Periodontal Disease
Periodontal Definitions
- Calculus:
Plaque bacteria that were never removed completely
with brushing and flossing.
The hard deposit of mineralized plaque that forms on the crown and/or root
of the tooth. Also referred to as tartar.
- Gingiva:
The soft tissue that covers the jawbone. Also referred to as the gums.
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| healthy |
- Gingivectomy:
The surgical removal of
gingiva (gum).
- Gingivitis:
An inflammation
or infection of the gingiva (gum tissue); the initial stage of periodontal disease.
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| gingivitis |
- Gingivoplasty:
A surgical
procedure to reshape or repair the gingiva (gum).
- Graft:
A piece of gum tissue or
synthetic material placed in contact with tissue to repair a defect or
supplement a deficiency.
- Gum:
See gingiva.
- Periodontal:
Relating to the
tissue and bone that supports the tooth (from peri, meaning
"around," and odont, "tooth").
- Periodontal
disease:
The inflammation and infection of gums, ligaments, bone,
and other tissues surrounding the teeth. Gingivitis (gums) and periodontitis
(gums and bone) are
the two main forms of periodontal disease. Also called gum disease or
pyorrhea.
- Periodontal pocket:
An
abnormal deepening of the gum crevice. It is caused when disease and
infection destroy the ligament that attaches the gum to the tooth and the
underlying bone.
- Periodontal surgery:
A
surgical procedure involving the gums and jawbone.
- Periodontics:
The dental specialty
that deals with and treats the gum tissue and bone that supports
the teeth.
- Periodontist: Dental specialist with
expertise in surgically treating the effects of periodontal disease.
- Periodontitis:
Inflammation
of the supporting structures of the tooth, including the gum, the
periodontal ligament, and the jawbone.
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| periodontitis |
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advanced
periodontitis |
- Plaque:
A film of sticky
material containing saliva, food particles, and bacteria that attaches to
the tooth surface both above and below the gum line. When left on the tooth
it can promote gum disease and tooth decay.
- Tartar:
See calculus.
Frequently Asked Questions
What is periodontal disease?
Periodontal disease, also called gum disease, periodontitis, or pyorrhea, is a
complex disease which can be acute or chronic with flare-ups and quiet periods,
like any chronic disease. Periodontal disease involves the inflammation of the gum
tissue, and the resulting destruction of the bone that holds the teeth in the
jaw by the inflammatory process. It is the number one cause of tooth loss in
adults. Periodontal disease also has implications for increased risk for
other health problems, click here.
What causes periodontal disease?
In its most basic form, the answer to this
question is bacteria. There are over 450 different species of bacteria that can live
in our mouths, some of which cause periodontal disease. The current
understanding of periodontal disease attributes 50% of the destruction directly
to the bacterial toxins and 50% to the inflammatory process that they trigger in
our own immune systems.
Thanks to Mr. Bill Landers,
president at
OraTec
for his expertise, review and comments. |
Are there contributing factors
in periodontal disease?
Yes: how effectively you clean your teeth, the type(s) of bacteria
present, tooth position and alignment, your general health and resistance, saliva (amount, pH, viscosity),
medications you may be taking, cigarettes and tobacco products are some of the
most significant factors.
The importance of gum tissue.
The gum tissue around the teeth overlies the bone that holds our
teeth in place. The top of the gum that is visible is approximately 2-3
millimeters (one millimeter is about the thickness of a dime) higher than the actual attachment of the
gum to the tooth in health,
making a space similar to a turtleneck collar. Within this space,
bacteria live and multiply. These bacteria produce
toxins that cause our bodies to respond in a localized reaction called inflammation.
In periodontal disease, the fibers that attach the gum to the tooth are destroyed by the
process of inflammation. Once these fibers are damaged,
the bacterial infiltration can continue to deeper levels of the gum and bone
typifying the advancing nature of periodontal disease.
What is gingivitis?
Gingivitis is inflammation of the gums and is apparent with red gums that
can bleed upon touching (brushing and/or flossing). Because inflammation of
the gums must occur before the bone is destroyed, gingivitis, or inflammation of
the gums is the precursor to periodontal disease. Gingivitis may persist for
years before the inflammatory process allows destruction of the bone to occur.
The important thing to note about gingivitis is that it cannot be distinguished
from periodontal disease simply by observation. To determine if someone has gingivitis
or periodontal disease, a periodontal examination must be performed.
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gingivitis |
What is a periodontal examination?
A number of components contribute to a thorough periodontal examination:
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periodontal probe |
- visual evaluation of the teeth
and gums, including measuring the crevice depth around each tooth
(periodontal probing)
- x-ray evaluation of supporting
bone, click here about types of x-rays
- review and evaluation of health
and dental history
(habits, medications)
- evaluation of bite and tooth
position (including models of
teeth)
- microscopic examination of
plaque, click here
- other appropriate diagnostic
aids as indicated
How do I know if I have periodontal disease?
