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Periodontal disease is an infection of the tissues that support your teeth. Your gum tissue is not attached to the teeth as high as it may seem. There is a very shallow v-shaped crevice called a sulcus between the tooth and gums. Periodontal diseases attack just below the gum line in the sulcus, where they cause the attachment of the tooth and its supporting tissues to break down. As the dental tissues are damaged, the sulcus develops into a pocket: generally, the more severe the disease, the greater the depth of the pocket.

Periodontal diseases are classified according to the severity of the disease. The two major stages are gingivitis and periodontitis. Gingivitis is a milder and reversible form of periodontal disease that only affects the gums. Gingivitis may lead to more serious, destructive forms of periodontal disease called periodontitis.

Causes or Factors that Worsen Periodontal (Gum) Disease

• Because of a dulled immune response and less oxygen in the mouth, smokers are 2-7 times more likely to develop periodontitis than nonsmokers.
• Diabetes worsens periodontal disease. If a person’s blood sugar level is poorly controlled, a worse infection, poor healing, and a greater loss of bone and connective tissue are likely.
• Stress increases certain hormones that make a person more susceptible to infection. Pregnancy and birth control pills can also increase hormone levels.
• Steroids, antiseizure medicines, cancer medicines, and blood pressure medicines can all affect the gums. Some drugs decrease the flow of saliva, irritating the mouth and making it prone to infection.

Eight Warning Signs of Periodontal Disease

• Gums that bleed when you brush or floss your teeth
• Gums that are red, swollen or tender
• Gums that have pulled away from teeth
• Infection including purulence(pus) between the teeth and gums when the gums are pressed
• Permanent teeth that are loose or separating
• Any changes in the way your teeth fit together when you bite
• Any changes in the fit of your partial denture
• Bad breath
• Itchy sensation

Moderate and Early Periodontal Desease

Periodontitis occurs when the inflammation of the gums progresses into the deeper underlying structures and bone.

In the most common form of periodontitis, plaque (and sometimes calculus) is found below the gumline. The gums may feel irritated, appear bright red, and bleed easily.

The ligaments holding the tooth in its socket break down and the gums pull away from the teeth, resulting in a periodontal pocket or space between the tooth and gum.

The periodontal pocket deepens and fills with more bacteria. Supportive ligaments and bone start to show damage.

Moderate periodontal disease: notice the accumulation of calculus around the gumline. The gums are red, swollen and tender.

Calculus and plaque do not have to be evident to the naked eye for periodontal disease to be present. You need regular examinations performed by your oral health professional to assess your periodontal health and determine if periodontal disease is active in your mouth.

Advanced Periodontal Disease

When periodontitis progresses to the advanced stage, the gums severely recede (pull away from the tooth ); pockets deepen and may be filled with pus.

There may be swelling around the root and you may experience sensitivity to hot or cold or feel pain when brushing your teeth. This is due to the severely receding gums exposing the root surface.

As bone loss increases, your teeth may lose so much support that they need to be removed to preserve the overall health of your mouth.

Diagnosis of Periodontal Disease

During a periodontal exam, your gums are checked for bleeding, swelling, and firmness. The teeth are checked for movement and sensitivity. Your bite is assessed. Full-mouth X-rays can help detect breakdown of bone surrounding your teeth.

Periodontal probing determines how severe your disease is. A probe is like a tiny ruler that is gently inserted into pockets around teeth. The deeper the pocket, the more severe the disease.

In healthy gums, the pockets measure less than 3 millimeters — about one-eighth of an inch — and no bone loss appears on X-rays. Gums are tight against the teeth and have pink tips. Pockets that measure 3 millimeters to 5 millimeters indicate signs of disease. Tartar may be progressing below the gumline and some bone loss could be evident. Pockets that are 5 millimeters or deeper indicate a serious condition that usually includes receding gums and a greater degree of bone loss.

Following the evaluation, your dentist or periodontist will recommend treatment options. Methods used to treat gum disease vary and are based on the stage of the disease.

Treatment of Periodontal Disease

If you’re diagnosed with periodontal disease, your periodontist may recommend periodontal surgery. Periodontal surgery is necessary when your periodontist determines that the tissue around your teeth is unhealthy and cannot be repaired with non-surgical treatment. Following are the four types of surgical treatments most commonly prescribed:

• Pocket Reduction Procedures
• Regenerative Procedures
• Crown Lengthening
• Soft Tissue Grafts

If you’ve already lost a tooth to periodontal disease, you may be interested in dental implants — the permanent tooth replacement option.

Categories: Gums