Periodontal Disease is the #1 cause of adult tooth loss.
Other Names: Gingivitis, gum disease, periodontitis, periodontosis, pyorrhea.
Periodontal disease is a bacterial infection that causes destruction of gum and bone around teeth. If not controlled, periodontal disease will result in the loss of teeth. It can involve one or two teeth or the entire mouth. Periodontal disease is a communicable disease; it is often transmitted from parent to child.
There are several stages in the disease as it progresses to tooth loss.
Bacterial toxins and the body’s reaction to harmful bacteria adhering to the teeth cause periodontal disease. Bacteria are always in your mouth and around your teeth, they attach to the tooth surface forming dental plaque. If this plaque is not removed properly it will harden and become calculus.
Calculus, also called tartar, forms as bodies of dead bacteria, food debris, and minerals begin to deposit and build up in the bacterial plaque. Calculus adheres to the tooth like cement and often cannot be removed without a professional dental cleaning. The surface texture and the bacteria within this rough bacteria-filled mass are very irritating to the gum tissue.
In the presence of plaque and calculus, the gums become red and puffy, this is called gingivitis. Gingivitis is the earliest form of periodontal disease, it affects 50-90% of adults worldwide. About half of the US population has gingivitis. With careful tooth cleaning the effects of gingivitis can be completely reversed.
Prolonged inflammation will result in the gums losing attachment to the teeth. The gums will start to recede or shrink back from the tooth roots forming pockets between the teeth and gums. While the gums are receding, the growth of the plaque and calculus deposits will continue to move further and further below the gum line, before long the bone that supports the tooth will begin to draw away. When bone is lost around a tooth it cannot grow back on its own.
Once irreversible bone damage has occurred, the disease is termed periodontitis. It has been estimated by the Centers for Disease Control that 47.2%, or 64.7 million Americans have periodontitis.
There are several forms of periodontitis. The most common form, "chronic peroiodontitis”, is categorized by the stage of the disease. There are early, moderate and advanced stages of chronic periodontitis. In early and moderate periodontitis the pockets will deepen to 3.5mm - 5mm. Gingival recession (receding gums) is often noted in early and moderate periodontal disease, this has the appearance of the teeth getting longer or open spaces appearing between teeth (black triangles) where the gums used to be. In early and moderate stages the teeth are usually stable, if the disease is controlled before the teeth become mobile it is possible to keep teeth and maintain chewing function for life.
In advanced periodontitis, the teeth may be loose and move or wiggle when chewing. Chewing may become difficult or painful. Spacing of teeth will change creating either crowding or bigger gaps between teeth. Treatments for advanced periodontal disease are far more complicated and have a much lower success rate at saving teeth than treatment at earlier stages.
Periodontitis can be controlled; however, it is rarely cured. The damage caused by periodontal disease is permanent. The sooner the disease is managed the more controllable it will be.
Periodontal disease has many symptoms. Most people with the disease will experience these symptoms, however, it is possible to have no symptoms other than increasing pocket depth and eventual loss of teeth.
Symptoms of Periodontal Disease Include:
*Note the symptoms of progressing stages of periodontal disease include all of the symptoms of the earlier stages.
Redness or puffiness of the gums
Gums may bleed more easily
Halitosis (bad breath)
Inflamed gums may be painful or irritating
May have measurable pockets (from swelling or puffiness)
Early and moderate periodontitis
Exposed root surfaces
Heavy calculus buildup
Will have measurable pockets (from attachment loss)
Mobility of Teeth
Feeling like the teeth do not come together correctly
Teeth falling out.
The symptoms listed above are for "chronic periodontitis”, the most common form of periodontitis. Chronic means persistent or long lasting. In most cases it takes many years for the disease to run its course, sometimes decades.
The other types of periodontal disease are distinguished by their rate of destruction, the age of onset, or their link to other systemic conditions.
Less common forms include:
Juvenile periodontitis, this often painful form of the disease effects late adolescents and teens.
Aggressive periodontitis is very destructive causing bone loss at a faster rate than chronic preiodontitis.
Refractory periodontitis is a form of aggressive periodontitis that does not respond to traditional therapy.
