Periodontal or gum disease is an inflammation of the gum line around the teeth. Peri means “around” and odontal refers to the teeth. In the early stages of gum disease only the gums are affected. As the disease progresses all of the supporting tissues around the teeth are affected. The three stages of periodontal disease are:
- Advanced Periodontitis
In the first stage, the gums are red and swollen and may bleed easily while brushing. Gums that bleed during brushing may not be gingivitis but it is a sign of a problem such as irritation. As the disease progresses the gum pulls away from the teeth and pockets form between the gums and teeth where food debris can collect and become infected. The toxins in the bacteria and the enzymes produced to fight the infection in point of fact start to degrade the bone and tissue that hold the teeth in place. As the periodontal disease gets worse more bone and tissue are destroyed.
Signs & Symptoms of Periodontal Disease
- Change in how teeth fit together when biting
- Change in fit of partial dentures
- Formation of pockets between teeth and gums
- Gums that recede or move away from the tooth
- Loose teeth
- Persistent bad breath or bad taste in mouth
- Swollen, red, tender or bleeding gums
- Visible pus surrounding the teeth and gums
Although the signs and symptoms of gum disease may not be immediately obvious, certain symptoms may point to some sort of dental problem. Only a dentist or a specially trained dentist called a periodontist can diagnose and establish how far the disease has progressed.
According to the American Academy of Periodontology (AAP) up to 30 percent of the population of the United States may be genetically predisposed to gum disease. People with a genetic susceptibility to gum disease may be up to six times more likely to develop the disease. Genetic testing can help these people get treatment.
How is Periodontal Disease Diagnosed?
During dental exams the dentist checks the gums for swelling, bleeding, and firmness. Teeth are checked for sensitivity and movement. A full mouth X-ray can help to diagnose break down of the bone and connecting tissue around the teeth.
If the dentist suspects gum disease, a periodontal probe is gently inserted into the pockets around the teeth. The probe is similar to a tiny ruler. The larger the pockets are the more severe the gum disease. Healthy gums have pockets that measure less than 3 millimeters or about one-eighth of an inch and x-rays show no bone loss. Healthy gums fit tightly against the teeth and have pink tips. If pockets measure 3 millimeters to 5 millimeters it is an indication of periodontal disease. X-rays may show signs of bone loss. Pockets that measure 5 millimeters or larger indicate a severe gum disease and x-rays show more bone loss.
Treatment for Periodontal Disease
The goal for the treatment of periodontal disease is two-fold; first, to control an existing infection and second, to stop the progression of the disease. Treatment may depend on the severity of the disease, from home treatment of brushing and flossing and eating healthy, therapy to control the growth of harmful bacteria, and in severe cases, surgery to rebuild the supportive tissues.
During regular professional dental cleaning the dental hygienist or dentist will remove the build-up of tartar and plaque along and below the gum line of each tooth. If there are signs of the gingivitis or the early stages of gum disease the dentist may recommend professional cleaning more than twice a year and the use of toothpaste for stopping gingivitis that is approved by the FDA.
If the dentist find that there is bone loss or the gums have receded from the tooth, the dentist may recommend a deep cleaning treatment called scaling and root planing (SRP). During scaling the tartar and plaque are scraped from tooth above and below the gun line. Planing smoothes rough spots on the tooth root where bacteria collects and removes disease causing bacteria. Scaling and root planing helps the gums to reattach to the teeth. The dentist may use a drug called Periostat in combination with SRP treatment to stop the enzyme collagenase that causes damage to the teeth and gums.
Advanced cases of gum disease may require surgery to repair the damage periodontal disease causes.
In each stage of the disease, antibiotics may be used alone or in conjunction with other treatments. Relatively new antibiotic drugs doxycycline hyclate, chlorhexidine gluconate, and minocycline have been approved in continued release doses that are applied into the tooth pocket.