What is periodontitis?
Periodontitis, or gum disease, is the serious infection of the gum that damages supporting tissues of the teeth. If periodontitis progresses, it can cause significant damages to both gum tissues and bone structures where teeth are anchored (periodontal ligament and alveolar bone). Periodontitis is mainly caused by poor oral hygiene, which increases risks of bacterial activity in dental plaque.
Periodontitis is common but it is preventable. You can simply brush your teeth twice a day, floss daily and have regular dental visits to greatly improve your oral health and minimize risks of periodontitis development. It is highly important to visit your dentist to prevent and stop gum disease in the early stages since the damages caused by periodontitis can be irreversible.
What are the symptoms of periodontitis?
As gingivitis precedes periodontitis, knowing the symptoms of gingivitis can set an alarm to prevent much serious gum disease occurrence. You can notice changes like:
- Red and swollen gums
- The existence of plaque and tartar buildups on teeth
- Bleeding in gums that can happen spontaneously or when triggered by eating or brushing teeth
- Receding gums in which your teeth look longer
- Bad breath
- Loose teeth
- Pain or sensitivity
- Recurrent inflammation in gums
Sometime, you may not notice peritonitis, but your dentist can detect any high-risk signs and symptoms that are present in your gums or teeth even during the early phases. Before things go too far, seek dentist’ help and, if diagnosed, receive the necessary treatments.
What causes periodontitis?
To make it simple, periodontitis is caused by the buildup of bacterial plaque that is the result of lack of proper oral hygiene. Our mouth is full of hundreds of species of bacteria. Although some of these bacteria don’t cause any harm, the others can build up to form dental plaque, which colonize the surface of teeth. If you don’t brush your teeth and don’t remove the accumulated plaque, it turns into harder deposits of bacterial plaque, called calculus or tartar.
As bacterial plaque multiply and become more active, they can occupy every corner of teeth, such as below the gum line and tooth root spots. The bacteria cause infection and damage attachment tissues that connect teeth to gums, this is when a gap is formed between the root of the tooth and the gum tissue, known as periodontal pocket. The gum and bone tissues deteriorate and this loss of attachment can get bigger and bigger. This is why teeth become loose because they are no longer firmly fixed to its base. The most common risk factors that reinforce and increase the risks of developing periodontitis include:
Tobacco use or smoking habits are the biggest risk factors for periodontitis. In smokers, there is a favorable environment for bacteria to breed and form gum pockets and the periodontitis advances with much higher speed. Bear in mind that treatments are also difficult for smokers than non-smokers. There are even higher risks of not responding to periodontal treatment in individuals who smoke.
- Type 2 diabetes.
People who are suffering from diabetes are at a greater risk of periodontitis development. Changes in blood sugar level should be managed to prevent periodontal issues. It is important to visit the dentist to do periodontal examination for possible periodontitis or gingivitis signs and symptoms.
Periodontitis is directly linked to the interplay between the bacterial infection and the immune system. Individuals with systemic diseases or certain syndromes and disorders can be susceptible against the way the body reacts to the progression of periodontitis.
- Poor diet and nutritional deficiencies.
The negative eating habits and consumption of unhealthy foods such as processed food, diets high in sugar, soft drinks and carbohydrate-rich diet are well-known causes of tooth decay, which help bacterial plaque to thrive and hence pave the way for gingivitis or gum inflammation. Some type of deficiencies like vitamin C shortages are linked to gingivitis. Therefore, poor diet not only is an issue for teeth but a reinforcer for more gum problems and periodontitis.
Periodontitis can start at early adulthood or even earlier but may take years to progress. As we age, longtime untreated diseases, poor oral hygiene and many other factors exacerbate the periodontitis. The new phase of periodontitis (chronic periodontitis) appears to cause immense damages especially when people reach higher ages, like older than 35 years of age.
Other risk factors include:
- Medications used like those that interrupt saliva function and cause dry mouth
- Hormonal changes during pregnancy, menopause and other situations
- HIV or other compromised immune system conditions
What are the stages of periodontitis?
Early stage of periodontal disease (gingivitis)
At the beginning of gum disease, individuals show signs of gingivitis, which is the milder form of gum disease and is characterized by redness, inflammation and bleeding gum problems. Gingivitis then leads to periodontitis (periodontal disease) if it is not treated.
The most common cause of gingivitis is the poor oral hygiene. With increasing risks of dental plaque, many species of bacteria living in the unremoved plaque or in your mouth find the chance to harm your teeth and gums. If you don’t brush your teeth and have no regular flossing, this gives rise to bacterial plaque and therefore a growing risk of infections, which results in gingivitis.
Once periodontitis occurs, you can expect the irreversible and serious damages to gums, teeth and the connective tissues that support your teeth. Chronic periodontitis is divided into three stages:
- Mild periodontal disease.
At this stage of periodontitis, attachment loss has occurred, meaning that connective tissues (gingival fibers and periodontal ligament) in contact with tooth root become detached. Gums recede and teeth appear longer than normal. Pockets with smaller depth begin to form between gums and teeth and there is an increasing bacterial infection, which may give you a foul odor in mouth.
- Moderate periodontal disease.
As the periodontitis goes untreated, the damages become much significant. The connective tissue and the alveolar bone are destroyed, leading to loose teeth. Receding gums, bleeding, bone loss and deeper periodontal pocket causes irreversible damages that require long time care and treatment.
- Advanced periodontal disease.
