Periodontal Disease

Periodontal disease is inflammation and infection of the tissues that support and anchor teeth.

Tissues that support and anchor the teeth include the gums (gingiva), the bone around the roots of teeth (alveolar bone), and the ligament between the alveolar bone and the root of each tooth (periodontal ligament). Most older people have periodontal disease to some degree.

Periodontal disease usually develops after plaque has been accumulating between the gum and teeth for a long time. Bacteria thrive in plaque. They produce acids and other substances that penetrate the gums and may trigger inflammation. The gums may become inflamed, infected, and swollen—a disorder called gingivitis. A deep space (pocket) may form between the gum and the root of an affected tooth. Bacteria may accumulate there and damage the tooth further. The inflammation and infection can spread to the periodontal ligaments and alveolar bone, weakening and destroying them. Then, the teeth have less support and become loose. This disorder is called periodontitis. When periodontitis continues for a long time, all the bone supporting the affected teeth may be lost, and the affected teeth may have to be removed (extracted).

Causes

Conditions that make plaque more likely to accumulate between the gum and teeth can lead to periodontal disease. Not brushing and flossing the teeth regularly allows plaque to accumulate. Plaque tends to accumulate in older people because they are likely to have receding gums. Receding gums leave spaces between gums and teeth—a place where plaque can accumulate quickly and be trapped.

If the mouth is dry, plaque is not washed away by saliva and thus remains on tooth surfaces.

Certain drugs, such as phenytoin (used to treat seizures) and calcium channel blockers (used to treat coronary artery disease), cause the gums to grow excessively (hypertrophy). Then, bacteria can invade the gums more easily. The gums may bleed and become painful. As a result, people are less likely to brush their teeth and floss in the affected areas, making gingivitis more likely to develop or worsen. Disorders and treatments that interfere with the way the body heals itself, such as undernutrition, diabetes, leukemia, or chemotherapy, increase the risk of developing periodontal disease.

Symptoms and Diagnosis

Gingivitis produces swelling that a person can feel and see. The gums are sometimes tender and may bleed during brushing or flossing. Periodontitis causes teeth to loosen. The loose teeth are usually noticed when a person chews.

A doctor or dentist can detect gingivitis during an examination of the mouth. A dentist checks for periodontitis by inserting a probe between the gum and teeth to look for spaces (pockets) and to measure how deep pockets, if present, are. Periodontitis is diagnosed when very deep pockets are found and when bone loss is seen on dental x-rays.

Prevention and Treatment

Thorough, regular care of the mouth can help prevent periodontal disease. Brushing and flossing are most helpful. Using a mouth rinse that slows the growth of bacteria may help. Having regular professional cleanings at a dentist's office is important.

Treatment of gingivitis usually involves improving the care of the mouth, including brushing and flossing. Treatment of periodontitis usually involves surgery to remove the debris and pus that accumulate as a result of inflammation and infection. Antibiotic mouth rinses and antibiotics to be taken by mouth can be prescribed. If the alveolar bone is greatly damaged, surgery may be needed to repair it.

Treatment of periodontitis takes a long time. It usually requires many dental visits and often requires repeated treatments. For treatment to be effective, people must also be diligent in brushing and flossing their teeth regularly and thoroughly.

Outlook

Gingivitis usually disappears with treatment. The gums return to normal within several days to a few weeks. Periodontitis responds to treatment more slowly. Loose teeth become tighter as the inflammation and infection subside, usually within several weeks or sometimes months. However, if periodontitis has progressed, a lot of gum, ligament, and bone tissue may be permanently lost.