What is Periodontal (Gum) Disease?

The term “periodontal”means “around the tooth.”  Periodontal disease (also known as periodontitis and gum disease) is a common inflammatory condition which affects the supporting and surrounding tissues of the teeth including  the bone itself.

Periodontal disease is most often preceded by gingivitis which is a bacterial infection of the gum tissue only.  A bacterial infection affects the gums when the toxins contained in plaque begin to irritate and inflame the gum tissues.  Once this bacterial infection colonizes in the gum pockets between the teeth, it becomes much more difficult to remove and treat.  Periodontal disease is a progressive condition that eventually leads to the destruction of the connective tissue and bone.  If left untreated, it can lead to shifting teeth, loose teeth and eventually tooth loss.

Periodontal disease is the leading cause of tooth loss among adults in the developed world and should always be promptly treated.

Types of Periodontal Disease

When left untreated, gingivitis (mild gum inflammation) can spread to below the gum line.  When the gums become irritated by the toxins contained in plaque, a chronic inflammatory response causes the body to break down and destroy its own bone and soft tissue.  There may be little or no symptoms as periodontal disease causes the teeth to separate from the infected gum tissue.  Deepening pockets between the gums and teeth are generally indicative that soft tissue and bone is being destroyed by periodontal disease.

Here are some of the most common types of periodontal disease:

• Chronic periodontitis – Inflammation within supporting tissues cause deep pockets and gum recession.  It may appear the teeth are lengthening, but in actuality, the gums (gingiva) are receding.  This is the most common form of periodontal disease and is characterized by progressive loss of attachment, interspersed with periods of rapid progression.  One major risk factor is cigarette smoking with an almost 100% correlation .
• Aggressive periodontitis – This form of gum disease occurs in an otherwise clinically healthy individual.  It is characterized by rapid loss of gum attachment, chronic bone destruction and familial aggregation.
• Necrotizing periodontitis – This form of periodontal disease most often occurs in individuals suffering from systemic conditions such as HIV, immunosuppression and malnutrition.  Necrosis (tissue death) occurs in the periodontal ligament, alveolar bone and gingival tissues.  It is characterized by severely painful gums and an extraordinary fetid odor.
• Periodontitis caused by systemic disease – This form of gum disease often begins at an early age.  Medical condition such as respiratory disease, diabetes and heart disease are common cofactors.

Treatment for Periodontal Disease

There are many surgical and nonsurgical treatments we may choose to perform, depending upon the exact condition of the teeth, gums and bone.  A complete periodontal exam of the mouth will be done before any treatment is performed or recommended.

Here are some of the more common treatments for periodontal disease:

• Scaling and root planing (SC/RP)– In order to preserve the health of the gum tissue and bone, the bacteria and calculus (tartar) which initially caused the infection, must be removed.  The gum pockets will be cleaned and treated with antibiotics as necessary to help alleviate the infection.  A prescription mouthwash may be incorporated into daily cleaning routines.  SC/RP is  almost always done as an initial step in therapy to reduce inflammation and allow for better results should more advanced treatment be needed afterward .  It is not unusual for SC/RP to be sufficient therapy alone in mild cases.
• Tissue regeneration – When the bone and gum tissues have been destroyed and lost, some regrowth can be actively encouraged using grafting procedures.  A dissolving membrane may be placed over the grafted sites to assist in the regeneration process when bone grafting is attempted. Soft tissue grafting can be done using the patients own gum tissue or tissue grown in a laboratory,
• Pocket elimination surgery – Pocket elimination surgery  is a surgical treatment which can be performed to reduce the pocket size between the teeth and gums.  This is commonly done in conjunction with bone recontouring  which serves to eliminate indentations in the bone which foster the colonization of bacteria.
• Dental implants – When teeth have been lost due to periodontal disease, the aesthetics and functionality of the mouth can be restored by implanting prosthetic roots into the bone.  Tissue regeneration procedures may be required prior to the placement of a dental implant in order to augment the bone.  Crowns or bridges are then placed onto the implants.  

Ask your dentist if you have questions or concerns about periodontal disease, periodontal treatment, or dental implants.