·          What is meant by the term periodontal disease?

·          Causes of periodontal diseases

·          Types of periodontal disease

·          Treatment of periodontal disease

Periodontal (gums) diseases

Periodontal (gum) diseases, including gingivitis and periodontitis, are serious infections that, left untreated, can lead to tooth loss. The word periodontal literally means "around the tooth." Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth.

Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) causes the gums to become inflamed.

In the mildest form of the disease, gingivitis, the gums redden, swell and bleed easily. There is usually little or no discomfort. Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with professional treatment and good oral home care.

Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.

Causes of Periodontal Disease

The main cause of periodontal disease is bacterial plaque, a sticky, colorless film that constantly forms on your teeth. However, factors like the following also affect the health of your gums.

1.       Smoking/Tobacco Use - tobacco use is linked with many serious illnesses such as cancer, lung disease and heart disease, as well as numerous other health problems. Tobacco users also are at increased risk for periodontal disease. Recent studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease.

2.       Genetics – Research proves that up to 30% of the population may be genetically susceptible to gum disease. Despite aggressive oral care habits, these people may be six times more likely to develop periodontal disease. Identifying these people with a genetic test before they even show signs of the disease and getting them into early interceptive treatment may help them keep their teeth for a lifetime.

3.       Hormonal changes in women – Pregnancy, Puberty, Menopause, Mensturation etc. - During these phases, women’s bodies experience hormonal changes which can affect many of the tissues in the body, including gums. Gums can become sensitive, and at times react strongly to the hormonal fluctuations. This makes gums more susceptible to diseases. Additionally, recent studies suggest that pregnant women with gum disease are seven times more likely to deliver preterm, low birth weight babies.

4.       Stress - is linked to many serious conditions such as hypertension, cancer, and numerous other health problems. Stress also is a risk factor for periodontal disease. Research demonstrates that stress can make it more difficult for the body to fight off infection, including periodontal diseases.

5.       Medications - Some drugs, such as oral contraceptives, anti-depressants, and certain heart medicines, can affect the oral health.

6.       Clenching & grinding of teeth (Bruxism) - can put excess force on the supporting tissues of the teeth and could speed up the rate at which these periodontal tissues are destroyed.

7.       Diabetes - is a disease that causes altered levels of sugar in the blood. Diabetes develops from either a deficiency in insulin production (a hormone that is the key component in the body's ability to use blood sugars) or the body's inability to use insulin correctly. Diabetic patients are at higher risk for developing infections, including periodontal diseases. These infections can impair the ability to process and/or utilize insulin, which may cause the diabetic status to be more difficult to control and the infection to be more severe than a non-diabetic.

8.       High LDL cholesterol levels – apart from causing coronary artery disease, high cholesterol levels have also been proven to cause periodontal disease.

9.       Other systemic diseases - Diseases that interfere with the body's immune system (eg. HIV infection, Hepatitis B infection etc.)  may worsen the condition of the gums.

10.    Poor nutrition - a diet low in important nutrients can compromise the body's immune system and make it harder for the body to fight off infection. Because periodontal disease is a serious infection, poor nutrition can worsen the condition of the gums.

Types of Periodontal Disease

There are many forms of periodontal disease. The most common ones include the following.

a)  Gingivitis - Gingivitis is the mildest form of periodontal disease. It causes the gums to become red, swollen, and bleed easily. There is usually little or no discomfort at this stage. Gingivitis is reversible with professional treatment and good at home oral care.

b)  Aggressive Periodontitis - A form of periodontitis that occurs in patients who are otherwise clinically healthy. Common features include rapid attachment loss and bone destruction and familial aggregation.

c)  Chronic Periodontitis - A form of periodontal disease resulting in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss and is characterized by pocket formation and/or recession of the gingiva. It is recognized as the most frequently occurring form of periodontitis. It is prevalent in adults, but can occur at any age. Progression of attachment loss usually occurs slowly, but periods of rapid progression can occur.

d)  Periodontitis as a Manifestation of Systemic Diseases - Periodontititis, often with onset at a young age, associated with one of several systemic diseases, such as diabetes.

e)  Necrotizing Periodontal Diseases - An infection characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions including, but not limited to, HIV infection, malnutrition and immuno-suppression.

