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Periodontal Diseases
Your teeth are intended to last a lifetime and they can, with proper care.
This means thorough daily brushing, cleaning between the teeth, and regular
professional cleaning to avoid periodontal diseases. Advanced periodontal
diseases are a major cause of tooth loss in adults. But they can be prevented.
"Periodontal" comes
from two Greek words that
 mean "around
the tooth." There are several types of periodontal diseases. All
are started by a bacterial infection which attacks the gums, bone and
ligaments that support the teeth and hold them in the jaw. Periodontal
diseases are usually painless, and may develop slowly or progress quite
rapidly. Unless you have regular dental checkups, you may not be aware
you have a periodontal disease until your gums and bone have been so
seriously damaged that tooth loss is inevitable.
More than half of all people over age 18 have
at least the early stage of some type of periodontal disease. After age
35, about three out of four adults are affected by some form of the disease.
However, periodontal diseases can occur at any age. Even children as young
as five or six can have signs of some of these diseases.
To prevent periodontal diseases, you need to
understand what causes them, practice good oral health habits and seek
regular professional care.
Causes of Periodontal Diseases
Periodontal diseases are caused by certain types of bacteria in plaque,
the sticky, colorless film of bacteria that constantly forms on teeth.
These bacteria create toxins (poisons) which irritate the gums and result
in a break down of the attachment of gum tissues to teeth. Over time, these
toxins can destroy gum tissues, allowing the infection to progress to bone
loss.
In addition, plaque that is not removed can combine with other materials
and harden into a rough, porous deposit called calculus (tartar). Calculus
on the tooth surface, above the gemlike, may not contribute to periodontal
diseases; but calculus on the root surface, below the gums, makes removal
of new plaque and bacteria more difficult. Unlike plaque, which you can
remove, only a dentist or dental hygienist can remove calculus.
Types of Periodontal Diseases
While there are many forms of gingival and periodontal
diseases, the most common types are gingivitis and adult periodontitis:
Gingivitis is the earliest stage, and
affects only the gum tissue. At this stage, the disease is still reversible.
If not treated, however, it may lead to a more severe condition.
Periodontitis is the more advanced stage
of periodontal diseases. The gums, bone and other structures that support
the teeth become damaged. Teeth can become loose and fall out or
may have to be removed. At this stage, the disease may require more complex
treatment to prevent tooth loss.
Other Factors Contributing to Periodontal
Diseases
Although periodontal diseases are caused by plaque, a number of other
factors can increase the risk, severity and speed of development of the
condition.
- People who smoke or chew tobacco are more likely
to have periodontal diseases, and to have them more severely, than those
who do not use any form of tobacco.
- Poorly fitting bridges, malocclusion (badly aligned
teeth) or defective restorations (fillings), can all contribute to plaque
retention and increase the risk of developing periodontal diseases.
- Habits which place excessive biting forces on
your teeth, such as clenching or grinding, may also accelerate the rate
at which supporting bone is lost.
- Poor diet may cause periodontal diseases to progress
more rapidly or increase the severity of the condition, according to
some researchers. There is also some evidence that an unbalanced diet
makes mouth tissues less resistant to infection.
- Pregnancy or use of oral contraceptives
- increases hormone levels which can cause gum
tissues to react more sensitively to the toxins in plaque and accelerate
growth of certain bacteria. The gums are more likely to become red, tender
and swollen and to bleed easily.
- Systemic diseases, such as AIDS or diabetes,
can lower the tissues' resistance to infection, making periodontal diseases
more severe.
- Medications steroids, some types of anti-epilepsy
drugs, cancer therapy drugs, some calcium channel blockers and many others
affect the gums. It is critical that your dentist know about any medications
you are taking, so be sure you update your medical history whenever necessary.
While all these factors can contribute to the risk
or severity of periodontal diseases, they do not cause them. If one or
more of these factors applies to you, you may still have good oral health
by following your dentist's advice and practicing thorough plaque control.
Prevention of Periodontal Diseases
Keeping your teeth and gums healthy for a lifetime is possible if you
take proper care of them. Here's how:
Clean your teeth daily
Brush your teeth thoroughly at least twice a day. This removes plaque
from the outer, inner and chewing surfaces of the teeth. Choose a soft bristled
toothbrush that is in good condition. A worn, frayed or hard-bristled brush
can injure the gums. Be sure to use ADA accepted products because this is
an assurance of safety and effectiveness. The product claims are also reviewed
for accuracy.
Use dental floss or other interdental cleaners to aid in removing plaque
from between the teeth, where a toothbrush cannot reach. Gingivitis can
often be successfully reversed by regular daily brushing and cleaning between
the teeth.
