Periodontal (gum) diseases , including gingivitis and periodontitis, are serious infections that, if 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.

Types of Gum Disease

Gingivitis ("inflammation of the gums”) around the teeth is a general term for gingival diseases affecting the gingiva (gums). As generally used, the term gingivitis refers to gingival inflammation induced by bacterial biofilms (also called plaque) adherent to tooth surfaces. There is usually little or no discomfort from suffering gingivitis; it is often caused by inadequate oral hygiene, and is reversible with professional treatment and good oral home care. Untreated gingivitis, however, can advance to periodontitis.

Periodontitis (formerly known as Pyorrhea alveolaris) is the name of a collection of inflammatory diseases affecting the tissues that surround and support the teeth. Periodontitis involves progressive loss of the bone around teeth, which may lead to loosening and eventual loss of teeth if untreated. Periodontitis is caused by bacteria that adhere to and grow on tooth surfaces (microbial plaque or biofilms), particularly in areas under the gum line.

Treatment of Gum Disease

People with a healthy periodontium (gums, bone and ligament) or people with gingivitis only require periodontal debridement every 6 months. However, many dental professionals only recommend periodontal debridement (cleanings) every 6 months, because this has been the standard advice for decades, and because the benefits of regular periodontal debridement (cleanings) are too subtle for many patients to notice without regular education from the dental hygienist or dentist.

A dentist or dental hygienist will perform a thorough cleaning of the teeth and gums; following this, persistent oral hygiene is necessary. The removal of plaque is usually not painful, and the inflammation of the gums should be gone between one and two weeks. A gargling of brine water also helps.

Oral hygiene including proper brushing and flossing is required to prevent the recurrence of gingivitis. Anti-bacterial rinses or mouthwash, in particular chlorhexidine digluconate 0.2% solution, may reduce the swelling and local mouth gels which are usually antiseptic and anesthetic can also help.

If good oral hygiene is not yet already undertaken daily by the patient, then twice daily brushing with daily flossing, mouth-washing and use of an interdental brush needs to be started. Technique with these tools is very important. Aged persons may find that use of these interdental devices more necessary and easier, since the gaps between the teeth may become larger.

A dental hygienist or a periodontist can use professional scraping instruments, such as scalers and currettes, to remove bacterial plaque and calculus (formerly referred to as tartar) around teeth and below the gumline. There are devices that use a powerful ultrasonic vibration and irrigation system to break up the bacterial plaque and calculus. Local anesthetic is commonly used to prevent discomfort in the patient during this process.

Sometimes bone grafting surgery may be tried, but this has mixed success. Bone grafts are more reliable in instances of vertical defects, where there might be a sufficient "hole" within which to place the added bone. Horizontal defects are rarely if ever able to be grafted properly, as there is nowhere to secure the bone.

Dentists sometimes attempt to treat patients with periodontitis by placing tiny wafers dispensing antibiotics underneath the gumline in affected areas. However, the general scientific consensus is that antibiotic treatment is of minimal value in treating bone loss due to periodontitis. It may help to recover about one millimeter of bone, but it is questionable if this is of significant therapeutic value.

Alternatively, regular subgingival flushing with an anti-calculus composition can dissolve subgingival calculus (tartar), thus facilitating natural healing without surgery. This process is widely used for supragingival tartar via tartar-control toothpastes. Subgingival application of an anti-calculus composition requires a subgingival syringe or an oral irrigator.

One such anti-calculus composition (Periogen) contains sodium tripolyphosphate, tetrapotassium pyrophosphate, sodium bicarbonate, citric acid and sodium fluoride. In the composition, tetrapotassium pyrophosphate (TKPP) is a cleaning agent designed to clear away biofilms in order to facilitate chemical access to calculus.

Sodium tripolyphosphate (STPP) acts as the anti-calculus agent, activated by sodium fluoride (.04%), providing a chelating action on the structure of the calculus. Sodium bicarbonate and citric acid are product activators which assist in dissolving the composition in water for periodontal delivery via a subgingival syringe or oral irrigator with a periodontal tip.

Prevention of Gum Disease

Daily oral hygiene measures to prevent periodontal disease (both gingivitis and periodontitis) include:

• Brushing properly on a regular basis (at least twice daily), with the patient attempting to direct the toothbrush bristles underneath the gumline so as to help disrupt the bacterial growth and formation of subgingival plaque and calculus.
• Flossing daily and using interdental brushes (if there is a sufficiently large space between teeth), as well as cleaning behind the last tooth in each quarter.
• Using an antiseptic mouthwash. Mouthwash based on chlorhexidine gluconate or hydrogen peroxide, in combination with careful oral hygiene, may cure gingivitis, although they cannot reverse any attachment loss due to periodontitis (and alcohol based mouthwashes may aggravate the condition).
• Regular dental checkups and professional teeth cleaning as required. Dental checkups serve to monitor the person’s oral hygiene methods and levels of attachment around teeth, identify any early signs of periodontitis, and monitor response to treatment.

