Periodontal Dentistry

What is Periodontal Disease?

Periodontal disease is an infection of the gums and/or bone that supports the teeth. It is referred to in many terms, including gum disease, deep pockets and bone loss. This problem can manifest itself at any age, but most commonly presents or is recognized in our 30's. The disease generally is painless and as a result it is generally recognized once an appropriate dental examination is completed by your dentist.

A healthy tooth has a root that is supported or held by bone. It is attached to the bone by a powerful but thin ligament called the periodontal ligament. This ligament acts as a shock absorber during chewing. The bone is covered by gum tissue that is called the gingiva. The gum is the first protective barrier against bacteria that cause periodontal disease; it is attached to the root at the tooth/root junction. The gum forms a rounded collar above the attachment and looks like a turtleneck sweater, forming a small space at this junction that is called a sulcus or a pocket. Your dentist and hygienist often measure this sulcus or pocket with a periodontal probe; in health it should range from 1 to 3.5 millimeters in depth. Pockets deeper than 5 millimeters are generally associated with periodontal disease.

Large quantities and many types of bacteria have been found to occupy all of our mouths. So far, more than 500 types of bacteria have been found through research in the oral cavity. Most mouths will have more than 100 different types of bacteria, and the bacteria types will vary from person to person. Not all of these bacteria are considered to be harmful to our gums and bone, and not all individuals harbor bacteria capable of destroying bone. It is believed that a small number of the bacteria in the oral cavity are capable of destroying bone; they are referred to as periodontal pathogens. Brushing and flossing are considered to be the most effective tools that we can use on a daily basis to limit the growth of these bacteria. There are many additional mechanical devices and rinses available to assist us in keeping our mouths clean.

All oral hygiene tools have limited or poor access to the pocket area, and as a result, bacteria can grow and thrive in this sheltered area. The bacteria organize into populations on the tooth and root surface and are called plaque. If plaque is not removed by daily cleaning and professional cleaning, it will lead to infection of the gum called gingivitis and may eventually lead to bone destruction called periodontitis. When bacteria remain on teeth or roots for long periods of time, salts present in our saliva attach or adsorb to the plaque and form tartar or calculus. This is the hard yellow or brown material that is removed by your dentist or hygienist. It is referred to as tartar or calculus. Once formed, it cannot be removed by brushing, flossing or rinsing. The removal of calculus is called scaling on the exposed part of your tooth and root planing in the pocket area.

Warning Signs of Periodontal Disease

Periodontal disease is a widespread problem, with recent studies suggesting that at least 35% of the population has periodontitis. Since periodontal disease does not generally result in pain until it becomes very advanced, it is referred to as a silent disease. Many people do not realize that they have it.

Warning signs of periodontal disease may include:

  • Persistent bad breath
  • Gums that bleed when you brush or floss your teeth
  • Red, swollen and tender gums
  • Gums that have pulled away from the teeth
  • Loose or separating teeth
  • Pus between the gums and teeth
  • A change in the way your teeth fit together when you bite.

What Are the Stages of Periodontal Disease and How Does it Progress?

The first stage of periodontal disease is inflammation of the gum or gingiva. It is referred to as gingivitis. It is the result of the body's attempt to fend off the bacteria occupying the tooth at the gum level. Blood vessels in the gum enlarge in order to allow white blood cells to enter the area, to attack or kill the adjacent bacteria. The result is that the gum will look red and maybe puffy, it will bleed more easily when brushing and flossing and it may feel tenderer to touch. The supporting bone around our teeth is not affected at this stage. Gingivitis can be controlled by improving our oral hygiene, and will reverse the problem. There are special forms of gingivitis that are not caused primarily by bacteria; among these forms of inflammation are gingivitis caused by fungus/viruses, some medications or hormone-related gingivitis at puberty or during pregnancy.

If gingivitis is not corrected, bacteria may alter or destroy the gum attachment to the tooth; this allows the bacteria to advance and form plaque on the root surface. Again, in an attempt to protect itself against this invasion, the body's immune system activity increases. In part, this active microscopic battle actually contributes to destruction of the tissues in the area. This process of protection/destruction is complex and influenced by many factors including general health, stress, some medications and smoking. The result of the gum and bone destruction is deepening of the pocket. As a result, dentists and hygienists will routinely measure pocket depths to assess the health and stability of your periodontal tissues.

The Relationship Between Periodontal Disease and Your Health

There is increasing evidence that supports a strong link between our oral health and our overall physical health and well being. In fact, there is a two-way association; periodontal health can affect your physical health and your physical health can affect your oral health.

Systemic diseases like poorly controlled diabetes, cancer, immunocompromised states such as AIDS/HIV infection to name a few, have strong links to worsened oral health. The method of action is often through impairment of the immune system, compromising our ability to control the infection by oral bacteria. Conditions such as osteoporosis can also contribute to periodontal deterioration in a susceptible individual, since the bone structure is less solid.

Oral infections like periodontal disease can also negatively impact our general health. Uncontrolled oral infections can have a negative effect on the ability to control blood sugar levels in diabetes. In recent years, there has been extensive research into the effect of poor periodontal health on cardiovascular disease and stroke risk, respiratory infections and pregnancy complications. There is a growing body of evidence to support a link between poorly controlled periodontal disease and difficulty controlling blood sugar levels in diabetes, an increased risk of a fatal heart attack and stroke (2X increase), respiratory problems (4.5X increase) and pre-term low-weight births (7X increase).