Causes of Periodontal Disease
Periodontal disease is a disease of the gums and bone which support the teeth. It affects, to one degree or another, a vast majority of the adult population in the United States. The beginning of the disease manifests itself as an inflammation of the gums known as gingivitis. If left untreated, the disease may progress to periodontitis, which in its early stages will effect the bone levels around existing teeth. As the disease progresses more and more bone is lost. In advanced periodontitis, tooth loss is the inevitable outcome. The disease process is due to a bacterial infection of the gums and the bone that supports the teeth.
The bacteria colonize in the gingival tissue. This bacterial colonization will lead to gingival inflammation, causing a pocket to form between the teeth and the gums. If these bacterial colonies are removed promptly, in the early stage of the disease process known as gingivitis, the effects of the disease are completely reversible. If these bacterial colonies are left untreated, however, the disease process will spread to the underlying bone and will begin to destroy it. As teeth lose their supporting bone, they will get loose and may eventually be lost..
Common Causes of Gum Disease
While intraoral environmental factors play the major role in the development of periodontal disease, studies have shown familial tendency to develop the disease. The best way to prevent the disease, however, is through the use of easy preventative measures, which if adhered to, may in most cases prevent the onset of the disease process completely.
Here are some of the most common causes of gum disease:
- Poor oral hygiene:
Good oral home care, including proper brushing and flossing, a healthy diet and regular dental visits are the best way to maintain good oral hygiene and prevent the build up of plaque and calculus. In the absence of good oral hygiene, plaque and calculus will accumulate on the teeth and will effect the gum and the supporting bone structure leading to gingivitis and periodontitis.
- Tobacco use:
Among the most significant causes of periodontal disease is tobacco use. Smokers are far more likely to develop periodontal disease, will build up plaque at a faster pace and are less likely to respond positively to periodontal treatments than are non-smokers.
- Genetic or familial predisposition:
Studies have shown that nearly 30% of the population has either a familial or genetic predisposition to periodontal disease. These patients will be six times more likely to suffer the consequences of periodontal problems than the general population. Even with outstanding oral home care, these patients tend to develop the symptoms of the disease. It is imperative that this segment of the population be seen by a periodontist on a regular basis to assess the development and progress of periodontal disease.
- Pregnancy and menopause:
Pregnancy and the hormonal changes associated with it tend to lead to the development of gingivitis. It is imperative to have a meticulous oral hygiene regimen during pregnancy.
- Chronic stress and poor diet:
Poor diet and a high level of stress tend to lower the bodyâ€™s ability to fight off infection and weaken the immune system in general. These contributing factors will effect oral health to a great degree. People undergoing high stress thresholds who have poor diets are much more likely to develop periodontal disease.
- Diabetes and underlying medical issues:
Many medical conditions can exacerbate the onset and progression of periodontal problems. These include, but are not limited to, diabetes, heart disease, circulatory problems and osteoporosis.
- Malocclusion and oral habits:
Harmful oral habits such as grinding or clenching of the teeth are also contributing factors to periodontal disease. Malocclusion, the lack of a proper bite, also may promote and exaggerate the effect of the disease process.
Many medicatons have oral manifestations which may lead to periodontal problems. Many of these medications inhibit salivary flow which also promotes periodontal disease.
Types of Periodontal Disease
Periodontal disease manifests itself in many different ways, all of which require early intervention by a periodontist and other oral healthcare professionals. Early treatment will result in much better prognoses and treatment outcomes:
Gingivitis is the mildest and most common form of periodontal disease. It is characterized by gum inflammation without involvement of the supporting bone structures of the teeth. If treated at an early stage, gingivitis is totally reversible.
Gingivitis is treated by a combination of meticulous home care and professional cleaning. The dentist may perform root planing and deep scaling procedures to remove the plaque and calculus which are the causative factors of the inflammation.
Chronic Periodontal Disease
Chronic periodontal disease, while it may effect younger people, occurs much more frequently in people over 40. Chronic periodontal disease is characterized by gingival inflammation and bone loss. Once bone is lost, it cannot be restored. Chronic periodontitis is not reversible.
The goal in treating chronic periodontitis is to halt the progression of the disease. This is accomplished using several different regimens. The first is the reinforcement of the patientâ€™s oral hygiene and home care. The periodontist will then remove the plaque and calculus that are causing the disease process to progress by using scaling and root planing procedures in combination with debriding the infected material that line the pocket formed between the teeth and the gums. The periodontist may also treat the pockets with antimicrobial agents. The periodontist may also perform surgical treatments such as pocket reduction surgery and tissue grafts to strengthen the bone and improve the aesthetic appearance of the oral cavity. In some cases, dental lasers may be used to treat the pockets and halt the progress of the disease.
Periodontal Disease Relating to Systemic Conditions
Many systemic illnesses may cause or worsen the effects of periodontal disease. Among the most common of these are heart disease, diabetes and respiratory disease. In these cases, the patient may have aggressive periodontal disease even though they maintain excellent oral hygiene and little plaque and calculus is evident.
Initially, the medical condition which caused the onset of periodontal disease must be controlled. The periodontist can then treat the disease using all of the treatment possibilities mentioned above.
