Periodontal Disease
Causes
There are genetic and environmental factors involved in the onset of gum disease and in many cases the risk of developing periodontitis can be significantly lowered by taking preventative measures.
Here are some of the most common causes of gum disease:
Poor dental hygiene - Preventing dental disease starts at home with good oral hygiene and a balanced diet. Prevention also includes regular dental visits which include exams, cleanings, and x-rays. A combination of excellent home care and professional dental care will ensure and preserve the natural dentition and supporting bony structures. When bacteria and calculus (tartar) are not removed, the gums and bone around the teeth become affected by bacteria toxins and can cause gingivitis or periodontitis, which can lead to tooth loss.
Tobacco use – Research has indicated that smoking and tobacco use is one of the most significant factors in the development and progression of gum disease. In addition to smokers experiencing a slower recovery and healing rate, smokers are far more likely to suffer from calculus (tartar) build up on teeth leading to significant bone loss.
Genetic predisposition – Despite practicing rigorous oral hygiene routines, as much as a third of the population may have a strong genetic predisposition to gum disease. These individuals are much more likely to develop periodontal disease than individuals with no genetic predisposition. Genetic tests can be used to determine susceptibility and early intervention can be performed to keep the oral cavity healthy.
Pregnancy and menopause – During pregnancy, regular brushing and flossing is critical. Hormonal changes experienced by the body can cause the gum tissue to become more sensitive, rendering them more susceptible to gum disease.
Chronic stress and poor diet – Stress lowers the ability of the immune system to fight off disease, which means bacterial infections may be more exaggerated when compared to a healthy immune response. Poor diet or malnutrition can also lower the body’s ability to fight periodontal infections, as well as negatively affecting the health of gums.
Diabetes and underlying medical issues – Many medical conditions can intensify or accelerate the onset and progression of gum disease including respiratory disease, heart disease, arthritis, and osteoporosis. Diabetes hinders the body’s ability to utilize insulin which makes the bacterial infection in the gums more difficult to control and cure.
Grinding teeth – The clenching or grinding of the teeth can significantly damage the supporting tissue surrounding the teeth. Grinding teeth is usually associated with stress or the misalignment of teeth. When suffering from gum disease, the addition of grinding can increase the destruction of gingival tissue and accelerate the progression of the disease.
Medication – Many drugs including oral contraceptive pills, heart medicines, anti-depressants and steroids affect the overall condition of teeth and gums; making them more susceptible to gum disease. Steroid use promotes gingival overgrowth, which creates deeper pockets for bacteria to colonize more readily in the gum tissue.
Signs and Symptoms
It is extremely important to note that periodontal disease can progress without any signs or symptoms such as pain. This is why regular dental checkups are important. Described below are some of the most common signs and symptoms of periodontitis.
If you have any of these please seek the advice of a general dentist or periodontist as soon as possible:
Unexplained bleeding – Bleeding when brushing, flossing or eating food is one of the most common symptoms of a periodontal infection. The toxins in plaque cause inflammation which makes the tissues prone to bleeding.
Pain, redness or swelling – A periodontal infection may be present if the gums are swollen, red, or painful for no apparent reason. It is important to prevent the progression of the infection before the gum tissue and jaw bone have been affected. It is also critical to treat the infection before it is carried to the bloodstream effecting other areas of the body.
Longer-looking teeth – Periodontal disease can lead to gum recession. The toxins produced by bacteria can destroy the supporting tissue and surrounding bone making the teeth look longer and the smile appear more “toothy.”
Bad breath/halitosis – Breath odor usually originates from the back of the tongue, the lungs and stomach. Coming from the food we consume, or from tobacco use, bad breath may be caused by old particles which sit between the teeth and underneath the gum line. The deeper gum pockets are, the more they are able to house more debris and bacteria, causing a foul odor.
Loose teeth/change in bite pattern – A sign of rapidly progressing periodontitis is the loosening or shifting of the teeth in the affected area. As the bone tissue gets destroyed, teeth that were once firmly attached to the jawbone become loose or may shift in position.
Pus – Pus oozing from between the teeth is a definitive sign that a periodontal infection is in progress. The pus is a result of the body trying to fight the bacterial infection.
Diabetes
Experts suggest that diabetes and periodontal disease can worsen both the other if either condition is not properly controlled.