Treatment of Periodontal Disease

Following are some of the procedures that are employed to treat patients diagnosed with a periodontal (gum) disease. The treatment is aimed at eliminating / controlling the main cause of periodontal disease -  the bacteria in the form of a sticky, colorless plaque that constantly forms on the teeth. However, treatment can be complete only when all factors causing / promoting periodontal (gum) diseases are brought under control .

A)  Non-Surgical Treatments

Scaling and root planing are the non-surgical treatment methods adopted to control periodontal disease. Scaling is the procedure that meticulously removes plaque and tartar (the adherent, sticky substance on teeth containing toxins and micro-organisms). This is done in order to obtain a healing response. Root planing is a careful cleaning of the root surfaces to remove plaque and calculus [tartar] from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins. These procedures are followed by adjunctive therapy such as local delivery antimicrobials. Many patients do not require any further active treatment, including surgical therapy. However, the majority of patients will require ongoing maintenance therapy to sustain health. Non-surgical therapy does have its limitations, however, and when it does not achieve periodontal health, surgery may be indicated to restore periodontal anatomy damaged by periodontal diseases and to facilitate oral hygiene practices.

B)  Periodontal Surgery

Periodontal surgery turns necessary when the tissue around the teeth is unhealthy and cannot be repaired with non-surgical treatment. Following are the four types of surgical treatments most commonly prescribed:

• Pocket Reduction Procedures – Periodontal pockets are formed when gums recede from the tooth surface as a result of gum disease, forming clefts between the tooth and the gums. These clefts or pockets facilitate accumulation of food debris and plaque. Reduction / elimination of these pockets by surgical means is essential to maintain periodontal health.

• Regenerative Procedures - Eliminating existing bacteria and regenerating bone and tissue helps to reduce pocket depth and repair damage caused by the progression of periodontal disease. Membranes (filters), bone grafts or tissue- stimulating proteins are used to encourage the body's natural ability to regenerate bone and tissue in these procedures. GTR (Guided Tissue Generation) methods come under this category of procedures.

Bone Substitute Grafting to fill bone defects

Bone growth seen around the diseased tooth after pulpo-periodontal therapy

• Crown Lengthening -  excess gum and bone tissue is reshaped to expose more of the natural tooth. This can be done to one tooth, to the entire gum line, or to several teeth to expose a natural, broad smile.

• Soft Tissue Grafts - Soft tissue grafts can be used to cover roots or develop gum tissue where absent due to excessive gingival recession. During this procedure, gum tissue from the palate or another donor source is taken to cover the exposed root. This can be done for one tooth or several teeth to even to the gum line. This procedure also helps in reducing dental sensitivity to a large extent.

Ridge augmentation – when one or more teeth are lost, an indention may develop in the gums and jawbone where the tooth used to be. This happens because the jawbone recedes when it no longer is holding a tooth in place. Not only is this indentation unnatural looking, it also causes the replacement tooth to look too long compared to the adjacent teeth. This “defect” can be filled by a procedure called ridge augmentation, recapturing the natural contour of the gums and jaw. A new tooth can then be created that is natural looking, easy-to-clean and beautiful.

RIDGE AUGMENTATION DONE TO ELIMINATE INDENTATION

C)  The Use of Lasers in Periodontal Therapy

• Limited research suggests that the use of lasers as an adjunct to scaling and root planing (SRP) may improve the effectiveness of this procedure. In addition, when the lasers are used properly during periodontal therapy there can be less bleeding, swelling and discomfort to the patient during surgery.

If you wish to have more information on periodontal disease and its management, please email us to   drprasanth@pramodclinic.com

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