Periodontal diseases range from simple gum inflammation to serious disease that results in major damage to the soft tissue and bone that support the teeth. In the worst cases, teeth are lost.

Gum disease is a threat to your oral health. Research is also pointing to possible health effects of periodontal diseases that go well beyond your mouth (more about this later). Whether it is stopped, slowed, or gets worse depends a great deal on how well you care

In gingivitis, the gums become red and swollen. They can bleed easily. Most people can reverse this with daily brushing and flossing and seeing their dentist regularly. Untreated gingivitis can lead to periodontitis. The gums pull away from the teeth and form pockets that are infected. If not treated, the bones, gums and connective tissue that support the teeth are destroyed.

What causes periodontal disease ?

Periodontitis occurs when inflammation or infection of the gums (gingivitis) is untreated or treatment is delayed. Infection and inflammation spreads from the gums (gingiva) to the ligaments and bone that support the teeth. Loss of support causes the teeth to become loose and eventually fall out. Periodontitis is the primary cause of tooth loss in adults. This disorder is uncommon in childhood but increases during adolescence.

Plaque and tartar accumulate at the base of the teeth. Inflammation causes a pocket to develop between the gums and the teeth, which fills with plaque and tartar. Soft tissue swelling traps the plaque in the pocket. Continued inflammation eventually causes destruction of the tissues and bone surrounding the tooth. Because plaque contains bacteria, infection is likely and a tooth abscess may also develop, which increases the rate of bone destruction.

Hundreds of types of bacteria live in the mouth, so keeping plaque at bay is a constant battle. That’s why brushing and flossing every day – and regular trips to the dentist – are so important.

Risk and symptons

Certain things can make teens more likely to develop gum disease. Some may inherit this tendency from their parents. The snacks you eat also can put you at risk of developing gum disease – especially if you grab fries and a soda in the mall after school and aren’t able to brush immediately after eating them. You probably know that sugar is bad for your teeth, but you may not know that starchy foods like fries also feed the acids that eat into your tooth enamel.

If you have braces, fending off plaque can be tougher. Some medical conditions (including diabetes and Down syndrome) and certain medicines increase the risk of gum disease.

Girls have a higher risk of gum disease than guys. Increases in female sex hormones during puberty can make girls’ gums more sensitive to irritation. Some girls may notice that their gums bleed a bit in the days before their periods.

  • Gingivitis
    • Gingivitis includes swelling and bleeding of the gums,bad breath, or a bad taste in your mouth. Good teeth-brushing and flossing can reverse the affects of gingivitis.
    • Acute necrotizing ulcerative gingivitis (ANUG) is an advanced and invasive form of gingivitis that causes sore gums and a whitish membrane on the gums. It requires antibiotics as part of the treatment.
  • Periodontitis
    • Periodontitis occurs when bacterial toxins and enzymes destroy the connective tissue and bone.
    • The gums draw back, and the roots of the teeth are exposed. The teeth may become very sensitive to temperature changes, or new cavities can develop.
    • The pocket between the tooth and the gums deepens; plaque in this area is very difficult to remove. Bacteria invade the surrounding structures.
    • When the gums pull away from the teeth, pus develops between the teeth and the gums or the permanent teeth become loose in their sockets. Only a dentist can decide whether the teeth can be saved.

Examination of the mouth and teeth by the dentist shows soft, swollen, red-purple gingiva. Deposits of plaque and calculus may be visible at the base of the teeth, with enlarged pockets in the gums. The gums are usually painless or mildly tender, unless a tooth abscess is also present. Teeth may be loose and gums may be receded.

Diagnosis of Periodontitis:

The dentist or dental hygienist will inspect the color and firmness of the gums and test the teeth for looseness. They will also check the way your teeth fit together when you bite. X-rays may be taken to evaluate the bone supporting the teeth.

A technique called periodontal probing is the cornerstone of testing for gum disease. In this procedure, a small measuring instrument is gently inserted between the tooth and gum to measure the depth of the pocket.

Treatment

Good oral hygiene prevents periodontal disease.

  • Brush the teeth at least twice every day. Brushing removes plaque from the inner, outer, and chewing surfaces of each tooth. A dental hygienist can demonstrate the proper technique.
  • Get a new toothbrush every 3 months.
  • Use a toothpaste that contains fluoride.
  • Floss every day. Flossing removes plaque between the teeth that a toothbrush cannot reach.
  • Use a mouthwash that kills bacteria.
  • Eat a well-balanced diet; avoid too many sweets.

In the earlier stages of the disease, most of the treatment involves root planing and curettage (cleaning) under the gum margins. It involves the removal of plaque and inflamed soft tissue in the pockets around the tooth with an instrument called a curette. Its purpose is to remove the bacterial colonies and the mechanical and chemical irritants that cause inflammation in hopes that the disease can be eradicated. The goal is that the gum will reattach itself to the tooth or will shrink enough to eliminate the pocket.

In most early cases, root planing, curettage, and proper daily plaque removal are all that are required for a satisfactory result.

In more advanced cases, the treatment may become more complex. If after removal of the deposits, fairly deep pockets remain, they can be eliminated by a minor surgical procedure called gingivectomy. This is done under local anesthesia, and a medicinal dressing is placed to cover the wound area for a week or so while it heals.

A similar procedure, called gingivoplasty, is used to remove excessive gum tissue and to provide a new and healthier shape for the gums.

In some cases, flap procedures are performed. The gum tissue in an area is lifted away from the teeth, all the underlying inflamed tissue and calculus are removed, the bone may then be reconstructed to a proper shape and the gum is then replaced to proper position and sutured. Healing of these procedures takes from seven to 21 days and is usually uneventful, although not without some expected post-operative discomfort.

Antibiotics are sometimes prescribed to treat gum inflammation.

Prevention

The most effective nonprescription tool available is the toothbrush. Because a toothbrush’s ability to remove plaque is markedly reduced by splayed or matted bristles, toothbrushes need to be replaced at the first sign of wear.

Soft bristles are superior to hard for removing plaque, but the kind of brush you buy is less important than how well you use it. Several techniques have been developed for effective tooth brushing and it is advisable to be instructed in at least one by a dentist.

Flossing daily and brushing after meals will reduce the risk of developing plaque. Regular dental check-ups are important as well.

Sources: Kids Health, Emedicine Health

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