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What is periodontal disease?

 Periodontal disease,  also know as gum disease, is the progressive destruction of the supporting structures of the teeth caused by the accumulation of plaque and tartar and associated bacteria on the teeth and gums, releasing toxins and causing inflammatory response leading to bleeding gums, gum swelling, gum tenderness and bone loss. Depending on the severity, one or all of the symptoms may be present.

What is the cause of periodontal disease and gingivitis?

Gum disease is caused by the body's response to the bacteria and toxins that are found in plaque and tartar accumulation on the teeth and gums.  The factors that contribute to gum disease include:

  • oral hygiene ineffectiveness - There are many places in between the teeth for plaque to hide and most people do not remove 100% of the plaque from their teeth daily. This allows accumulation of the plaque and the conversion of the plaque to tartar which is more difficult to remove.
  • lack of professional cleanings - when plaque is left to turn to tartar, it needs to be professionally removed, because brushing and flossing will not remove tartar. Without seeing a dentist for a cleaning regularly, periodontal disease will occur.
  • family history of gum disease - Periodontal disease has a genetic component.  When a person is more genetically predisposed to periodontal disease, taking advantage of preventive measures becomes very important.
  • inflammatory diseases such as diabetes and arthritis - Periodontal disease is an inflammatory disease much like diabetes and arthritis and because of this they can antagonize each other if not kept under control.
  • crooked teeth causing "plaque traps"- When plaque has more places to hide because of crooked teeth, it makes oral hygiene attempts more difficult and often times less effective, allowing plaque to accumulate and turn to tartar. When the teeth are aligned properly, plaque can be more easily and predictably removed on a daily basis.
  • Smoking significantly increases instance of gum disease - smokers are twice as likely to develop gum disease as non smokers. Resources to stop smoking
  • Medications causing dry-mouth- saliva is the first defense against gum disease. Immediately after eating, saliva helps wash away any particles that are left.  When the mouth is dry, because of medications, this is not as effective.
  • Teeth Grinding - Although teeth grinding does not cause periodontal disease, when all the other factors are present, teeth grinding can make periodontal disease worse by putting extra stress on the structures supporting the teeth.

periodontal disease symptoms include:

  • Gums that bleed easily usually during brushing, flossing or eating
  • gums that are sometimes swollen and tender
  • receded gum-line 
  • loose teeth when disease is advanced.

periodontal disease diagnosis

Periodontal disease is diagnosed by looking at the color and texture of the gums, looking for redness and areas of swelling and the presence of tartar. A probe is used to detect the height of the bone, feel for tartar below the gum-line and detect bleeding gums. 

The stages of periodontal disease

Healthy Gums

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Healthy gums have little or no plaque and tartar accumulation resulting in no inflammation in the gums, no bleeding during brushing and flossing and no loss of bone. The probing depth is 3 mm or less.

 

PRE-PERIODONTAL DISEASE GINGIVITIS

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Pre-periodontal disease also known as gingivitis is characterized by inflammation in the gums causing the gums to bleed during brushing and flossing. There is usually plaque and tartar present. The probing depths are usually 3 mm with some areas with bleeding with probing. Regular teeth cleaning and good oral hygiene usually corrects the disease at this stage.

 

EARLY PERIOdoNTAL DISEASE

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Early periodontal disease is characterized by the accumulation of plaque and tartar, bleeding gums when brushing and flossing caused by inflammation, and small amounts of bone loss at the crest of the bone, usually 1-2 millimeters (the root of the tooth usually being around 10 millimeters total.) The probing depths usually include 4mm pockets with bleeding when probing. Scaling and Root Planing also know as "deep cleaning" is used to treat this stage of periodontal disease.

 

 

MODERATE PERIODONTAL DISEASE

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Moderate periodontal disease is characterized by the accumulation of plaque and tartar, bleeding gums when brushing and flossing caused by inflammation, and larger amounts of bone loss at the crest of the bone. Probing depths include 5-6mm pockets with bleeding when probing. Scaling and Root Planing also known as "deep cleaning" usually treats this stage successfully, but occationally periodontal surgery is needed.

 

ADVANCED PERIODONTAL DISEASE

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Advanced periodontal disease is characterized by the accumulation of plaque and tartar, bleeding gums when brushing and flossing caused by inflammation, and extensive bone loss. Probing depths include pocket depths of 7+mm and bleeding and sometimes pus when probing.  Many times the teeth are loose.  Periodontal surgery is needed at this point to treat this condition and tooth loss or tooth extraction may occur.