At least once a year during routine dental exam you will receive a thorough gum exam. We will make notations about the color and texture of your gums and use a special instrument to gently take measurements of the health of your gums. Dental x-rays can show us changes in the level of bone around teeth and are essential to diagnose periodontal issues.
There is a naturally occurring groove or sulcus between the gums and the tooth. At the depth of this groove the gums are attached to the tooth by a series of tiny fibers referred to as the periodontal ligament. Healthy gums have a stippled appearance, like the surface of an orange peel, and probing depths in the sulcus are between zero and three millimeters.
Deeper probing depths can indicate that there is either inflammation of the gums or destruction of the ligament that attaches to the tooth.
Receding gums is part of the natural aging process. In natural recession the gums remain healthy and do not form pockets. There are several characteristic differences we can see on x-rays to help differentiate between natural recession and disease related recession. Many treatment options are available to restore the gum position. The decision of when to treat areas of natural recession is often based on the cosmetic appearance or root sensitivity. Gum recession from a bacterial infection is much more harmful and treatment should be initiated at the time the disease is discovered.
Periodontal disease has been linked to overall health.
Gum disease may affect your overall health. Associations have been found between periodontal disease and other chronic inflammatory conditions. People with cardiovascular disease, or diabetes are more likely to have periodontal disease, and periodontal disease can make cardiovascular disease and diabetes harder to control. Managing periodontal disease may actually aid in managing these other conditions. Researchers are currently looking into links to other conditions including: Alzheimer’s disease, vascular dementia, stroke, rheumatoid arthritis, and chronic kidney disease.
Periodontal disease can be prevented with careful home care and regularly scheduled dental check-ups and cleanings. Getting into a good routine of brushing 2-3 times daily and flossing every night will allow you to remove the bacteria filled plaque before it hardens. Routine dental visits help keep your teeth clean, regular examinations allow us to diagnose and treat disease earlier.
Smoking and chewing tobacco increases the damage caused by periodontal disease and greatly reduces the prognosis for successful treatment. The good news is quitting now can improve your odds of treating the disease.
To treat periodontal disease it is essential to keep the number of bad bacteria around the teeth as low as possible. This usually starts with a procedure called scaling and root planing. Scaling and root planing is the removal of plaque and calculus from the crowns and roots of teeth. Although many of the same instruments are used, root planing is different from a normal "cleaning” in that we are treating an active disease and need to clean the surfaces of the tooth below the gums.
After scaling and root planing, the health of the gums is maintained with periodontal maintenance procedures. The frequency of periodontal maintenance is based on the severity of disease and is re-evaluated at each visit. A majority of patients receiving periodontal maintenance are seen every 3 to 4 months.
It is essential to keep up the home care, be diligent about brushing and flossing, and stick to the periodontal maintenance schedule your doctor recommends. Quitting habits such as smoking and use of smokeless tobacco will greatly improve your gums ability to heal. We may recommend the use of additional home cleaning aids such as small brushes to clean between tooth roots or a special type of floss.
Antibiotic or antimicrobial therapy may be recommended. Antibiotics can be very effective in the treatment of periodontal disease. Antibiotics can either be taken as a pill you swallow or placed directly into the infected periodontal pockets. These therapies are used in conjunction with scaling and root planning.
Using a antimicrobial mouth rinse prescribed by your dentist can give your homecare an extra disease fighting boost.
Periodontal surgery may be indicated for severe periodontal disease or periodontal disease not responding to traditional therapy.
Periodontal surgery is a procedure where the gums are carefully reflected away from the tooth and the underlying bone, allowing greater access to clean the surfaces of the teeth and reshape bone when needed.
Not all bacteria are bad.
It should be noted that, while there are several strains of bacteria that promote disease, a healthy mouth is still full of bacteria. Not all bacteria are harmful, good bacteria can aid in digestion and help keep harmful bacteria, fungi, and yeast from establishing in the mouth
Periodontal Disease is a very complex infection that often takes a multifaceted strategy to treat. If you have more questions about periodontal disease or would like to schedule a consult with Dr. Roger Mondale or Dr. Brian Mondale, give our office a call,
Mondale Dental (763) 512-8500, We are conveniently located for most of the west metro at our Plymouth, MN, office just off of HWY 55.