What is Periodontitis?
The word periodontal means “around the tooth”. Periodontal disease attacks the gums and the bone that support the teeth. Periodontal disease (also known as periodontitis and gum disease) is a common inflammatory condition that affects the supporting and surrounding soft tissues of the tooth, eventually affecting the jawbone itself in the disease’s most advanced stages. Our North Vancouver dentists are skilled and knowledgeable in the diagnosis and treatment of periodontitis and can help you keep your gums healthy and clean.
How Does Periodontal Disease Form?
Periodontal disease is most often preceded by gingivitis which is a bacterial infection of the gum tissue. 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 jawbone.
Another reason that periodontal disease can form is due to plaque. Plaque is a sticky film of food debris, bacteria, and saliva. If plaque is not removed, it turns into calculus (tartar). When plaque and calculus are not removed, they begin to destroy the gums and bone. Periodontal disease is characterized by red, swollen, and bleeding gums.
Smoking also increases the risk of periodontal disease.
How Serious is Periodontitis?
Many people do not know that periodontal disease is the leading cause of tooth loss among adults in the developed world and should always be promptly treated. If left untreated, it can cause shifting teeth, loose teeth, and eventually tooth loss. Four out of five people have periodontal disease and don’t know it! Most people are not aware of it because the disease is usually painless in the early stages.
Not only is it the number one reason for tooth loss, but research also suggests that there may be a link between periodontal disease and other diseases such as strokes, bacterial pneumonia, diabetes, cardiovascular disease, and increased risk during pregnancy. Researchers are determining if inflammation and bacteria associated with periodontal disease affect these systemic diseases and conditions.
What Are the Signs and Symptoms of Periodontitis?
While signs and symptoms may be subtle at the start, they can quickly lead to painful mouths and many appointments. 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.
Good oral hygiene, a balanced diet, and regular dental visits can help reduce your risk of developing periodontal disease.
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 are being destroyed by periodontal disease.
Here are some of the most common types of periodontal disease:
- Chronic periodontitis – Inflammation within supporting tissues causes 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.
- Aggressive periodontitis – 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 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.
- Periodontitis caused by systemic disease – This form of gum disease often begins at an early age. Medical conditions such as respiratory disease, diabetes, and heart disease are common cofactors.
How is This Disease Diagnosed?
Periodontal disease is diagnosed by our North Vancouver dentist or dental hygienist during a periodontal examination. This type of exam should always be part of your regular dental check-up.
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 one of the categories below.
- Advanced Periodontitis
How Can I Treat Periodontal Disease?
Periodontal treatment methods depend upon the type and severity of the disease. Our dentist and dental hygienists in North Vancouver will evaluate for periodontal disease and recommend the appropriate treatment.
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. 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 at home.
If the disease has progressed to more advanced stages, a special periodontal cleaning called scaling and root planing (deep cleaning) will be recommended. It is usually done in 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 (planing). This procedure helps gum tissue heal and pockets shrink. Medications, special medicated mouth rinses, and an electric toothbrush may be recommended to help control infection and healing.
If the pockets do not heal after scaling and root planing, periodontal surgery may be needed to reduce pocket depths, making teeth easier to clean. We may also recommend that you see a periodontist (specialist of the gums and supporting bone).
Surgical and Non-Surgical Treatments
There are many surgical and nonsurgical treatments the periodontist may choose to perform, depending upon the exact condition of the teeth, gums, and jawbone. 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 – In order to preserve the health of the gum tissue, 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.
- Tissue regeneration – When the bone and gum tissues have been destroyed, regrowth can be actively encouraged using grafting procedures. A membrane may be inserted into the affected areas to assist regeneration.
- Pocket elimination surgery – Pocket elimination surgery (also known as flap surgery) is a surgical treatment that can be performed to reduce the pocket size between the teeth and gums. Surgery on the jawbone is another option that 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 teeth into the jawbone. Tissue regeneration procedures may be required prior to the placement of a dental implant in order to strengthen the bone.
At Home Care
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 is complete, 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 and have not deepened again. 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!
Schedule Your Check-Up Today!
It may be difficult to diagnose your periodontal disease at home, learn all the tips and tricks online, or treat your pain alone. Schedule an appointment with our North Vancouver dental clinic to ensure your mouth, gums, and teeth are properly treated and you’re back smiling the way you ought to be!