What is periodontal disease?

Periodontal disease is a disease affecting the tissues that support the teeth, including gum tissue and bone. The most important periodontal diseases are gingivitis and periodontitis. Gingivitis is inflammation of the gums. Periodontitis, which used to be called pyorrhea, is a more serious disease that affects the underlying bone structure of the teeth.

Periodontal disease is the leading cause of tooth loss in adults over 40. However, early diagnosis and treatment can usually prevent tooth loss.

How does it occur?

The most common cause of periodontal disease is long-term neglect of oral health.

The first stage of periodontal disease is gingivitis, which is most often caused by bacteria found in plaque. Plaque is a sticky material made of mucus and saliva, food particles, and bacteria that live in the mouth. Chemicals produced by the bacteria in plaque inflame the gum tissue, causing it to swell and become tender.

Over time, if untreated, the inflammation becomes worse as bacteria begin to attack the underlying, supporting tissues of the teeth, which include bone and the ligaments that attach the bone, teeth, and gums. In periodontitis, the supporting tissues are slowly destroyed and the teeth can become loose and eventually may need to be pulled.

Other contributing causes of periodontal disease may include:

• vitamin deficiency, especially vitamin C deficiency

• diseases such as insulin-dependent and non-insulin- dependent diabetes, thyroid disorders, and disorders of the immune system

• drugs that cause your mouth to be dry or change the development of the gums

• pregnancy.

What are the symptoms?

Symptoms of periodontal disease include:

• bad breath

• unpleasant taste in mouth

• red, swollen gums that bleed easily and ache deep into bones

• loose teeth

• sensitivity of teeth to hot and cold or to sweet foods

• infections in the gums.

How is it diagnosed?

A dentist will diagnose periodontal disease by examining your gums and teeth. He or she will take a thorough dental history and full mouth dental x-rays.

In addition, the dentist will look for these signs of periodontal disease:

• pockets, a deepening of the natural space between a tooth and its tissue measured when the dentist or hygienist is probing with a special instrument

• spaces developing between teeth that normally touch

• development of a blunt or flat contour to the tissue between the teeth

• evidence of plaque and tartar under the tissue, in the spaces between the teeth; tartar is plaque that has absorbed minerals from the saliva and calcified.

How is it treated?

The most common treatment of periodontal disease is a thorough dental cleaning, which includes:

• removing tartar and plaque deposits from above and below the gum tissue

• removing hard deposits from the roots

• removing all diseased tissue lining the spaces between the teeth

• polishing the teeth to remove stain.

For severe periodontal disease, your dentist may refer to a specialist.

After the tartar and plaque are removed and the teeth and root surfaces are clean, the tissue can heal. You may also need antibiotics or further surgical treatment to reshape the gum tissue for easier self-cleaning.

In addition to cleaning, the dentist or hygienist will teach you the best techniques of brushing, flossing, and caring for your teeth.

Other forms of treatment may include:

• antibacterial mouth rinses, either prescribed or nonprescription

• daily use of special dental tools to help you clean areas that are hard to reach

• reshaping your bite by grinding tooth surfaces

• orthodontics

• splinting teeth together to stabilize loose teeth

• gum or bone surgery.

Managing periodontal disease includes a commitment to excellent, daily oral hygiene to remove plaque from your teeth. In addition, it is important to receive regular and more frequent professional dental care.

How long will the effects last?

If periodontal disease is not treated, it may cause permanent damage to the support of the teeth. However, the disease process can be stopped and further damage kept to a minimum with proper oral hygiene and good professional care.

How can I take care of myself?

The best care you can give yourself is to practice good oral hygiene, which includes the following:

• Brush your teeth correctly for at least 2 minutes at least twice a day. The most important time to brush is before you go to sleep. It is also a good idea to brush or rinse after meals.

• Floss correctly between your teeth once a day.

• Gently massage the tissue with a soft toothbrush.

• Schedule more frequent professional cleanings, as recommended by your dental office. Ask your dentist or hygienist to demonstrate proper techniques for brushing and flossing.

• Use any special cleaning tools prescribed by your dental office to help you reach difficult to clean areas.

• Eat nutritious foods, rich in vitamins and minerals, and varied in texture.

• Avoid highly sugared, sticky foods. If you have deep gum pockets, avoid nuts and seeds.

How can I help prevent periodontal disease?

To prevent periodontal disease, practice excellent oral hygiene. In addition, see your dentist regularly and be sure to keep all your scheduled appointments.

Avoid hard brushes and scrubbing the gums and teeth because they can cause severe damage. If you grind your teeth, a night guard can be made by your dentist. The guard helps prevent loosening of teeth and worsening of periodontal disease.