Periodontal Disease

What Causes Periodontal Disease?
Bacterial plaque is the primary cause of gum disease and tooth decay. Plaque is a sticky, colorless film of bacteria that constantly forms on your teeth and gums. Certain types of plaque bacteria create toxins (poisons) that can injure the gums and underlying bone. Over time, these toxins can destroy your gums and the bone underneath them.

Plaque is removed with careful brushing and flossing. Plaque that is not completely removed every 24 to 48 hours can combine with other materials and harden into a rough, porous deposit called calculus (tartar). Calculus above the gum line is primarily a cosmetic problem. However, calculus that extends below the gum line interferes with thorough plaque removal and can, therefore, contribute to the development of periodontal disease. Once calculus has formed, only your dentist or dental hygienist can remove it. Good brushing and flossing helps prevent calculus buildup in your mouth.

Other contributing factors: Although bacterial plaque is the main culprit in periodontal disease, there are other contributing factors. Your genetic makeup determines how your body will react to the bacteria, and heredity plays a major role in whether or not you are likely to develop the disease. If your parents lost teeth to gum disease, then you are susceptible.

Other contributing factors are:

  • stress
  • poor diet
  • clenching, grinding of teeth
  • smoking

Pregnant women's gums will overreact in the presence of bacterial plaque, due to their increased hormone levels. People who have systemic diseases such as AIDS and diabetes have a lower resistance to infection, making periodontal disease more severe. There are some medications that can affect the gums as well, such as steroids, cancer therapy drugs, some calcium channel blockers, antidepressants and some types of anti-epilepsy drugs. It is important to update your medical history at each dental appointment so that your dentist or hygienist is aware of any factors that may cause increased susceptibility to gum disease.

Common Types of Periodontal Disease
Gingivitis is the earliest and most treatable stage of gum disease. Only the gums are affected, and it is reversible. If you have gingivitis, your gums will be red and swollen, and you are likely to bleed easily. Often, people will tell me, "I don't have gingivitis. My gums have always bled, that's normal for me." Sometimes we become comfortable with what we consider to be "normal." But the fact is that healthy gums don't bleed.

Treatment can be as simple as having your teeth professionally cleaned and following a daily home-care routine. But if not treated early, it can progress to the next stage of gum disease, which is periodontitis.

Periodontitis is a more advanced stage of gum disease and is irreversible. At this stage the gums, bone, and other structures that support the teeth are damaged. Toxins destroy the tissues that anchor the teeth in the bone. Gums pull away from the teeth forming pockets that fill with more plaque. The deeper the pocket, the harder it is to clean, which can lead to further bone loss. Sometimes, the gums drift down the neck of the tooth exposing the root surfaces. Now plaque can adhere to the root surface making it more susceptible to decay and sensitive to cold and touch. Breathing in cold air can be painful.

At this stage your teeth may become loose or fall out. It may become necessary for your dentist to remove teeth. Treatment is more involved and usually requires multiple visits to your dentist/dental hygienist or a referral to a periodontist (dentist specializing in gum disease). Left untreated the disease will progress. The gum and bone that is lost will not grow back. You are never cured at this stage. But with treatment and good home-care, you can stabilize the disease or slow it down.

Diagnosis of Periodontal Disease
The only accurate method of diagnosing periodontal disease is to have a complete examination by your dentist. It should include x-rays of all your teeth (to check the bone) and a full mouth probing (measuring the pocket depths). The earlier you are diagnosed, the easier it will be to treat your periodontal disease.

Warning Signs of Periodontal Disease
Diagnosing periodontal disease early can increase your chances of a successful treatment. It is helpful to be aware of any changes that may occur in your mouth that may signal trouble.

Warning signs (from the American Dental Association)

  • gums that bleed
  • red, swollen, or tender gums (healthy gums are pink)
  • gums that have pulled away from the teeth
  • Pus appears between the teeth and gums when the gums are pressed (pus can look white or yellowish in color)
  • Persistent bad breath or bad taste
  • Permanent teeth that are loose or separating (gaps between the teeth that weren't there before
  • Changes in the way your teeth fit together when you bite (difficulty chewing certain foods, like raw vegetables)
  • Changes in the fit of partial dentures