If you were diagnosed with periodontal disease, you are not alone. 50% of the US population has periodontal disease, and of those, only about half are treated. Treatment is the first step in preventing tooth loss.
The word periodontal means “around the tooth.” Healthy gum tissue fits like a cuff around each tooth. Where the gum line meets the tooth, it forms a slight crevice called a sulcus. In healthy teeth, this space is usually three millimeters or less.
Periodontal disease is an infection that affects the tissues and bone that support teeth. In its early stage, called gingivitis, the gums can become swollen and red, and they may bleed. As the tissues are damaged, the sulcus develops into a pocket that is greater than three millimeters. With this more serious form called periodontitis, the gums can pull away from the tooth, bone can be lost, and the teeth may loosen or even fall out.
Generally, the more severe the disease, the greater are the pocket depth and bone loss. The enlarged pockets allow harmful bacteria to grow and make it difficult to practice effective oral hygiene.
How would I know if I have periodontal disease?
It’s possible to have periodontal disease without apparent symptoms. Quite often, people become accustomed to this slow process and never notice the subtle signs. Sometimes the signs don’t even become apparent until the disease is treated and the symptoms are gone!
Any of these warning signs can signal a problem.
- Gums that bleed easily
- Red, swollen, or tender gums
- Gums that have pulled away from your teeth
- Persistent bad breath
- Pus between the teeth and gums
- Loose or separating teeth
- A change in the way your teeth fit together when you bite
- A change in the fit of partial dentures
What causes periodontal disease?
The mouth is filled with countless bacteria. Periodontal disease begins when certain bacteria in plaque (the sticky film that forms on the teeth) produces toxins and enzymes that irritate the gums and cause inflammation. The resulting inflammation, which may be painless, can damage the attachment of the gums and bone to the teeth.
Plaque that is not removed becomes hardened by the minerals in your saliva into rough, porous deposits called calculus, (sometimes called tartar). This calculus harbors plaque and bacteria and cannot be removed with a toothbrush.
The periodontal-systemic disease interrelationships
Tooth loss is not the only potential problem posed by periodontal disease. There is strong evidence that toxins and inflammatory cells in the gums get into the bloodstream daily. These toxins go wherever the blood flows. Research suggests that there are links between periodontal disease and other health concerns such a diabetes, heart disease, stroke, bacterial pneumonia, and increased risk during pregnancy.
Heart Disease: Bacteria from inflamed gums that have reached the bloodstream can attach to platelets and form clumps that lodge inside blood vessels causing stroke and heart attack.
Diabetes: The presence of gum inflammation makes it more difficult for a diabetic to control their blood sugar. Elimination of periodontitis can directly improve diabetic control.
Bacterial pneumonia: The bacteria in your mouth are inhaled into the lungs. The bacteria that cause gum disease are the same as are found in bacterial pneumonia and other respiratory disease.
Pregnancy: Women with periodontal disease are seven to eight times more likely to give birth prematurely to low birth weight babies. Researchers believe that gum disease causes the body to release inflammatory chemicals, which are linked to pre-term birth.
Are you at risk?
There are several factors that increase the risk of developing periodontal disease:
- Studies show that smoking just a half a pack of cigarettes a day can increase your risk of periodontal disease to three times that of the general population. Smokers’ and tobacco chewers’ symptoms are often masked for years and do not exhibit inflammation and bleeding that leads to early diagnosis. As a result, the disease has often progressed to an advanced state by the time it is treated.
- Straight teeth are easy to clean. If you have crooked teeth, cleaning out the debris and plaque that gets caught between them becomes much harder. And incomplete plaque removal causes periodontitis. If any of your teeth are facially displaced, the bone around them is thin. Those teeth are highly susceptible to early gum recession. Crooked teeth also cause trauma when biting to the supporting structures and cause loss of bone around the teeth.
- Systemic diseases, such as diabetes, blood cell disorders, HIV and AIDS can lower the body’s resistance to infection, making periodontal disease more severe.
- Puberty, pregnancy, and oral contraceptives change the body’s hormone levels. This can cause gum tissue to become more sensitive to toxins and enzymes and an accelerate growth of some bacteria. Some patients may be predisposed to a more aggressive, severe type of periodontitis. Patients with a family history of tooth loss or who have parents wearing dentures should pay particular attention to their gums.
- According to some studies, periodontal disease may be passed from parents to children and between couples. Research suggests that bacteria that cause periodontal disease are passed through saliva.
Categories of Periodontal disease
Gingivitis is the mildest form of periodontal disease. It causes the gums to be red, swollen, and bleed easily. There is usually little or no discomfort at this stage. Gingivitis is reversible with a hygiene visit followed by good oral care at home.
Chronic periodontitis is a form of periodontal disease that results in inflammation within the supporting tissues of the teeth. Patients experience progressive loss of tissue attachment and bone. Chronic periodontics is characterized by pocket formation and/o recession of gum tissue and is the most frequently occurring form of periodontitis. It is prevalent in adults, but can occur at any age. Progression of attachment loss usually occurs slowly, but periods of rapid progression can occur.
Aggressive Periodontitis is a highly destructive form of periodontal disease associated with rapid bone and tissue attachment loss. It is most often found in a younger population who may lack calculus and inflammation seen in chronic periodontitis. This disease may occur in localized or generalized patterns.
Checking for Periodontal Disease
During your checkup, your gums will be examined. A probe is gently used to determine the depth of the sulcus surrounding each tooth. The depth of the healthy sulcus is usually 3 millimeters or less. Generally, the more severe the disease, the deeper the pocket. With active disease, the examiner will also observe bleeding upon probing. Dental X-rays are used to evaluate the amount and shape of the bone support. If disease is diagnosed, the dentist will recommend treatment.