Periodontal Disease and Treatment
The word “periodontal” literally means “around the tooth”. Periodontal diseases are bacterial gum infections that destroy the gums and supporting bone that hold your teeth in your mouth. Periodontal disease can affect one tooth or many.
The main cause of periodontal disease is bacterial plaque, a sticky, colourless film that constantly forms on your teeth. If the plaque is not removed, it can turn into a hard substance called calculus or tartar. Calculus is so hard, that it can only be removed by an oral health professional, such as a dentist or dental hygienist. The bacteria in plaque infect the gums and release toxins that cause redness and inflammation. The inflammation and the toxins themselves cause destruction of the tissues that support the teeth, including the bone. When this happens, the gums separate microscopically from the teeth, forming pockets that fill with even more plaque causing even more infection.
Periodontal Diseases are multi-factorial
This means that there is not just one cause but rather multiple factors that can affect the health of your gums.
Examples are: Tobacco, Hormonal changes, Genetics, Stress, Oral contraceptives, Poor nutrition, Systemic diseases such as Diabetes.
Types of Periodontal Diseases
There are many types of Periodontal diseases. The following are the most common:
Gingivitis: Mildest form of periodontal disease. Gingivitis causes the gums to become red, swollen and bleed easily. There is usually no discomfort at this stage. It is reversible.
Chronic Periodontitis: Results in inflammation within the soft tissues surrounding the teeth, causing progressive attachment and bone loss. It is diagnosed by the formation of “pockets”, bone loss on a dental radiograph (x-ray) and/or receding gums. It is most common in adults, but can occur at any age.
Aggressive Periodontitis: This form occurs in patients who are otherwise in good health. Common features include rapid attachment loss and bone destruction.
Periodontitis as a manifestation of Systemic Diseases: Associated with one of several systemic diseases that are related to periodontitis, such as diabetes.
Necrotizing Periodontal Diseases: These types of periodontal diseases cause ulcers in the gums between the teeth and are most commonly observed in individuals with certain conditions including, but not limited to, HIV infection, malnutrition and immunosuppression. Stress and smoking can sometimes contribute to this problem..
Signs and Symptoms of Periodontal Diseases
Periodontal diseases are often silent, meaning that symptoms may not materialize until significant bone loss has occurred. Common symptoms and signs include:
- red, swollen or tender gums
- bleeding while brushing or flossing
- receding gums
- loose or separating teeth
- pus between gum and tooth
- persistent bad breath
- a change in the way your teeth fit together when you bite
- a change in the fit of partial dentures
The Periodontal Examination
The periodontist (a dentist who specializes in the prevention, diagnosis and treatment of tissues surrounding the teeth) will evaluate your periodontal health and will work with you to determine the best treatment options to control your disease and bring you back to health.
During a periodontal examination, the periodontist will gently place a small measuring instrument, called a periodontal probe, in the space between the teeth and gums to measure their depth. Probing measurements up to 4mm are considered generally healthy, and >5mm pockets may indicate periodontitis.
In addition, dental radiographs may be taken to evaluate the health of the bone supporting your teeth.
The Periodontal Treatment
Usually divided into 3 Phases:
Phase 1 (non-surgical periodontal therapy) – Oral Hygiene Instruction is the first step to learn how to control plaque-build-up. Scaling and Root Planing (SRP) is a meticulous cleaning of the root surfaces below the gum line to remove plaque, toxins and calculus from the root surfaces of the teeth. For comfort, dental anesthesia will be used. SRP may be the only mode of treatment needed or may be the first step towards more advanced periodontal treatments, such as periodontal surgery. Following adequate time to respond to your treatment, you will be asked to return to the office for a re-evaluation, to determine if further active therapy is needed.
Phase 2 – If periodontitis has advanced to the point where the pockets are very deep and significant amounts of bone are lost, surgical therapy may be necessary.
Phase 3 – Ongoing periodontal maintenance will allow your periodontist to assess your periodontal health and make sure your infection stays under control or remains eliminated. Regular cleanings (every 3-4 months) will be needed. Without ongoing treatment, periodontal diseases can often recur.