Fluoride toothpastes and mouth rinses with the American Dental Association's
Sea] of Acceptance are recommended to help prevent tooth decay. If you
need extra help in controlling plaque above the gumline and gingivitis,
your dental professional might recommend the use of an ADA-accepted antimicrobial
mouth rinse as an effective addition to your daily oral hygiene regimen.
Eat a balanced diet for good general health.
Select foods from the basic food groups breads, cereals, and other
grain products; fruits; vegetables; meat, poultry, fish and alternates;
and milk, cheese, and yogurt. These foods will provide adequate proteins,
carbohydrates, fats, vitamins, minerals and water.
Schedule regular dental visits.
Professional cleaning is essential to prevent
periodontal diseases. Your dentist and dental hygienist will also show
you proper techniques for brushing and cleaning between the teeth, answer
your questions and recommend an appropriate schedule for checkups.
You can help your dentist and yourself in
your fight against periodontal diseases by learning the warning signs.
If you notice any of the following signs, see your dentist immediately:
- Gums that bleed easily.
- Red, swollen or tender gums.
- Gums that have pulled away from the teeth.
- Pus between the teeth and gums when the gums
are pressed.
- Persistent bad breath or bad taste.
- Permanent teeth that are loose or separating.
- Any change in the way your teeth fit together
when you bite.
- Any changes in the fit of partial dentures.
However, you may have periodontal disease and not have these signs. Most
people do not experience any pain due to periodontal diseases so it is
important to have regular dental checkups, including a periodontal exam.
Diagnosing Periodontal Diseases
With regular dental visits, dentists can detect
developing periodontal diseases early, before the gums and the bone around
your teeth are irreversibly damaged. These diseases are progressive and,
initially, do not cause any discomfort to warn you of problems. Pain can
occur, however, in advanced stages or in rapidly progressing forms of the
diseases. So don't wait till it hurts!
 During checkups, your dentist will examine your gums for periodontal problems.
An instrument called a periodontal probe will be used to determine if there
is any breakdown in the gum tissue attachment or development of pockets
between your gums and teeth. The depth of pockets can be measured with
this device. Your dentist may also need to take X-rays to determine if
any bone has been destroyed.
If a periodontal disease is diagnosed, your dentist
may provide treatment, or may refer you to a periodontist. A periodontist
is a dentist who specializes in the diagnosis, prevention and treatment
of these diseases.
 Treating Forms of periodontitis
The method of treatment of periodontal diseases depends upon the type
of disease and how far the condition has progressed. Regardless of the
treatment plan, however, good daily oral hygiene is essential to the success
of any periodontal therapy.
 The
first step is usually a thorough cleaning which may include scaling to
remove plaque and calculus deposits beneath the gumline. The tooth roots
may also be planed to smooth the root surface so that gum tissue may heal
next to the teeth. In some cases, the occlusion (bite) also may require
adjustment.
Antibiotics or irrigation with antimicrobial (agents or mouth rinses) may
be recommended to help control the growth of subgingival bacteria which
create toxins and cause periodontitis.
Surgery may be required when deeper pockets
(over 4 to 6 mm) are found. It is difficult for the dentist or hygienist
to thoroughly remove plaque and calculus from deep pockets. Patients can
seldom, if ever, keep them clean and free of plaque. Allowing pockets to
remain may invite infection and bone destruction.
When pockets are deep and bone
has been destroyed, flap surgery may be necessary to allow the dentist
to get access to the roots of the teeth in order to thoroughly remove calculus,
plaque and any diseased tissue. In this technique, the gum is lifted away
and is then sutured back into place or into a new position that will be
easier to keep clean.
 Other
effective procedures are also available for replacing gum tissue and bone
destroyed in advanced stages of the disease. These procedures are used
for specific periodontal problems. Talk with your dentist about the treatments
that may be right for you.
Smoking increases your risk
It's
common knowledge that smoking has been linked to both lung and heart
disease. But smoking can also increase your risk of periodontal disease.
Smokers are more likely to have a build up of tartar on their teeth,
where disease-causing bacteria thrive.
A chronic infection
 Periodontal
disease is essentially a chronic, open infection in your mouth. Smoking
worsens the condition by damaging the natural processes your body uses
to fight the periodontal infection; smoking reduces saliva levels, restricts
blood flow, and damages your immune system.
There is no good news
There
are over 4000 chemicals in cigarette smoke, including formaldehyde, carbon
monoxide, ammonia and arsenic. Also, smokers are four times more likely
to have advanced periodontal disease, and are twice as likely to lose
their teeth.
 A professional dental cleaning is the only way to have calculus removed.
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