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Periodontal disease

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Periodontal disease is the name for bacterial infections of the gums in the mouth. Periodontitis is the general scientific term for this disease. It is caused by plaque bacteria and bacterial toxins that accumulate below the gumline and cause inflammation THAT ALSO results in a loss of bone around the teeth. Gum inflammation by itself is called gingivitis. Gum inflammation that persists for enough years that it causes loss of bone around teeth is called Periodontitis. Gingivitis can be stalled if a patient receives regular gum cleanings from his or her dentist every 3-6 months. The cleanings are designed to disrupt and clean out bacterial plaque and toxins from below the gumline. This temporarily removes the bacterial plaque and toxins (the causes of the gum inflammation). But after 3-4 months the bacteria tend to grow back and have to be cleaned out again by the dentist. It is important for all people to have regular gum cleanings every 3-6 months from their dentist. Otherwise continued inflammation (gingivitis) can over the years lead to loss of bone around the teeth (periodontitis). The bone in the jaws surrounds the teeth and is what holds the teeth in the jaws. If that bone breaks down, the teeth over the years can become loose and fall out. This is the most important cause of tooth loss, besides tooth decay. Once bone breaks down around the jaws, it is very difficult or impossible to build it back. Sometimes bone grafting may be tried, but this has mixed success.

A dentist can use professional scraping instruments called scalers to remove bacteria and plaque and tartar (also known as calculus) around teeth and below the gumline. The dentist can also use a powerful ultra-sonic vibrating and irrigating device to break up bacteria, plaque and tarter around the teeth and below the gum line. This device is sometimes called a "cavitron," and gives off a high-pitched whine when used. It is just as effective, if not more so, than just using hand instruments and scalers to clean teeth.

Dentists "measure" periodontal disease using a device called a "periodontal probe." This is a thin "measuring stick" that is gently placed into the space between the gums and the teeth, and slipped below the gumline. If the probe can slip more than 4 millimeters length below the gumline, the patient is said to have a "gum pocket" around that tooth. This is important because if there is a pocket over 5 mm. deep around the tooth, hand instruments and cavitrons cannot reach deeply enough into the pocket to clean out the bacteria and plaque that cause gum inflammation. So, no matter how many cleanings are done, the pocket or the gums around that tooth will always have inflammation. This constant inflammation will likely result in bone loss around that tooth. The only way to stop the inflammation would be if the patient had gum surgery to change the pocket so that it was less than 5 mm. in depth, so that it could once again be cleaned. If a patient has 5 mm. or deeper pockets around most of his or her teeth, the teeth may be in general in a constant state of inflammation and bone loss. This patient would then risk loss of all of his or her teeth over the years due to bone loss. If a dentist does not catch these deep pockets, the patient may be unaware of their presence and be suddenly surprised years later that the teeth have come loose in general and must all be extracted! Fortunately, the science exists to routinely catch and prevent this catastrophic loss of teeth years before it actually happens, as long as the patient is regularly examined every 6 months by a dentist for bone loss and also dental decay.

In most cases this disease is linked to poor oral hygiene. Some people however can have a genetic pre-disposition to the disease. The disease once initiated can progress more rapidly in people who have diabetes, especially if the diabetes is poorly controlled. Smoking is a strong risk factor for periodontal disease and can cause the breakdown of bone around teeth by contributing to bacterial growth and inflammation under the gumline.

Symptoms

  • occasional redness or bleeding of gums while brushing or using dental floss teeth or biting into hard food (e.g. apples)
  • occasional swellings that recur
  • halitosis or bad breath
  • persistent bad taste in the mouth
  • shaky teeth in later stages
  • recession of gums resulting in apparent lengthening of teeth (also caused by heavy handed brushing using a hard tooth brush)
  • pockets between the teeth and the gums (Pockets are sites where the jaw bone has been destroyed gradually or by repeated swellings. Teeth become loose or shaky when sufficient jaw bone has been destroyed. The unfortunate thing is that the bone destruction is largely painless.)
  • lack of pain when bleeding happens after cleaning is NOT a sign of health.

Treatment

  • regular brushing and flossing and using an interdental brush at least daily.
  • treatment by a Periodontist, which includes professional cleaning to remove calculus (tartar, tooth stone)and may include drugs (infrequently), and/or surgery occasionally.

Prevention

  • brushing properly on a regular basis (2 times a day)
  • flossing daily and using interdental brushes if there is sufficient space between teeth and behind the last tooth in each quarter.
  • regular dental checkups and professional teeth cleaning as required. This serves to monitor the person's oral hygiene methods and how the condition has responded to treatment. Professional tooth cleaning is not the only solution to overcome the disease because the bacterial plaque (biofilm) returns on the tooth surfaces every 24 hours. It will however ensure an initial thorough removal of built up plaque and calculus, so that ongoing plaque removal and health is more easily achieved. Excellent home care is then also needed to ensure good periodontal health. Without good technique and habits at home, periodontal disease will not be overcome.

See also

Disease progression and predisposition

  • According to the Sri Lanka Tea Labourer study [citation needed], on the absence of any oral hygiene activity, approximately 10% will suffer from severe periodontal disease with rapid loss of attachment(>2 mm/yr). 80% will suffer from moderate loss (1-2 mm/year) and the remaining 10% will not suffer any loss.
  1. http://www.nlm.nih.gov/medlineplus/ency/article/001059.htm (Medical Encyclopedia, NIH)
  2. http://www.mayoclinic.com/invoke.cfm?id=DS00369 (Mayo Clinic)
  3. http://www.collagenex.com/core_periodontal.asp
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