PERIODONTAL DISEASE

Gum disease is responsible for about 70 percent of adult tooth loss. It is characterized by swollen, inflamed gums surrounding the teeth. Plaque, a sticky substance that forms in the mouth from food, saliva and bacteria gets inside the space between the gum line and the tooth. If not removed, plaque hardens into a substance called calculus or tarter that is very difficult to remove.
Eventually, the bacteria in the plaque and tarter eat away at the fibers that hold the gums to the teeth, creating deep pockets. As bacteria spread, the pockets become deeper until the bacteria finally eat away the bone that holds the tooth in place.

In periodontitis, bone is affected or reduced in height. Pocket probing will reveal pocket depths greater than 4mm. The gingiva may also be red swollen, and may bleed during brushing or flossing. When periodontitis has been present for a long time, the tooth may be seen to move in its socket and the gingiva may be receded (a condition where the gingiva has shrunk and exposed the root of the tooth).

Gingival recession predisposes a tooth to decay of the root surfaces and dentin sensitivity (a condition wherein the patient experiences severe pain whenever he brushes his teeth, eats something sweet or drinks something cold).

Signs and symptoms of periodontal disease:

• Bleeding gums – Gums should never bleed, even when you brush vigorously or use dental floss.
• Loose teeth – Also caused by bone loss or weakened periodontal fibers (fibers that support the tooth to the bone).
• New spacing between teeth – Caused by bone loss.
• Persistent bad breath – Caused by bacteria in the mouth.
• Pus around the teeth and gums – Sign that there is an infection present.
• Receding gums – Loss of gum around a tooth.
• Red and puffy gums – Gums should never be red or swollen.
• Tenderness or Discomfort – Plaque, calculus, and bacteria irritate the gums and teeth.

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

Your dentist or hygienist will use pocket depths, amount of bleeding, inflammation, tooth mobility, etc., to make a diagnosis that will fall into a category 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. Generalized moderate to severe bone loss may be present.

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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 eventually, 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 planning (deep cleaning) will be recommended. It 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 (planning). This procedure helps gum tissue to heal and pockets to shrink. Medications, special medicated mouth rinses, and an electric tooth brush may be recommended to help control infection and healing.

Laser Treatment in a state of the art technology that can help in the treatment of periodontal disease A small amount of laser energy is directed through a tiny fibre that is gently placed between the gum and tooth. This laser energy aids in reducing the bacteria associated with the disease. Most procedures are virtually painless but the area may be anesthetized for your comfort.

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

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Maintenance


It only takes twenty four 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 dental hygienist will recommend that you have regular maintenance cleanings (periodontal cleanings), usually four times a year. At these cleaning appointments, the pocket depths will be carefully checked to ensure that they are healthy. Plaque and calculus that is 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): Essential for detection of decay, tumors, cysts, and bone loss. X-rays also help determine tooth and root positions.
• Examination of existing restorations: Check current fillings, crowns, etc.
• Examination of tooth decay: Check all tooth surfaces for decay.
• Oral cancer screening: Check the face, neck, lips, tongue, throat, cheek tissues, and gums for any signs of oral cancer.
• Oral hygiene recommendations: Review and recommend oral hygiene aids as needed. (Electric toothbrushes, special periodontal brushes, fluorides, rinses, etc.)
• Teeth polishing: Remove stain and plaque that is not otherwise removed during tooth brushing and scaling.

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

Treatment of periodontal disease requires the patient's cooperation. Both doctor and patient have a role to play in order for the treatment to be successful. The dentist is responsible for removing all plaque and tartar on the teeth while the patient is in the clinic. The patient is responsible for keeping the teeth clean outside the clinic For most patients, this entails learning new skills, acquiring new habits or even modifying one's lifestyle.

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