While there are a number of signs and even some symptoms of periodontal disease, the only true way to determine if
periodontal disease is present is by having a periodontal exam. Even x-rays do not show many areas where the bone may have been
destroyed. However, here are some signs to look for:
- Gums that bleed when you brush your teeth. (This may
appear as a "pink toothbrush".)
- Gums that are red, swollen or tender.
- Gums that have pulled away from the teeth.
- Pus between the teeth and gums when pressed.
- Permanent teeth that are loose or separating.
- Any change in the way your teeth fit together when
you bite.
- Any changes in the fit of your partial denture.
- Bad breath or bad taste.
Are there different types of periodontal disease?
By far the most prevalent form of periodontal disease is adult
periodontitis. This is classified into mild, moderate and severe types,
depending on the amount of bone loss. Mild periodontitis occurs when the probing
depths of the gum crevice range from 4-5 millimeters. Moderate
periodontitis is designated for probing
depths between 6-7 millimeters, while severe periodontitis occurs when
depths of 8 millimeters or above are observed. Since tooth roots average between
10-12 millimeters long, the deeper the pocket (higher the measurement) the more
severe the disease and the greater chance for tooth loss. Different readings can
occur around different sides on the same tooth.
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severe
periodontitis |
Is periodontal disease
transmissible?
Yes. See more about a microscopic examination of plaque,
click
here.
What are the treatments for periodontal disease?
Treatment for periodontal disease depends on the severity of the problem.
What all types of treatment
do is to reestablish healthy gums that can be maintained and act as a barrier to future disease.
Bacteria must be effectively and thoroughly removed on a daily basis for permanent success to occur.
The first type of
treatment involves what is called deep scaling
or root
planing. It is the most conservative treatment
available and is commonly called the Non-Surgical approach. This is almost always done with local anesthetic and rarely
causes residual discomfort. In many cases it is best to do each pocket more than
once as it is impossible to remove all deposits and debris in the deeper
pockets on the first treatment. When successful, the gum will reattach at a
higher level than before thus reestablishing a better barrier to the bacteria
and the disease process will be eliminated. There are many ways to enhance these
results, including first among these improved homecare techniques. Other
treatment options include antibiotics and advanced therapy such as
Periostat
(collagenase inhibitor).
The second major
treatment is surgery.
Surgery is not a cure for the disease. Surgery helps create a more
maintainable periodontal situation. The simplest type of surgery is called a
gingivectomy. A gingivectomy is the surgical
removal of the diseased gum tissue with the healing of the gum at a lower level.
Depending on the pocket depth, this may involve massive tissue loss. More common
are "flap" procedures. While there are different types of "flaps"
and different techniques, the goal is to temporarily move the gum back during
the surgery, remove the underlying disease process and if necessary, change the
contour of the bone. The gum tissue is then sutured back in place.
With successful healing, the gum will reattach at a higher level than it was when the
disease process was present, although never back to where it was originally.
Other surgical techniques include the implantation of new bone and the use of a
synthetic bone matrix that stimulates bone growth. The last treatment is the use of
extractions, or removal of the teeth. Certainly, the goal of any treatment is to
save the teeth, however there are times when the bone destruction is so great
around one or more teeth that it threatens to infect the tooth next to it.
If
the adjacent tooth has a level of bone that can successfully be treated by one of
the methods mentioned above, yet its next door neighbor cannot, then removal of
the hopeless tooth can only help the long term prognosis.
It is not uncommon to find
periodontally involved teeth often respond positively to root canal
treatment. Many studies have shown periodontal disease causing bacteria
within the tooth. Even with antibiotic treatment these bacteria are not
eliminated.
Some upper molars, which usually
have three roots, often respond positively to the removal of one of the smaller
roots - this is referred to as a root amputation.
Tooth position and bite are very
significant factors. When the forces on teeth are more than the supporting
bone and gum can withstand the underlying periodontal disease can be
aggravated. The ultimate successful treatment of periodontal disease
usually involves some sort bite adjustment and/or orthodontic treatment (braces).
It cannot be
emphasized enough that while treatment may re-establish a healthy gum condition,
if the bacteria are not regularly and effectively removed, the disease will
reappear.
What is gum recession?
Gum recession occurs when the
gum and supporting bone are destroyed so that the top of the gum recedes
away from the biting edge or chewing surface. This is the origin of the
expression "long in the tooth". Gum recession is most often caused by
too much force on teeth; however, it can be also be caused by periodontal
disease (NOTE: it is not caused by toothbrushing,
click
here). Gum recession caused by periodontal disease most commonly occurs
where the inflammation caused by the disease process destroys the
attachment of the gum progressively down the root.
What can be done about gum recession?
Treatment options
depend on the nature of the problem and the cause. If root surface sensitivity
occurs,
early treatment may simply involve desensitizing the root surface.
Sometimes a bonded filling can serve as a
barrier to temperature. Grafting of gum tissue is very common and
successful for noticeable cases of recession. If the bite is the
significant underlying cause, then a bite adjustment
and/or orthodontic treatment (braces) is indicated.
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