Periodontal disease or Periodontitis is an infection of the tissues that support the teeth. It is the inflammation of the supporting tissues of the teeth caused by specific microorganisms, resulting in progressive destruction of the periodontal ligament and alveolar bone with pocket formation, recession or both. It is clinically determined by the presence of a pocket. A shallow v-shaped crevice known as sulcus is present between the tooth and gums.
Periodontal diseases attack below the gum line in the sulcus, where they destroy the attachment of the tooth and its supporting tissues and thus a pocket is formed. Generally, the more severe is the disease; the greater is the depth of the pocket.
Periodontal diseases are classified according to the severity of the disease. It exists in three primary forms: Chronic, Aggressive and manifestation of systemic disease. The chronic periodontitis is the most common type and has two major stages, 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.
Factors Responsible for Periodontal Disease
Periodontitis is caused by certain factors like weak immune response, improper Oxygen supply to the oral tissues.
Smokers are more prone to periodontal diseases when compared to a non-smoker.
Gum disease is very common among diabetic patients. If a person’s blood sugar level is very high, Chances of infection are high and the healing process is delayed. This results in more amounts of microbial activity and the alveolar bone loss increases rapidly, and finally the teeth mobility increases.
Stress, Pregnancy and birth control pills can increase hormone levels and hence aggravate periodontitis.
Some medicines like steroids, anti-seizure medicines, cancer medicines, and blood pressure medicines decrease the flow of saliva, irritating the mouth and making it prone to infection.
There are few warning signs of the periodontal diseases which every person should keep in mind.
Some of these are the gums bleed when you brush or floss your teeth, gums become red, swollen or tender, gums that are loose, bad breath, purulence(pus) between the teeth and gums when the gums are pressed, spacing between permanent teeth, change in the bite or changes in the fit of your partial denture.
Etiology of Periodontitis
Moderate and Early Periodontal Disease
Periodontitis occurs when the inflammation of the gums progresses into the deeper underlying supportive tissues like the alveolar bone and supporting ligaments. In the most common form of periodontitis, plaque (and sometimes calculus) is found below the sulcus. The gums get irritated, appear bright red, and bleed easily.
The periodontal ligaments holding the tooth in the socket gets destroyed and the gingival recession is visible. This results in formation of periodontal pockets and spacing in between the tooth and gum. The pocket deepens, resulting in more amount of food lodgment which is a favorable medium for microorganisms to grow, this in turn causes destruction of bone and the teeth become mobile.
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, that is, pulling away from the tooth and hence pockets deepen and may be filled with pus. The tissues around the root get inflamed and sensitivity to hot or cold is increased. There is tenderness in the gums while brushing the teeth. This is due to the severe gum recession exposing the root surface.
As bone loss increases, the teeth lose support and start moving and finally teeth fall on their own or have to be removed by a dental profession to maintain over all oral health.
Diagnosis of Periodontal Disease
A thorough dental check up is required initially, followed by percussion and palpitation of the teeth. By help of a periodontal probe the depth of the pocket can be determined and grade of mobility of the teeth should be done thoroughly. The deeper the pocket, the more severe the periodontal disease is. The teeth are checked for bleeding & sensitivity and a bite assessment is done. OPG X-rays can help determine periodontal diseases by showing the level of bone loss and surrounding tissues.
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 firmly attached to the teeth and are pink in color. Pockets that measure 3 millimeters to 5 millimeters indicate signs of disease. 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 stages of the disease.
Treatment of Periodontal Disease
If you’re diagnosed with periodontal disease, your periodontist may initially recommend you to maintain good oral hygiene. A periodontal surgery is the most common treatment plan. The surgeon determines the tissue around your teeth whether it can be repaired with non-surgical methods or not.
The four types of surgical treatments most commonly prescribed are Pocket Reduction Procedures, Regenerative Procedures, Crown Lengthening, and Soft Tissue Grafts.
In order to replace a lost tooth due to periodontal disease, you may be interested in dental implants — the permanent tooth replacement option.