Periodontitis is a disease of the gums and jaw bone. This condition tends to be progressive (it gets worse over time if it is not treated). Periodontitis usually starts out as gingivitis, a simple inflammation of the gums. At the very early stages, gum inflammation is often fairly easy to treat and many patients fully recover. However, untreated periodontitis can result in erosion of the gums and jawbone, and eventual tooth loss. Chronic periodontitis has also been linked to systemic infection, an apparent risk factor for serious health conditions such as heart disease and stroke.
How Can You Identify Periodontitis?
The symptoms for periodontitis are similar to those for gingivitis and include:
- Gum redness
- Swollen or puffy gum tissue
- Bleeding gums
- Receding gum line
- Bad breath
More advanced symptoms of gum disease include teeth that are loose or shifting out of alignment. By the time this occurs, periodontitis is much more difficult to treat.
What Causes Periodontitis?
The most common cause of periodontitis (as with gingivitis) is poor oral hygiene that allows plaque and tartar to remain in the mouth. Periodontitis occurs when plaque and tartar build up between the gums and the roots of the teeth. The irritation from the tartar rubbing against the gums causes the gums to pull away from the teeth. The gap becomes filled with anaerobic bacteria, food debris and the byproducts of the immune system trying to fight the infection. These pockets get deeper over time, eventually affecting the bones and gums supporting the teeth.
Who Is Most Likely to Get Periodontitis?
There is a strong genetic component for periodontitis (about 30 percent of the population is prone to developing this condition). If you have family members with gum disease, you may be at an even greater risk. Age is also strongly correlated with gum disease with more than eight out of 10 patients over the age of 70 showing signs of periodontitis. Here are additional risk factors:
- Hormonal changes (pregnancy, menopause, use of oral contraceptives)
- Diet high in acidic and sugary foods
- Autoimmune disorders
- Bite misalignment, tooth clenching, poorly structured tooth restorations
- Wisdom teeth not extracted in a timely manner
How Is Periodontitis Treated?
A dentist or periodontist makes a clinical diagnosis of periodontitis based on the depth of the “pockets” of infected material along the gum line. The deeper the pockets, the more severe the infection. The first step in treating periodontitis is the removal of dental calculus (plaque). This is done through a process called scaling that involves scraping the plaque off of all tooth surfaces above and below the gum line. This is followed by root planing. This is a technique for smoothing of the tooth root below the gum line to reduce the ability of bacteria to colonize the root surface.
The pockets along the gums are cleaned of bacteria and debris. An anti-bacterial product may be prescribed for the patient to use at home in custom-molded mouth trays every day to keep bacteria to a minimum. Or, the periodontist may inject an antibiotic agent directly into the infected pockets. Oral antibiotics such as doxycycline are also commonly prescribed after root planing. More extensive periodontal disease may be treated with osseous surgery. Such procedures include pocket reduction, gum and bone grafting and tissue regeneration.
Ongoing Periodontitis Management
At home oral care with diligent brushing, flossing and mouthwash use is key to maintaining results from periodontal treatment. This is usually combined with more frequent prophylactic or periodontal cleanings. Once the gums begin to heal, it is often possible to prevent the recurrence of periodontitis with good oral hygiene. However, if there are additional risk factors in play, the disease may still return. All patients who have been diagnosed with periodontitis should have their gum health regularly monitored by their dentist or periodontist to ensure the condition has not recurred.