It is extremely important to prevent further progression of periodontitis as soon as possible. In the advanced periodontitis stages, the disease may get unresponsive to treatment or recur again and again. The connective tissue, gums and the supporting bone get so severely damaged that tooth loss will be even more likely. Thus, the destruction of attachment tissues and the high level of tooth mobility eventually leads to tooth loss.
While gingivitis is gum inflammation that affects gum line and other surrounding gum tissues, periodontitis goes beyond the soft tissues of the gums and damages bones that anchor teeth in place.
Gingivitis can be reversed and you can restore your gum health with good oral hygiene practices. But once periodontitis comes in, the oral hygiene alone is not enough because of adverse destruction of the gums and periodontium. The repair of the damages caused needs a dentist or a periodontist’s treatment and care.
Your dentist or periodontist (the dentist specializes in treating periodontal diseases) will diagnose the existence of periodontitis through periodontal probe for the presence of periodontal pocket or through diagnostic images. These measurements and radiographic images allow dentists to easily detect or notice signs of bone loss, infections and other periodontal conditions in gums and surrounding bony structures. Therefore, it is important to visit dentists regularly to prevent further damages caused by periodontitis so that situations do not get worse.
By probing, your dentist or periodontist will measure the pocket depth with a probe (ruler) to detect periodontal destruction. They can take X-rays for the sign of bone loss surrounding the tooth or teeth that are affected by periodontitis.
Depending on the periodontitis condition, treatments aim to eliminate the infection in pocket gums and improve the affected gum or bone structures. If the periodontitis is in the early stages, you may be asked to best manage your oral health at home along with treatments at dentists’. Common treatments of periodontitis include:
Maintaining oral hygiene
Your dentist can instruct you or remind you on the better teeth cleaning ways and the importance of oral hygiene. Your dentist will guide you on ways to remove plaque better and prevent the growth of bacteria in your mouth.
You may be required to use the right toothbrush, the appropriate toothpaste and the antibacterial mouthwashes. Your dentist will advise on:
- Brushing teeth twice a day or even better after snacking
- Changing your toothbrush (e.g., every 3 months)
- Using the electric toothbrushes or the suitable form of toothbrush designed for easier interdental or posterior teeth cleaning to clean teeth of plaque and tartar formed on hard-to-reach spots
- If recommended, using antiseptic mouthwashes to treat gum infection and inflammation
- Medication use especially those that directly impact oral functions such as saliva problems
- Trying healthier lifestyle such as quitting smoking, cutting down on high-sugary foods/drinks and avoiding carbonated and acidic beverages
Deep cleaning is the name for professional cleaning of teeth which involve removal of accumulated plaque on teeth and hardened tartar. Dentists can perform the following treatments:
- Tooth scaling and root planing:
Scaling is done to scrape off plaque from the surface of teeth which you can’t remove with toothbrushing alone. Your dentist can use ultrasonic instruments, laser or other necessary dental instruments to do scaling. With root planing the lower root area of teeth, after removal of plaque, is smoothed to prevent bacteria buildups form residing on the tooth root below the gum line areas. They can remove plaque buildups and calculus (tartar) that are formed on teeth’s surface or the exposed spots below the gums.
- Fluoride treatment (fluoride varnish):
Fluoride is a well-known ingredient used in toothpaste, which help strengthen teeth and fight caries. They will apply higher concentration of fluoride on teeth to speed up plaque elimination in much efficient way.
Sometime, oral hygiene regiment may not be enough. Your dentist can prescribe antibiotic medications to prevent further risks of persisting gum infections.
If the periodontitis has caused serious damages to bone and gums and the periodontal pocket is deeper, your dentist or periodontist will decide on the surgeries as treatment. They can perform:
- Flap surgery:
This surgery is done because the dentist or periodontist needs to get access to teeth in deeper pockets for scaling and root planing (debridement). Therefore, gums are lifted back, the bacterial deposits are cleaned along with scaling and planing of tooth roots. If required, the supportive underlying bone structures is recounted. Then the gum tissues are sutured back.
- Bone grafting:
Sometimes due to bone defects caused by periodontal issues, dentists or periodontists need to regenerate the lost bone structures. This way, they will use the bone grafts from your own bone or the donated bone graft to generate bone tissue regrowth in the site of periodontal pocket. Your dentist or periodontist can also help the defective bone to grow using the method called interdental denudation or guided tissue regeneration. After the excision of the gum tissues in the interproximal area between teeth and bone, it is covered with some form of periodontal dressing to allow for the healing of the bone.
- Gum grafting:
One of the notable symptoms of periodontitis is receding gum issues that can be treated through surgical operation. Dental specialists will treat this complication through gum grafting. This surgery allows for lost gum tissues to regenerate. The healthier soft tissue that is taken from other oral tissues (e.g., roof of the mouth) is inserted in the place of gum recession area.
How to prevent periodontitis?
You can prevent chances of periodontitis development by following below hygiene tips:
- Brush your teeth twice a day to remove plaque build ups on teeth
- Brush interdental spaces carefully or use the helpful oral care products to make brushing easier such as electric toothbrushes, dental picks or other specially designed products
- Floss daily
- Use fluoride toothpaste to strengthen teeth while fighting tooth decay and preventing cavities
- Try antiseptic mouthwashes to kill bacteria when recommended by your dentist
- Limit your sugar intake and eat/drink healthier
- Avoid smoking and using tobacco
- Most importantly, visit your dentist regularly to have your teeth examined for possible signs and symptoms or maybe for professional teeth cleaning appointment for better plaque removal.