Periodontal Disease

TYPES OF PERIODONTAL DISEASE
GINGIVITIS

Gingivitis is the mildest form of periodontal disease. It causes the gums to become red, swollen, and bleed easily. There is usually little or no discomfort at this stage. Gingivitis is often caused by inadequate oral hygiene. Factors that may contribute to gingivitis include, diabetes, smoking, aging, genetic predisposition, systemic diseases and conditions, stress, inadequate nutrition, puberty, hormonal fluctuations, pregnancy, substance abuse, HIV infection, and certain medication use.

 

Gingivitis is reversible with professional treatment and good oral home care.

PERIODONTITIS

Untreated gingivitis can advance to periodontitis and can eventually lead to tooth loss and other health problems. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.

Periodontitis as a manifestation of systemic diseases

Periodontitis as a manifestation of systemic diseases often begins at a young age. Systemic conditions such as heart disease, respiratory disease, and diabetes are associated with this form of periodontitis.

 

Necrotizing periodontal disease

Necrotizing periodontal disease is an infection characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions such as HIV infection, malnutrition and immunosuppression.

PERIODONTITIS

Untreated gingivitis can advance to periodontitis and can eventually lead to tooth loss and other health problems. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.

Periodontitis as a manifestation of systemic diseases

Periodontitis as a manifestation of systemic diseases often begins at a young age. Systemic conditions such as heart disease, respiratory disease, and diabetes are associated with this form of periodontitis.

 

Necrotizing periodontal disease

Necrotizing periodontal disease is an infection characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions such as HIV infection, malnutrition and immunosuppression.

RISK FACTORS

The main cause of periodontal disease is plaque, but other factors affect the health of your gums.

 

AGE

Studies indicate that older people have the highest rates of periodontal disease. Data from the Centers for Disease Control and Prevention indicates that over 70% of Americans 65 and older have periodontitis.

 

SMOKING/TOBACCO USE

Tobacco use is linked with many serious illnesses such as cancer, lung disease and heart disease, as well as numerous other health problems. Tobacco users also are at increased risk for periodontal disease. Studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease.

 

GENETICS

Research has indicated that some people may be genetically susceptible to gum disease. Despite aggressive oral care habits, these people may be more likely to develop periodontal disease. Identifying these people with a genetic test before they even show signs of the disease and getting them into early intervention treatment may help them keep their teeth for a lifetime.

 

STRESS

Stress is linked to many serious conditions such as hypertension, cancer, and numerous other health problems. Stress also is a risk factor for periodontal disease. Research demonstrates that stress can make it more difficult for the body to fight off infection, including periodontal diseases.

 

MEDICATIONS

Some drugs, such as oral contraceptives, anti-depressants, and certain heart medicines, can affect your oral health. Just as you notify your pharmacist and other health care providers of all medicines you are taking and any changes in your overall health, you should also inform your dental care provider.

 

TEETH CLENCHING OR GRINDING

Clenching or grinding your teeth can put excess force on the supporting tissues of the teeth and could speed up the rate at which these periodontal tissues are destroyed.

 

SYSTEMIC DISEASES

Some systemic diseases that interfere with the body's inflammatory system may worsen the condition of the gums. These include cardiovascular disease, diabetes, and rheumatoid arthritis.

 

POOR NUTRITION AND OBESITY

A diet low in important nutrients can compromise the body's immune system and make it harder for the body to fight off infection. Because periodontal disease begins as an infection, poor nutrition can worsen the condition of your gums. In addition, research has shown that obesity may increase the risk of periodontal disease.

SYMPTOMS

Periodontal disease is often silent, meaning symptoms may not appear until an advanced stage of the disease.

 

However, warning signs of gum disease include the following:

  • Red, swollen or tender gums or other pain in your mouth

  • Bleeding while brushing, flossing, or eating hard food

  • Gums that are receding or pulling away from the teeth, causing the teeth to look longer than before

  • Loose or separating teeth

  • Pus between your gums and teeth

  • Sores in your mouth

  • Persistent bad breath

  • A change in the way your teeth fit together when you bite

  • A change in the fit of partial dentures

PREVENTION

Periodontal disease is caused when bacteria in plaque (a sticky, colorless film that forms in the mouth) builds up between the gums and teeth. When the bacteria begin to grow, the gums surrounding the tooth can become inflamed. If left untreated, this inflammation can cause the gums and supporting bone structure to deteriorate. This can lead to gum recession or even tooth loss. In addition, research has shown that gum disease may be associated with other diseases, such as diabetes and heart disease. Luckily, periodontal disease can be preventable.

 

Adding these habits to your daily routine can help:

1. Brush your teeth. Brushing after meals helps remove food debris and plaque trapped between your teeth and gums. Don’t forget to include your tongue, bacteria loves to hide there. 

 

2. Floss/Interdental brush. Cleaning the spaces between the teeth where the toothbrush bristles cannot reach, using either dental floss or an interdental brush, depending on the size of the space. This should be done once daily.  Dental floss should be used where the teeth are close together, with little or no space between them, while interdental brushes are suitable for larger gaps.

