Periodontal Disease

Periodontal Disease

The word ‘periodontal’ means ‘around the tooth’. Periodontal disease attacks the gums and bone that surround and support the teeth.

Plaque is a sticky film of food debris, bacteria and saliva. If plaque is not removed, it turns into calculus (tartar). When plaque and calculus are not removed, they begin to destroy the gums and bone. The resulting periodontal disease is characterised by red, swollen and bleeding gums.

Four out of five people have periodontal disease and don’t know it. Most people are unaware of it, because the disease is usually painless in the early stages.

Not only is periodontal disease the number one reason for tooth loss, research suggests there may be a link between periodontal disease and other diseases such as stroke, bacterial pneumonia, diabetes and cardiovascular disease.

There is an increased risk of periodontal disease during pregnancy. Smoking also increases the risk of periodontal disease.

Good oral hygiene, a balanced diet and regular dental visits can help reduce your risk of developing periodontal disease.

Signs and symptoms of periodontal disease

  • Bleeding gums – gums should never bleed, even when you brush vigorously or use dental floss.
  • Loose teeth – this can be caused by bone loss or weakened periodontal fibres (fibres that support the tooth to the bone) around the teeth.
  • New spacing between teeth – caused by the loss of bone surrounding the teeth.
  • Persistent bad breath – caused by bacteria in the mouth.
  • Pus around the teeth and gums – this is a sure sign an infection is present.
  • Receding gums – loss of gum tissue around the teeth.
  • Red and puffy gums – gums should never be red or swollen.

 

Tenderness or discomfort – plaque, calculus and bacteria irritate the gums and teeth. This leads to tenderness and discomfort.

Diagnosis

Periodontal disease is diagnosed by your dentist during a periodontal examination. This type of exam should always be part of your regular dental check-up.

A periodontal probe (small dental instrument) is gently used to measure the sulcus (pocket or space) between the tooth and gums. The depth of a healthy sulcus measures 3 mm or less and does not bleed. The periodontal probe helps indicate if pockets are deeper than 3 mm. As the disease progresses, the pockets usually get deeper.

Your dentist will use pocket depths, amount of bleeding, inflammation, tooth mobility, etc. to make a diagnosis. This will fall into one of the categories below:

Gingivitis

Gingivitis is the first stage of periodontal disease. Plaque and its toxin by-products irritate the gums, making them tender, inflamed and likely to bleed.

Periodontitis

Plaque hardens into calculus (tartar). As calculus and plaque continue to build up, the gums begin to recede from the teeth. Deeper pockets form between the gums and teeth and become filled with bacteria and pus. The gums become very irritated, inflamed and bleed easily. Slight to moderate bone loss may be present.

Advanced periodontitis

The teeth lose more support as the gums, bone and periodontal ligament continue to be destroyed. Unless treated, the affected teeth will become very loose and may be lost. Moderate to severe bone loss may be present.

Treatment

Periodontal treatment methods depend upon the type and severity of the disease. Your dentist will recommend the appropriate treatment.

Periodontal disease progresses as the sulcus (pocket or space) between the tooth and gums gets filled with bacteria, plaque and tartar, causing irritation to the surrounding tissues. When these irritants remain in the pocket space, they can cause damage to the gums and the bone that supports the teeth.

If the disease is caught in the early stages of gingivitis, and no damage has been done, one to two regular cleanings will be recommended. You will also be given instructions on improving your daily oral hygiene habits and having regular dental cleanings.

If the disease has progressed to more advanced stages, a special periodontal cleaning called scaling and root planing (deep cleaning) will be recommended. This is usually done one quadrant of the mouth at a time, while the area is numb. In this procedure, tartar, plaque and toxins are removed from above and below the gum line (scaling) and rough spots on root surfaces are made smooth (planing). This procedure helps gum tissue to heal and pockets to shrink.

Medications, special medicated mouth rinses and an electric toothbrush may be recommended to help control infection and healing.

If the pockets do not heal after scaling and root planing, periodontal surgery may be needed to reduce pocket depths, making teeth easier to clean. Your dentist may also recommend you see a periodontist – a specialist in treating disease of the gums and supporting bone.

Maintenance

It only takes 24 hours for plaque that is not removed from your teeth to turn into calculus (tartar). Daily home cleaning helps control plaque and tartar formation, but those hard-to-reach areas will always need special attention.

Once your periodontal treatment has been completed, your dentist and oral hygienist will recommend you have regular maintenance cleanings (periodontal cleanings), usually 4 times a year. At these cleaning appointments, the pocket depths will be carefully checked to ensure they are healthy. Plaque and calculus that are difficult for you to remove on a daily basis will be removed from above and below the gum line.

In addition to your periodontal cleaning and evaluation, your appointment will usually include:

  • Examination of diagnostic X-rays (radiographs)
    This is essential to detect decay, bone loss, tumors, cysts, etc. X-rays also help to determine tooth and root positions.
  • Examination of existing restorations
    Current fillings, crowns, etc. will be evaluated.
  • Examination for tooth decay
    All tooth surfaces will be checked for decay.
  • General screening
    The face, neck, lips, tongue, throat, cheek tissues and gums will be checked for any signs of growths, tumors or oral cancer.
  • Oral hygiene recommendations
    A review will be done of your oral hygiene habits and recommendations made as needed. The use of oral hygiene aids such as electric toothbrushes, special periodontal brushes, fluorides, rinses, etc. might be recommended.
  • Teeth polishing
    Stains and plaque, not removed during tooth brushing and scaling, will be removed.

 

Good oral hygiene practices and periodontal cleanings are essential in maintaining dental health and keeping periodontal disease under control.

If you have any questions or concerns about dental treatments or procedures, contact your dentist today!