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Periodontitis, also known as gum disease, is a severe bacterial infection affecting the soft tissues surrounding your teeth. It initiates as inflammation in these tissues and, when left untreated, can progressively harm the bone supporting your teeth, potentially resulting in tooth looseness or loss. Preventing periodontitis largely hinges on oral care practices, including brushing teeth at least twice daily, daily flossing, and maintaining regular dental checkups.
Periodontal disease progresses through four stages, each with increasing severity:
- Gingivitis: This is the early stage, where gums become red and swollen, but there’s no bone loss. Gingivitis is reversible with better oral hygiene and regular dental cleanings.
- Mild periodontitis: If gingivitis is not treated, it progresses to this stage. Gums recede, forming pockets where plaque and bacteria gather. Some bone loss begins
- Moderate periodontitis: More bone loss occurs, leading to sore and tender gums. Ligaments and soft tissues supporting teeth continue to deteriorate.
- Severe periodontitis: Untreated periodontitis can reach this advanced stage. Significant bone loss may result in loose teeth and chronic bad breath due to infection.
Symptoms
The color of healthy gums can be different, like light pink in some people or darker pink and brown in others. Gums that are in good health feel strong to touch and wrap the teeth tightly.
With periodontitis, the gums are swollen or inflamed. Other symptoms may include:
- Sensitive gums that feel soft to the touch
- Easy to bleed gums
- Bad breath
- Gums that are reddish or purple
- Tooth decay
- Tooth loss
- Difficulty chewing
- Infection or pus along the teeth and gum line
- Spitting blood while using a toothbrush or dental floss
- A toothbrush that appears pink after brushing
- Gum recession, or the gums pulling away from the teeth
- Newly formed holes or gaps between the teeth
- Teeth that fit differently
If you notice any indications of gum disease, such as redness, pain, or bleeding in your gums, it is advisable to seek diagnosis and essential treatment from a healthcare provider promptly. Delaying action can lead to a faster progression of the infection, possibly necessitating more extensive interventions. The chances of reversing damage caused by periodontitis are higher when treatment is initiated early. It is generally recommended to adhere to the suggested schedule for regular dental check-ups.
Causes
The primary cause of periodontitis is inadequate dental hygiene. Plaque and tartar accumulation on the tooth surfaces harbor harmful bacteria, serving as the initial catalyst for the onset of periodontitis. These detrimental bacteria contribute to the erosion of the tooth-supporting structures, leading to infection, bone depletion, and ultimately, tooth loss. If left untreated, plaque has the potential to progress into periodontitis.
- Plaque builds up on the teeth: This is when the sugars and starches in the food mix with the bacteria that naturally exist in the mouth. Plaque is removed by brushing twice a day and flossing once a day, but it returns very rapidly.
- Plaque can solidify into tartar behind the gum line: If left on the teeth. The longer plaque and tartar remain on the teeth, the more harm they can cause because they are full of bacteria. Brushing and flossing will not get rid of the plaque, a professional dental cleaning is required. It takes more effort to get rid of tartar.
- Plaque can lead to gingivitis: It is when the gum tissue around the teeth’s base becomes irritated and swollen. Gingivitis can be fixed with professional help and proper oral care at home, but it must be treated promptly to prevent any bone damage. It is known as the least severe type of gum disease.
- Continual gum inflammation can lead to periodontitis: Persistent inflammation can burden the immune system and lead to other health issues. If left untreated, these deep infections result in the loss of gum tissue and bone, and one might eventually lose one or more teeth. It creates deep gaps between the gums and teeth. These gaps fill up with plaque, tartar, and bacteria, and they get even deeper as time goes on.
Risk factors
Numerous factors can elevate an individual’s susceptibility to developing periodontitis, including:
- Poor oral hygiene
- Genetics and family history
- Smoking
- Gingivitis
- Being overweight
- Hormonal changes in women and those who were born with a feminine gender preference, such as pregnancy or the use of birth control pills
- Using drugs for pleasure, such as vaping or smoking marijuana
- Immunosuppressive conditions such leukemia, HIV/AIDS, and cancer treatment
- Poor nutrition, especially a deficiency in vitamin C
- Associated diseases, like arthritis, diabetes, Crohn’s disease, COVID-19, and cardiovascular disease
- Some medications that alter gums or produce dry mouth
Diagnosis
The diagnosis of periodontitis involves asking the symptoms, examining one’s medical history for any elements that might be connected to the symptoms, and looking for plaque and tartar accumulation in the mouth, as well as any signs of easy bleeding.
