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Definition
Periodontitis (per-e-o-don-TIE-tis) is a serious gum infection that damages the soft
tissue and destroys the bone that supports your teeth. Periodontitis can cause tooth loss
or worse, an increased risk of heart attack or stroke and other serious health problems.
Periodontitis is common but largely preventable. Periodontitis is usually the result of
poor oral hygiene. Brushing at least twice a day, flossing daily and getting regular dental
checkups can greatly reduce your chance of developing periodontitis.
Symptoms
Signs and symptoms of periodontitis can include:
Swollen gums
Gums that pull away from your teeth (recede), making your teeth look longer than normal
Bad breath
Loose teeth
A change in the way your teeth fit together when you bite
There are different types, or classes, of periodontitis. Chronic periodontitis is the most
common class, affecting mostly adults, though children can be affected, too. Aggressive
periodontitis usually begins in childhood or early adulthood and affects only a small
number of people.
Causes
It's thought that periodontitis begins with plaque a sticky film composed mainly of
bacteria. Plaque forms on your teeth when starches and sugars in food interact with
bacteria normally found in your mouth. Brushing and flossing your teeth removes
plaque. But plaque re-forms quickly, usually within 24 hours.
Plaque that stays on your teeth longer than two or three days can harden under your
gumline into tartar (calculus). Tartar also may form as a result of the mineral content of
your saliva. Tartar makes plaque more difficult to remove and acts as a reservoir for
bacteria. You can't get rid of tartar by brushing and flossing you need a professional
dental cleaning to remove it.
The longer that plaque and tartar remain on your teeth, the more damage they can do.
Initially, they may simply irritate and inflame the gingiva, the part of your gum around the
base of your teeth. This is called gingivitis, the mildest form of periodontal disease.
Ongoing inflammation eventually causes pockets to develop between your gums and
teeth that fill with plaque, tartar and bacteria. Bacteria deposit endotoxin a byproduct
of their own metabolism which is responsible for much of the inflammation around
teeth. In time, these pockets become deeper and more bacteria accumulate, eventually
advancing under your gum tissue. These deep infections cause a loss of tissue and
bone. If too much bone is destroyed, you may lose one or more teeth.
Risk factors
Factors that can increase your risk of periodontitis include:
Gingivitis
Heredity
Tobacco use
Diabetes
Older age
Poor nutrition
Certain medications
Substance abuse
Problems with the way your teeth fit together when biting
Complications
Some complications associated with gum disease include:
Tooth loss
Stroke
Respiratory problems
Rheumatoid arthritis
Asthma
Some research suggests that the bacteria responsible for periodontitis can enter your
bloodstream through your gum tissue, affecting your lungs, heart and other parts of your
body. For instance, bacteria may travel to the arteries in your heart, where they might
trigger a cycle of inflammation and arterial narrowing that contributes to heart attacks.
What steps can I take at home to keep my gums and teeth healthy?
Are there any brochures or other printed material that I can have?
Depending on the extent of your periodontitis, your dentist may refer you to a specialist
in the treatment of periodontal disease (periodontist).
Use a dental instrument to measure the pocket depth of the groove between
your gums and your teeth. Your dentist or a hygienist inserts a metal probe beside
your tooth beneath your gumline, usually at several sites throughout your mouth. In a
healthy mouth, the pocket depth is usually between 1 and 3 millimeters (mm).
Pockets deeper than 5 mm may indicate periodontitis.
Take dental X-rays to check for bone loss in areas where your dentist observes
deeper pocket depths.
Nonsurgical treatments
If periodontitis isn't advanced, treatment may involve less invasive procedures,
including:
Scaling. Scaling removes tartar and bacteria from your tooth surfaces and beneath your
gums. It may be performed using instruments or an ultrasonic device.
Root planing. Root planing smoothes the root surfaces, discouraging further buildup of
tartar and bacterial endotoxin.
Antibiotics. Your periodontist or dentist may recommend using topical or oral antibiotics
to help control bacterial infection. Topical antibiotics can include antibiotic mouth rinses or
insertion of gels containing antibiotics in the space between your teeth and gums or into
pockets after deep cleaning. However, oral antibiotics may be necessary to completely
eliminate infection-causing bacteria.
Surgical treatments
If you have advanced periodontitis, your gum tissue may not respond to nonsurgical
treatments and good oral hygiene. In that case, periodontitis treatment may require
dental surgery, such as:
Flap surgery (pocket reduction surgery). In this procedure, your periodontist makes
tiny incisions in your gum so that a section of gum tissue can be lifted back, exposing the
roots for more effective scaling and root planing. Because periodontitis often causes bone
loss, the underlying bone may be recontoured before the gum tissue is sutured back in
place. After you heal, it's easier to clean these areas and maintain healthy gum tissue.
Soft tissue grafts. When you lose gum tissue to periodontal disease, your gumline
recedes. You may need to have some of the damaged soft tissue reinforced. This is usually
done by removing a small amount of tissue from the roof of your mouth (palate) or another
donor source and attaching it to the affected site. This procedure can help reduce further
gum recession, cover exposed roots and give your teeth a more pleasing appearance.
Bone grafting. This procedure is performed when periodontitis has destroyed the bone
surrounding your tooth root. The graft may be composed of small fragments of your own
bone, or the bone may be synthetic or donated. The bone graft helps prevent tooth loss by
holding your tooth in place. It also serves as a platform for the regrowth of natural bone.
Guided tissue regeneration. This allows the regrowth of bone that was destroyed by
bacteria. In one approach, your dentist places a special piece of biocompatible fabric
between existing bone and your tooth. The material prevents unwanted tissue from entering
the healing area, allowing bone to grow back instead.
Brush your teeth twice a day or, better yet, after every meal or snack.
Floss daily.
Prevention
The best way to prevent periodontitis is to follow a program of good oral hygiene, one
that you begin early and practice consistently throughout life. That means brushing your
teeth at least twice daily in the morning and before going to bed and flossing at
least once a day. Better yet, brush after every meal or snack or as your dentist
recommends.
A complete cleaning with a toothbrush and floss should take three to five minutes or so.
Flossing before you brush allows you to clean away the loosened food particles and
bacteria.
Also, see your dentist or dental hygienist regularly for cleanings, usually every six to 12
months. If you have risk factors that increase your chance of developing periodontitis
such as having dry mouth, taking certain blood pressure medications or smoking you
may need professional cleaning more often.