Necrotizing Periodontal Disease
While rare, this form of periodontal disease is very aggressive. It generally effects people who suffer from HIV, immunosuppression, malnutrition, chronic stress or smokers. This aggressive form of the disease causes rapid bone loss and tissue necrosis (destruction).
Because it may be associated with HIV or another serious medical condition, the periodontist will work hand-in-hand with the treating physician to develop a treatment plan. Scaling, root planing, antibiotics, medicated mouth rinses and fungicidal medicines are all used to treat this form of the disease.
Gingival Grafts and Crown Lengthening
While the main goal of periodontal therapy is to preserve the health of the supporting structures of the teeth, there are several procedures that we perform to enhance dental aesthetics and improve the look of a patientâ€™s smile. For patients presenting with gum recession or a â€œtoothyâ€ smile, gum grafting procedures may be performed to cover the areas of recession. For patients with a â€œgummyâ€ smile or teeth that appear to be short, crown lengthening procedures are a relatively simple answer to solve this aesthetic problem.
Periodontal Scaling & Root Planing
Periodontal disease is caused by the buildup of plaque and calculus around the gum line and between the teeth. In order to prevent disease, it is imperative to remove these etiologic agents. This will prevent bacterial growth which leads to bone breakdown and advancement of the disease process. The objective of scaling and root planning is to physically remove the plaque and calculus which causes the disease. Scaling and root planning is a non-surgical procedure which is particularly effective in dealing with gingivitis and early stages of periodontitis. If performed effectively at these stages, no further periodontal treatment may be necessary.
What do scaling and root planing treatments involve?
After conducting a thorough examination of the oral tissues and viewing radiographic findings, we may suggest scaling and root planning treatments. Depending on the severity of the disease process and the amount of plaque and calculus, local anesthesia may be used to make the treatment more comfortable.
Scaling involves the removing of debris from the crown and root surfaces. This may be accomplished with the use of a combination of ultrasonic and hand scalers. After all the plaque and calculus are â€œscaledâ€ away, root planning may be undertaken using hand instruments to smooth the root surfaces of the tooth. Smooth root surfaces help prevent the buildup of the agents which cause periodontal disease.
After scaling and root planning procedures eliminate the causative factors, the remaining pockets may be treated with antibiotics.
Periodontal disease is caused by bacterial growth. This bacteria breaks down the periodontal lining of the gum and as the disease progresses, bacteria will begin to break down the supporting tooth structure which surrounds the teeth. One of the most effective ways to kill bacteria is to introduce antibiotics. These antibiotics may be prescribed orally, in pill form, or may be applied locally directly to the areas of the mouth that are periodontally infected.
Over the past several years, direct application of antibiotic into the periodontal pocket has proven to be very effective in halting the disease process if done in combination with other periodontal procedures.
Systemic antibiotics can be prescribed at a low dose for long term periodontal use, or as a short term medication to treat acute periodontal infections.
Oral and Locally Delivered Antibiotics
Several different antibiotics have proven to be useful and particularly effective in the treatment of periodontal disease.
Tetracycline antibiotics: The tetracycline family of antibiotics, which include tetracycline hydrochloride, doxycycline, and minocycline are generally thought of as the primary drugs used in periodontal treatment.
Macrolide antibiotics: Known for their effectiveness in reducing gingival inflammation, this family of antibiotic is often used for patients suffering from periodontitis.
Metronidazole: This antibiotic is generally used in combination with amoxicillin or tetracycline to combat inflammation and bacterial growth in severe or chronic periodontitis.
Arestin®: This antibiotic, which is delivered right into the gingival sulcus (pocket within the gum) has proven very effective in slowing the disease process and inhibiting bacterial growth.
Periodontal disease is caused by bacteria which infect the periodontal lining of the gum. If not removed, this bacterial growth will spread and will begin to destroy the bone that supports the teeth. As bone is destroyed by the bacteria that is found on plaque and calculus, pockets form between the teeth and gums. As these pockets become deeper, it is almost impossible to clean the bottom of the pockets using toothbrushing and flossing techniques. If the pockets are not adequately cleaned and debrided, they will continue to deepen and more bone will be destroyed. This destructive cycle will continue and will eventually lead to tooth loss. The goal of all periodontal surgical procedures is to eliminate the pocket and to allow the patient to keep the gums and teeth clean using proper brushing and flossing techniques.
What does pocket reduction surgery involve?
While a surgical procedure, periodontal surgery is generally very well tolerated by patients and in most cases can be performed under local anesthesia.
An incision will be made to allow us to gently pull the gum tissue away from the teeth. All calculus and plaque will be meticulously removed and all root surfaces will be smoothed. Antibiotic may be placed in the surgical site. The gum tissue will then be sutured back into place eliminating the pocket. In many cases a protective packing may be placed to keep the area clean and to facilitate faster healing.
The suture material (stitches) generally will remain in the mouth for 7-10 days
Though the gums will be more sensitive immediately following the procedure, there will be a significant reduction in pocket depth and a vast improvement in the condition of the teeth and gums.