Periodontal diseases are a group of diseases that affect the tissues that support and anchor the teeth. Left untreated, periodontal disease results in the destruction of the gums, alveolar bone (the part of the jaws where the teeth arise), and the outer layer of the tooth root.
Periodontal disease most often develops when a pocket or space is formed between the teeth and the gums. A number of distinct forms of periodontal disease are known, including gingivitis, acute necrotizing ulcerative gingivitis, adult periodontitis, and localized juvenile periodontitis. Although many people have some form of periodontal disease, serious cases are not common.
Factors that put individuals at higher risk for developing periodontal diseases include smoking, stress, poor diet, and taking certain medications such as antidepressants, some heart medicines, and oral contraceptives. Gingivitis can be aggravated by hormones and may temporarily worsen during puberty and pregnancy. Individuals with diabetes and diseases that depress the immune system are more likely to develop periodontal disease.
Symptoms
The main symptoms of periodontal disease include:
- bleeding gums – gums should never bleed, even when you brush vigorously or use dental floss
- red, sore, or swollen gums – gums should never be red or swollen
- gums that have receded - loss of gum from the base of the tooth
- chronic bad breath – caused by bacteria in the mouth
- loose permanent teeth – also caused by bone loss or weakened periodontal fibers
- open sores on the gums – sign that there is an infection present
Diagnosis
Diagnosis of periodontal disease is made by observation of infected gums. Usually a dentist diagnoses and characterizes the various types of periodontal disease.
Many periodontal diseases are distinguished based on the severity of the infection and the number and type of tissues involved.
Diagnosis of periodontitis includes measuring the size of the pockets formed between the gums and teeth. Normal gingival pockets are shallow. If periodontal disease is severe, jawbone loss will be detected in x-rays of the teeth. If too much bone is lost, the teeth become loose and can change position. This will also be seen in x-ray images.
Treatment
Tartar can be removed only by professional dental treatment. Following treatment, periodontal tissues usually heal quickly. Administering the needed vitamins and improving diet treats gingivitis caused by poor nutrition or vitamin deficiencies. Removing debris under the flap of gum covering the molar treats pericoronitis.
Treatment of periodontitis requires professional dental care. The pockets around the teeth are cleaned, and all tartar and plaque removed. In periodontitis, tartar and plaque can extend far down the tooth root. Normal dental hygiene, brushing and flossing, cannot reach deep enough to effectively treat periodontitis. In cases where pockets are very deep (more than 0.25 in, or 0.64 cm, deep), surgery is required to clean the pocket. This is performed in a dental office. Sections of gum that are not likely to reattach to the teeth may be removed to promote healing by healthy sections of gum. Periodontal abscesses are treated with a combination of antibiotics and surgery. If antibiotics are needed for gum disease, they are usually given orally. The antibiotics may be delivered directly to the infected gum and bone tissues to ensure that high concentrations reach the infected area. Abscess infections, especially of bone, are difficult to treat and require long term antibiotic therapy to prevent a recurrence of infection.
There are no useful drugs to treat herpetic gingivostomatitis, but Acyclovir is used in high-risk patients or those with a compromised immune system. Herpes lesions heal by themselves without treatment. After the herpetic lesions have disappeared, the gums usually return to normal if good oral hygiene is resumed.
Antibiotic Therapy
Antimicrobial therapy is the use of chemicals to kill or slow down the growth of bacteria that cause periodontal (gum) disease. The two most common forms of this therapy are antiseptics and antibiotics.
Antiseptics are found in mouth rinses. They usually are used to help prevent periodontal disease.
Antibiotics are used to kill specific bacteria. They are placed under the gums or given as pills to treat gum disease. Antibiotic pills typically are given only for acute (sudden and short-term) infections. Acute and long-term (chronic) gum infections require a procedure called scaling and root planing. Some people also need periodontal surgery.
One of the newest ways to kill bacteria is periodontal laser therapy. Dentists now use lasers to kill bacteria in the gum pockets around teeth. This treatment also seems to stimulate healing.
Scaling and Root Planing
Scaling and root planing is one of the most effective ways to treat gum disease before it becomes severe. Scaling and root planing cleans between the gums and the teeth down to the roots. Your dentist may need to use a local anesthetic to numb your gums and the roots of your teeth.
Some dentists and dental hygienists will use an ultrasonic tool for the scaling and planing. This tool is not as uncomfortable as a standard scraping tool, but not all cleanings require this type of tool.
Your dentist may place antibiotic fibers into the pockets between your teeth and gums. The antibiotic will help speed healing and prevent infection. The dentist will remove the fibers about 1 week after the procedure.
In some severe cases, osseous surgery may be necessary.
Prevention
Good oral hygiene, a well-balanced nutritious diet, and regular dental visits for tooth cleaning all help prevent periodontal disease. Prompt attention to gingivitis can prevent it from progressing to more serious periodontal diseases.
Home Care
It really doesn't take a lot of work to have healthy teeth and gums and a beautiful smile.
- Eat a diet high in calcium and vitamins C and D. Avoid sugary foods: When oral bacteria ferment sugar, they create tooth-eroding acids.
- Brush your teeth twice a day and floss daily to remove plaque and bacteria.
Tooth brushing - Brush your teeth at least twice a day (especially before going to bed at night) with an ADA approved soft bristle brush and toothpaste.
- Place the brush at a 45 degree angle to the gums and gently brush using a small, circular motion, ensuring that you always feel the bristles on the gums.
- Brush the outer, inner, and biting surfaces of each tooth.
- Use the tip of the brush to clean the inside of the front teeth.
- Brush your tongue to remove bacteria and freshen your breath.
Electric toothbrushes are also recommended. They are easy to use and can remove plaque efficiently. Simply place the bristles of the electric brush on your gums and teeth and allow the brush to do its job, several teeth at a time.
Flossing – Daily flossing is the best way to clean between the teeth and under the gumline. Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth, and bone.
- Take 12-16 inches (30-40cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5cm) of floss between the hands.
- Using your thumbs and forefingers to guide the floss, gently insert the floss between teeth using a sawing motion.
- Curve the floss into a "C" shape around each tooth and under the gumline. Gently move the floss up and down, cleaning the side of each tooth.
Floss holders are recommended if you have difficulty using conventional floss.
- It is important to rinse your mouth with water after brushing, and also after meals if you are unable to brush. If you are using an over-the-counter product for rinsing, it's a good idea to consult with your dentist or dental hygienist on its appropriateness for you.
- See your dentist twice yearly for checkups (including an oral cancer exam). If you smoke or have periodontal disease or diabetes, you may need cleaning and checkups every three to four months.