To Know
Gingivitis is the most common periodontal disease, affecting 90% of the population. It is an infection of the gums caused by bacteria that form plaque.
In small amounts (when it is newly formed), plaque is invisible and relatively harmless. But when left to accumulate, it increases in volume and the proportion of harmful bacteria grows. These gingivitis bacteria release toxins that result in inflammation of the gum tissue and bad breath.
Eventually, the plaque hardens and forms hard deposits called calculus or tartar. If not properly treated, gingivitis may progress to periodontitis, a periodontal disease in which there is loss of the bone that supports the teeth.
Signs of Gingivitis
Gingivitis can be identified by red or swollen gums. In some circumstances, the gingivitis can cause bleeding gums when brushing or eating, and there may be bad breath. To diagnose gingivitis, a dentist may probe gently under the gums. In healthy gums, there should not be any bleeding with this gentle probing. A bleeding gum indicates that there is gum inflammation or gingivitis.
Who's At Risk for Gingivitis?
Certain people are more susceptible to gingivitis. Stress, smoking and poor nutrition can contribute to the development of gingivitis. Certain medications such as steroids, heart medications, cancer therapy drugs, anti-epilepsy drugs, and anti-depressants also increase the risk for gingivitis.
In the presence of plaque, these medications can lead to gum overgrowth. The enlarged gums can further interfere with oral hygiene, precipitating a vicious cycle of further gum enlargement.
Changes in female hormones can also increase the vulnerability to gingivitis. Adolescent women, pregnant women and women who take hormone replacement or birth control pills also have a greater risk of developing gingivitis.
There are several systemic illnesses that are associated with gingivitis. These include
- acute leukemia
- Addison's disease
- diabetes
- hemophilia
- immunodeficiency diseases (including HIV)
The swelling and redness of the gums may be disproportional to the amount of plaque present. To prevent further complications, meticulous plaque control is critical for people with these illnesses.
Gingivitis Treatment
For gingivitis treatment, the bacterial plaque and tartar have to be removed from the surfaces of the teeth by a dentist or hygienist. Then, the factors that contribute to plaque retention have to be altered in order to facilitate oral hygiene procedures.
This can involve re-shaping existing restorations or even moving teeth with braces so that they are not crowded. Essential to the success of the gingivitis treatment is the person's ability to control plaque build-up after initial treatment. Daily brushing and flossing are key to gingivitis prevention and helps prevent bad breath.
If there is a lot of gum inflammation, if the gums are very sensitive, or if there is a lot of tartar buildup, it may be necessary to numb the gums in order to remove the buildup of bacteria underneath the gum margins. If the gum is very inflamed and swollen, it may be necessary to remove some of the excess gum tissue surgically.
Gingivitis is reversible, and with proper gingivitis treatment and maintenance, it can be controlled. However, untreated gingivitis can result in gum defects, bone loss around the teeth, and eventual tooth loss and systemic complications. The best way to prevent gingivitis is by brushing and flossing daily, and by visiting the dentist for a routine cleaning and an examination at least every six months.
By Laura Minsk, DMD