Typically dental hygienists (or dentists) use special instruments to clean (debride) teeth below the gumline and disrupt any plaque growing below the gumline. This is a standard treatment to prevent any further progress of established periodontitis. Studies show that after such a professional cleaning (periodontal debridement), bacteria and plaque tend to grow back to pre-cleaning levels after about 3-4 months.

Cleanings every 3-4 months might be expected to also prevent the initial onset of periodontitis. However, analysis of published research has reported little evidence either to support this or the intervals at which this should occur. Instead it is advocated that the interval between dental checkups should be determined specifically for each patient between every 3 to 24 months.

Nonetheless, the continued stabilization of a patient’s periodontal state depends largely, if not primarily, on the patient’s oral hygiene at home if not on the go too. Without daily oral hygiene, periodontal disease cannot be overcome, especially if the patient already has a history of extensive periodontal disease.

Causes of Gum Disease

Gingivitis

Gingivitis is usually caused by bacterial plaque that accumulates in the small gaps between the gums and the teeth and in calculus (tartar) that forms on the teeth. These accumulations may be tiny, even microscopic, but the bacteria in them produce foreign chemicals and toxins that cause inflammation of the gums around the teeth. This inflammation can, over the years, cause deep pockets between the teeth and gums and loss of bone around teeth otherwise known as periodontitis.

Since mandibular bone holds the teeth into the jaws, the loss of bone can cause teeth over the years to become loose and to eventually fall out or need to be extracted because of acute infection. When the teeth are not cleaned properly by regular brushing and flossing, bacterial plaque accumulates, and becomes mineralized by calcium and other minerals in the saliva, transforming it into a hard material called calculus (tartar) which harbors bacteria and irritates the gingiva (gums). Also, as the bacterial plaque biofilm becomes thicker, an anoxygenic environment is created, allowing more pathogenic bacteria to flourish and release toxins and cause gingival inflammation.

Periodontitis

Periodontitis is an inflammation of the periodontium or the tissues that support the teeth in the mouth. The periodontium is comprised of:

• The gingiva, or gum tissue.
• The cementum, or outer layer of the roots of teeth.
• The alveolar bone, or the bony sockets into which the teeth are anchored.
• The periodontal ligaments (PDLs), which are the connective tissue fibres that connect the cementum and the gingiva to the alveolar bone.

If left untreated, periodontitis causes progressive bone loss around teeth, looseness of the teeth and eventual tooth loss. Periodontitis is a very common disease affecting approximately 50% of U.S. adults over the age of 30 years. Periodontitis is thought to occur in people who have preexisting gingivitis, an inflammation that is limited to the soft tissues surrounding the tooth and does not cause bone loss on its own.

In some people, gingivitis progresses to periodontitis, where the gum tissues separate from the tooth and form a periodontal pocket. Subgingival bacteria (those that exist under the gum line) colonize the periodontal pockets and cause further inflammation in the gum tissues and progressive bone loss.

Examples of secondary etiology would be those things that cause plaque accumulation, such as restoration overhangs and root proximity. The excess restorative material that exceeds the natural contours of restored teeth, such as these, are termed overhangs, and serve to trap plaque, potentially leading to localized periodontitis.

Symptoms of Gum Disease

Symptoms of Gingivitis

• Swollen gums.
• Mouth sores.
• Bright-red or purple gums.
• Shiny gums.
• Gums which are painless, except when pressure is applied.
• Gums that bleed easily, even with gentle brushing, and especially when flossing.
• Gums that itch with varying degrees of severity.
• Receding gumline.

Symptoms of Periondontitis

• Occasional redness or bleeding of gums while brushing teeth, using dental floss or biting into hard food; that is, apples (though this may occur even in gingivitis, where there is no attachment loss).
• Occasional gum swellings that recurs.
• Halitosis, or bad breath, and a persistent metallic taste in the mouth.
• Gingival recession, resulting in apparent lengthening of teeth. (This may also be caused by heavy handed brushing or with a stiff tooth brush).
• Deep pockets between the teeth and the gums (pockets are sites where the attachment has been gradually destroyed by collagen-destroying enzymes, known as collagenases).
• Loose teeth, in the later stages (though this may occur for other reasons as well).

In any case, now that you know how to handle and avoid gum disease, your gums and teeth will be safe once again. Just remember to make use of these tips and information before it’s too late.