Periodontal disease is a bacterial infection that gets under the gums and into the bone around your teeth, causing inflammation. When the inflammation process goes on for a long period of time, tissue damage occurs (gums and bone). As a result, periodontal inflammation leads to tooth loss and may contribute to other medical conditions. When bone loss occurs, the gum tissue becomes very loosely bound to the tooth allowing additional bacteria to infiltrate near the bone. This loose area is called a periodontal pocket. Due to the infectious nature of periodontal disease, when your dentist recommends periodontal treatment, it is important to get started right away.

Your mouth is home to many different types of bacteria. Some forms of bacteria are harmless while others are responsible for cavities and periodontal disease. When there is an excess of bad bacteria in your mouth, as mentioned, the gum tissue becomes infected and as a consequence the tissue becomes inflamed (gum tissue becomes red, swollen, and sometimes there is pus formation). Due to the large amounts of blood vessels in the gums, the bad bacteria can enter your bloodstream affecting your whole body.

• A correlation between having periodontal disease and an increase risk of clogged arteries which lead to heart disease and stroke.
• People with diabetes more commonly have periodontal disease. Conversely, periodontal disease has been shown to worsen the diabetic condition.
• An association between having periodontal disease and pre-term low birth weight babies.
• Stress

If plaque is left to build up, the bacteria produce toxins that can irritate the gums and damage teeth. The earliest stage of gum disease is called gingivitis. This is an inflammation of the gums, which may cause swelling, tenderness and bleeding when brushing or flossing.

Who is at risk for gum disease?

Gum disease can affect any age group, including children. However, it most often affects adults. In fact, about three out of four adults over age 35 have some form of gum disease now or have had it in the past. Your risk of getting gum disease increases if you smoke or have certain medical conditions. It is therefore vital to keep your dentist informed of your general health.

What should I do if I think I have gingivitis?

Fortunately, with proper oral care every day and regular visits to the dentist, you can help prevent gingivitis. It is best prevented and, in most cases quickly healed, by following a routine to remove plaque every day-this is a two step process of brushing with a soft bristled toothbrush and cleaning between teeth with dental floss. Some of the newer toothpastes (Colgate Total or Crest Pro-Health) have been shown through clinical research to have an anti-gingivitis effect. In addition, using mouthrinses (Listerine or Crest Pro-Health) in addition to proper toothbrushing and flossing have shown to decrease plaque levels resulting in less gingivitis.

What is periodontitis?

If left untreated, gingivitis may progress to a more severe form of gum disease called periodontitis, or periodontal disease. Periodontitis damages the bone and gums that support the teeth. Once periodontitis develops, the damage can't be reversed: only a professional treatment program and an improved level of daily oral care at home can keep it from getting worse.

What symptoms should I be looking out for?

Periodontitis may initially occur without many visible symptoms, therefore regular dental exams are critical for early diagnosis. Common symptoms of periodontitis are red, swollen gums that have started to pull away from the teeth, creating pockets. This is often associated with tooth sensitivity, a feeling of intense pressure between the teeth or bleeding when brushing or flossing.In more advanced stages, you may experience gum recession, root decay, pus between teeth and gums, and loosening or eventual loss of teeth.

Early/Mild Periodontitis

Moderate Periodontitis

Advanced/Severe Periodontitis

How is Periodontitis treated?

After performing a clinical and radiographic examination, the periodontist will develop a diagnosis based on the amount of teeth affected and the severity. Periodontitis is typically treated by phase therapy. Phase I therapy consists of a deep cleaning, under local anesthesia, to remove plaque and tarter. In addition, antibiotics may be inserted into the area where the deep cleaning has taken place or antibiotics may be prescribed for the patient to take orally over a 1-2 week period. Upon completion of the deep cleaning, a 1 month healing period is allowed. At the 1 month re-evaluation appointment, a clinical exam is performed to determine the healing effects from the deep cleaning. Generally, earlier stages of periodontitis have a greater healing potential by the deep cleaning. As with most moderate and advanced periodontitis cases, a deep cleaning may not completely resolve the infection in which periodontal surgery may be required to arrest the disease (termed Phase II).

Periodontal surgery or pocket reduction surgery consists of retracting the gum tissue and thoroughly cleaning plaque and tartar that may be remaining. The diseased tissue is removed and depending on the shape of the supporting bone, some of the lost bone may be regenerated (via bone graft, guided tissue regeneration, biologic materials). All gum tissue is repositioned and held with sutures and given adequate time for healing. With proper post-operative follow up, the gum tissue will heal and return to a health state.

Before

After

Prevention and Maintenance

Once your periodontal treatment is completed it is very important you maintain regular professional cleanings. The research states that a 3 month recall is adequate and recommended. This is necessary because it takes 3 months for the bacteria to repopulate and start to cause destruction of gingival tissue attachment and bone loss. Good oral hygiene at home is essential to help keep periodontal disease from becoming more serious or from reoccurring. A few minutes a day is enough to care for your teeth and gums. You do not have to lose teeth to periodontal disease brush and clean between your teeth, eat a balanced diet, stay active and schedule regular dental visits for a lifetime of healthy smiles.