Periodontal Disease
from Gingivitis to Periodontitis and Treatment

Gingivitis

The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called "gingivitis."  In gingivitis, the gums become red, swollen and can bleed easily.  Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.

Periodontitis

When gingivitis is not treated, it can advance to "periodontitis" (which means "inflammation around the tooth.")  In periodontitis, gums pull away from the teeth and form "pockets" that are infected. The body's immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body's enzymes fighting the infection actually start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and connective tissue that support the teeth are destroyed.  The teeth may eventually become loose and have to be removed.   

Risk Factors 

• Smoking.  Need another reason to quit smoking?  Smoking is one of the most significant risk factors associated with the development of periodontitis.  Additionally, smoking can lower the chances of success of some treatments.
• Hormonal changes in girls/women.  These changes can make gums more sensitive and make it easier for gingivitis to develop.
• Diabetes.  People with diabetes are at higher risk for developing infections, including periodontal disease.
• Stress.  Research shows that stress can make it more difficult for our bodies to fight infection, including periodontal disease.
• Medications.  Some drugs, such as antidepressants and some heart medicines, can affect oral health because they lessen the flow of saliva.  (Saliva has a protective effect on teeth and gums.)
• Illnesses.  Diseases like cancer or AIDS and their treatments can also affect the health of gums.
• Genetic susceptibility.  Some people are more prone to severe periodontal disease than others.

How is periodontal disease treated?

The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease.  Any type of treatment requires that the patient keep up good daily care at home.  Additionally, modifying certain behaviors, such as quitting tobacco use, might also be suggested as a way to improve treatment outcome.

Deep Cleaning (Scaling and Root Planing)

The dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing.  Scaling means scraping off the tartar from above and below the gum line.  Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease. Deep cleaning is the initial non surgical treatment and ussually is done with local anesthesia. Post-operative is painless.

Medications

Medications may be used with treatment that includes scaling and root planing, but they cannot always take the place of surgery. Depending on the severity of gum disease, the dentist or periodontist may still suggest surgical treatment. Long-term studies will be needed to determine whether using medications reduces the need for surgery and whether they are effective over a long period of time.

Periodontal Surgery

The surgical procedure involves opening the gums around the teeth in order to clean the roots and the bone lost areas. The bone is trimmed and/or filled with bone graft material and protected with a collagen membrane. Post-operative is managed with pain medication and antibiotics most of the times.

See also

The Oral Systemic connection

Link Between Periodontal Disease and Heart Attack PDF