Periodontal Disease Treatment

Is periodontal disease permanent or is it possible to cure periodontal disease?

Periodontal disease like other inflammatory disease can be treated, but is not cured. There are things that can be done to slow the process of bone loss caused by periodontal disease.

  • Treatment to remove tartar and plaque - the first line of treatment is scaling and root planing and the use of an ultrasonic cleaning device.
  • Education on proper oral hygiene - treatment is ineffective if daily cleaning at home is not improved. Home cleaning tools and products are introduced and demonstrated.
  • Regular cleanings - the deep cleaning may remove the initial tartar, but it is important to maintain this level of health with the support of the dental team.
  •  Straightening of the teeth - if the teeth are crooked, 
  •  Removal of any fillings or crowns that are causing food to pack
  •  Treatment of other contributing inflammatory disease such as diabetes, arthritis all help to control and slow the loss of bone.
  • Stop Smoking - smokers are twice as likely to have periodontal disease and loose teeth as non-smokers. Resources to stop smoking.

 

Periodontal Disease Treatment to remove Tartar and Plaque

Scaling and Root Planing

bone resorption because of tartar

The treatment that is needed to stop the progression of gum disease is called scaling and root planing and is also know as deep cleaning. This is a process of tediously cleaning tartar from below the gum-line in places that it cannot be seen, only felt. The gums are anesthetized or deadened and special equipment is used to gently remove the tartar from the root surfaces below the gum-line and smooth the root surface of the tooth so that the gums can reattach.

Scaling and Root Planing Before and After

On the left, there is tartar above the gums and the gums are swollen and rounded and darker in color. The roundness and redness is because of the inflammation and infection. On the right, the tartar is removed, the gums between the teeth are much more pointed between the teeth and more pink. The gums are healthy on the right.

Scaling and root planing procedure

Special ultrasonic tools remove tough tartar with ease

Special ultrasonic tools remove tough tartar with ease

The scaling and root planing procedure from the patient perspective is simple. You may have a sedative such as nitrous oxide that numbs the senses. Also, many times the gums are anesthetized by the dentist, so that there is no pain or sensitivity during treatment. The hygienist or the dentist will then use special equipment to remove the tartar from the teeth above and below the gum-line.  Water and sometimes an antibiotic medication called Chlorhexidine is used with the ultrasonic equipment to flush out the tartar and associated bacteria. Once the tartar is removed, instructions are given to complete the process at home with proper home-care follow up. Healing usually begins immediately with some soreness over the first 24 - 48 hours. Full healing is realized after 4 weeks and a follow up should be scheduled to evaluate the effectiveness of the treatment.

Periodontal Treatment at home

After the initial buildup of tartar and plaque are removed, the treatment is not finished. Changes may be recommended to improve the effectiveness of the oral hygiene routine. Changes may include:

  • The use of an electric tooth brush
  • Proper flossing technique
  • Tools to clean between the teeth
  • Antibiotic mouth rinse

Regular Teeth Cleaning at the Dentist

It is important to be seen by the dentist or hygienist regularly to maintain the level of health achieved with treatment. Studies have shown that 3-6 month intervals are the most effective treating patients with a history of periodontal disease. The instance of periodontal disease and tooth loss increases as the interval between cleanings gets closer to 12 months.

Related Health Concerns

The mouth is the home for many types of bacteria. The thin attachment of the gums to the teeth where the plaque accumulates is the easiest place for bacteria to gain access to the bloodstream. While this is not healthy in anyone, it can be particularly threatening in certain situations. 

Orthopedic Joint Implants

In a small percentage of people that get joint implants such as a shoulder, hip or knee replacement, the bacteria from the mouth can travel through the blood stream to the joint and cause infection. An infection in an implanted joint can cause failure. While the instances are not high, those that find themselves with a failing joint implant due to infection many times have to have the joint replaced again. If you are planning to have a joint replacement, it is important to get a clearance from your dentist before surgery, and if you have already had joint replacement surgery, it is important to be seen regularly by a dentist to keep the gums healthy and reduce any chances of having an infection in the joint. Antibiotics are used to reduce the chances of infection of the joint during dental procedures that cause the gums to bleed. Bleeding gums in a person that has periodontal disease without antibiotic coverage is a threat of infecting the prosthetic joint.

Pregnancy

Pregnancy causes many hormonal changes which increase the risk of the expectant mother to develop periodontal disease. These oral problems have been linked in many research studies to problems such as preeclampsia, low birth weight of the baby and premature birth. It is important to have a healthy checkup before trying to get pregnant and continuing regular cleanings during pregnancy.