The stage of periodontitis is determined based on the severity of the condition, the difficulty of the required care, one’s own risk factors, and general health. To confirm the diagnosis, other tests may be required, such as:
- Dental X-rays: This imaging test can identify oral health problems like cavities and gum disease before they get worse. This is often requested to look for bone loss when the healthcare provider notices wider pockets.
- Measurement of pockets between the gums and teeth: The pocket depth in a healthy mouth typically ranges between 1 and 3 millimeters. Greater than 4 mm-deep pockets might be a sign of periodontitis. With ordinary treatment, pockets that are 5 mm or deeper cannot be effectively cleaned. This procedure requires inserting a small ruler known as a dental probe between the teeth and gumline to determine the depth of the pockets between the gums and the teeth.
Treatment
Treatment for periodontitis depends on the extent of the gum disease. The objective of treatment is to fully resolve the pockets around the teeth and protect the surrounding bone and gum tissue from harm. Consistent daily oral hygiene routines, addressing any medical conditions that may impact dental health, and quitting smoking can be beneficial in managing the condition. Typically, treatment for periodontitis encompasses a combination of surgical and non-surgical approaches.
- Nonsurgical treatments: For mild to moderate cases of periodontitis:
- Antibiotics: Oral antibiotics may be prescribed to combat infection. Topical antibiotics may be applied under the patient’s gums to target the affected area. It might also take the form of antibiotic mouthwashes.
- Scaling: During the procedure, a vibrating tool called an ultrasonic scaler is used. The scaler’s vibrating metal tip removes tartar above the gums, a water spray washes it away, and any remaining bits of tartar are scraped off with a manual tool called a curette.
- Root planning: This procedure is like a deep cleaning for the teeth. The healthcare provider carefully cleans the roots of the teeth under the gums, making them smooth. In some cases, an antibiotic medication is applied directly into the gum pockets to help with any infection. This helps in re-attaching the gums to the teeth.
- Surgical treatments: For moderate to severe periodontitis:
- Flap surgery: In flap surgery, the gum tissue is momentarily lifted away from the teeth by creating an incision along the gum line. This allows for more efficient scaling and root planning by exposing the tooth roots. If bone loss has occurred due to infection, the healthcare provider may perform a procedure to reshape the underlying bone ridge. This alteration makes it significantly easier to maintain proper cleaning and hygiene in the treated areas once they have healed. This procedure is also known as pocket reduction surgery.
- Soft tissue grafts: This procedure can prevent additional gum loss, cover exposed roots, and improve the appearance of the teeth. It involves taking a small amount of tissue from the roof of the mouth or obtaining it from another donor source and attaching it to the affected area. When gum tissue is lost, it can cause the gumline to recede, revealing parts of the tooth roots. Some of the tissue that has been injured may need to be reinforced through soft tissue grafts.
- Bone grafting: Graft serves as a support structure for new bone growth with the goal of reducing the person’s risk of future infections and tooth loss. In this process, bone-grafting material is placed in the areas where bone tissue has been lost, which can be the person’s own bone, donated bone, or synthetic material. Bone grafting is often recommended when periodontitis destroys the bone surrounding the tooth root.
- Guided tissue regeneration: In this procedure, a special membrane between the existing bone and the tooth is placed. This membrane stops unwanted tissue from growing and enables bone that was damaged by bacteria to regenerate instead.
- Tissue-stimulating proteins: A gel that encourages the formation of healthy bone and tissue and contains the same proteins that are present in forming tooth enamel may be applied directly to the affected tooth root.
- Platelet-rich plasma (PRP): During the procedure, the healthcare provider collects a blood sample from the individual and uses a centrifuge to separate the platelet-rich plasma from the red and white blood cells. The platelet-rich plasma is then placed in the deficient areas to stimulate the growth of new bone tissue. PRP can aid in the regeneration process among people who experienced bone or gum tissue loss.