Here are ways in which diabetes and periodontal disease are linked:
Increased blood sugar – Moderate and severe periodontal disease elevates sugar levels in the body, increasing the amount of time the body has to function with high blood sugar. In addition, the higher sugar levels found in the mouth of diabetics provide food for the very bacteria that worsen periodontal infections.
Blood vessel thickening – Thickening of the blood vessels is one of the other major concerns for people with diabetes. The blood vessels serve a vital function for tissues by delivering nutrients and removing waste products. With diabetes, the blood vessels become too thick for these exchanges to occur. This means that harmful waste is left in the mouth and can weaken the resistance of gum tissue, which can lead to infection and gum disease.
Smoking – Tobacco use does a great deal of damage in the oral cavity. Not only does tobacco use slow the healing process, it also vastly increases the chances of an individual developing periodontal disease. For diabetics who smoke, the risk is exponentially greater. In fact, diabetic smokers aged 45 and over are twenty times more likely to develop periodontal disease.
Poor oral hygiene – It is essential for diabetics to maintain excellent levels of oral health. When daily brushing and flossing does not occur, the harmful oral bacteria can ingest the excess sugar between the teeth and colonize more freely below the gum line. This exacerbates the metabolic problems that diabetes sufferers experience.
Heart Disease and Stroke
There is little doubt that the presence of periodontal disease can exacerbate existing heart conditions. There are several theories which may explain the link between heart disease, stroke and periodontal disease, which include the following:
Oral bacteria affect the heart – There are many different strains of periodontal bacteria. Researchers assert that some of these strains of bacteria enter the bloodstream and attach to the fatty plaques in blood vessels including coronary arteries. This attachment then contributes to clot formation causing grave danger to the individual.
Inflammation – Periodontal disease causes severe inflammation in the gum tissue which elevates the white blood cell count and also the high sensitivity C-reactive protein levels. Research studies have shown that elevated levels of C-reactive proteins have been linked to heart disease.
Infectious susceptibility – Individuals who experience particularly high levels of oral bacteria may have weaker immune systems and an inadequate host inflammatory response. These factors may induce specific vascular effects which have previously been shown to contribute to the onset of certain forms of heart disease.
Respiratory Disease
Oral bacterium linked with gum disease has been shown to possibly cause or worsen conditions such as emphysema, pneumonia, and Chronic Obstructive Pulmonary Disease (COPD). Oral bacteria can be drawn into the lower respiratory tract during the course of normal inhalation; causing bacterial infections. Studies have shown that the repeated infections which characterize COPD may be linked with periodontitis. In addition to the bacterial risk, inflammation in gum tissue can lead to severe inflammation in the lining of the lungs, which aggravates pneumonia. Individuals who suffer from chronic or persistent respiratory issues generally have lower immunity. This means that bacteria can readily colonize beneath the gum line unchallenged by body’s immune system.
Diagnosis
Gingivitis
is the first stage of periodontal disease. Plaque and its toxin by-products irritate the gums, making them tender, inflamed, and likely to bleed.
Periodontitis is when plaque hardens into calculus (tartar). As calculus and plaque continue to build up, the gums begin to recede from the teeth. Deeper pockets form between the gums and teeth becoming filled with bacteria and pus. The gums become very irritated, inflamed, and bleed easily. Slight to moderate bone loss may be present.
Advanced Periodontitis is when the teeth lose more support as the gums, bone, and periodontal ligament continue to be destroyed. Unless treated, the affected teeth will become very loose and may be lost. Generalized moderate to severe bone loss may be present.
Treatment
Periodontal treatment methods depend upon the type and severity of the disease. Your dentist and dental hygienist will evaluate for periodontal disease and recommend the appropriate treatment.
If the disease is caught in the early stages and no damage has been done, one to two regular cleanings will be recommended. You will also be given instructions on improving your daily oral hygiene habits and having regular dental cleanings.
If the disease has progressed to more advanced stages, a special periodontal cleaning called scaling and root planing (deep cleaning) will be recommended. It is usually done one quadrant of the mouth at a time while the area is numb. In this procedure, tartar, plaque, and toxins are removed from above and below the gum line (scaling) and rough spots on root surfaces are made smooth (planing). This procedure helps gum tissue to heal and pockets to shrink. Medications, special medicated mouth rinses, and an electric tooth brush may be recommended to help control infection and healing.
If the pockets do not heal after scaling and root planing, periodontal surgery may be needed to reduce pocket depths, making teeth easier to clean. Your dentist may also recommend that you see a Periodontist (specialist of the gums and supporting bone).