 

3. Swish with antibacterial mouthwash. Using a mouthwash can help reduce plaque and can remove remaining food particles that brushing and flossing missed. Mouthwash is only an aid to oral hygiene, and many of them have collateral effects such as taste disturbances, they also may cause staining on teeth, tongue and restorations. Please consult with your periodontist before using them.

 

4. Know your risk. Age, smoking, diet and genetics can all increase your risk for periodontal disease. If you are at increased risk, be sure to talk with your dental professional.

 

5. See a periodontist. Get an annual periodontal evaluation to examine your teeth, plaque level, gums, bite, bone structure and other risk factors for periodontal disease. Identifying symptoms of gum disease early is key to protecting your teeth and gums.

PERIODONTAL DISEASE AND SYSTEMIC HEALTH

Research has shown that periodontal disease is associated with several other diseases. For a long time it was thought that bacteria was the factor that linked periodontal disease to other disease in the body; however, more recent research demonstrates that inflammation may be responsible for the association. Therefore, treating inflammation may not only help manage periodontal diseases but may also help with the management of other chronic inflammatory conditions.

 

DIABETES

Diabetic patients are more likely to develop periodontal disease, which in turn can increase blood sugar and diabetic complications. In fact, periodontal disease is often considered a complication of diabetes. Those people who don't have their diabetes under control are especially at risk. Research has suggested that the relationship between diabetes and periodontal disease goes both ways - periodontal disease may make it more difficult for people who have diabetes to control their blood sugar. Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. This puts people with diabetes at increased risk for diabetic complications.

https://www.efp.org/publications/projects/perioanddiabetes/recommendations/index.html

 

HEART DISEASE

Several studies have shown that periodontal disease is associated with heart disease. While a cause-and-effect relationship has not yet been proven, research has indicated that periodontal disease increases the risk of heart disease. Scientists believe that inflammation caused by periodontal disease may be responsible for the association.  Periodontal disease can also exacerbate existing heart conditions. Patients at risk for infective endocarditis may require antibiotics prior to dental procedures. Your periodontist and cardiologist will be able to determine if your heart condition requires use of antibiotics prior to dental procedures. 

 

Additional studies have pointed to a relationship between periodontal disease and stroke. In one study that looked at the causal relationship of oral infection as a risk factor for stroke, people diagnosed with acute cerebrovascular ischemia were found more likely to have an oral infection when compared to those in the control group.

 

OSTEOPOROSIS

Researchers have suggested that a link between osteoporosis and bone loss in the jaw. Studies suggest that osteoporosis may lead to tooth loss because the density of the bone that supports the teeth may be decreased, which means the teeth no longer have a solid foundation.

 

RESPIRATORY DISEASE

Research has found that bacteria that grow in the oral cavity can be aspirated into the lungs to cause respiratory diseases such as pneumonia, especially in people with periodontal disease.

 

CANCER

Researchers found that men with gum disease were 49% more likely to develop kidney cancer, 54% more likely to develop pancreatic cancer, and 30% more likely to develop blood cancers.

PERIODONTAL DISEASE IN WOMEN

A woman's periodontal health may be impacted by a variety of factors.

 

PUBERTY

During puberty, an increased level of sex hormones, such as progesterone and possibly estrogen, causes increased blood circulation to the gums. This may cause an increase in the gum's sensitivity and lead to a greater reaction to any irritation, including food particles and plaque. During this time, the gums may become swollen, turn red and feel tender.

 

MENSTRUATION

Occasionally, some women experience menstruation gingivitis. Women with this condition may experience bleeding gums, bright red and swollen gums and sores on the inside of the cheek. Menstruation gingivitis typically occurs right before a woman's period and clears up once her period has started.

 

PREGNANCY

Some studies have suggested the possibility of an additional risk factor – periodontal disease. Pregnant women who have periodontal disease may be more likely to have a baby that is born too early and too small. However, more research is needed to confirm how periodontal disease may affect pregnancy outcomes. All infections are cause for concern among pregnant women because they pose a risk to the health of the baby. It is recommended that women considering pregnancy have a periodontal evaluation. 

https://www.efp.org/publications/projects/oralhealthandpregnancy/reports/treating-perio-disease.html

 

MENOPAUSE AND POST-MENOPAUSE

Women who are menopausal or post-menopausal may experience changes in their mouths. They may notice discomfort in the mouth, including dry mouth, pain and burning sensations in the gum tissue and altered taste, especially salty, peppery or sour. In addition, menopausal gingivostomatitis affects a small percentage of women. Gums that look dry or shiny, bleed easily and range from abnormally pale to deep red mark this condition. Most women find that estrogen supplements help to relieve these symptoms.

PERIODONTAL DISEASE IN CHILDREN

Chronic gingivitis is common in children. It usually causes gum tissue to swell, turn red and bleed easily. Gingivitis is both preventable and treatable with a regular routine of brushing, flossing and professional dental care. However, left untreated, it can eventually advance to more serious forms of periodontal disease.

 

Aggressive periodontitis

Aggressive periodontitis can affect young people who are otherwise healthy.

 

Localized aggressive periodontitis is found in teenagers and young adults and mainly affects the first molars and incisors. It is characterized by the severe loss of alveolar bone, and ironically, patients generally form very little dental plaque or calculus.

 

Generalized aggressive periodontitis may begin around puberty and involve the entire mouth. It is marked by inflammation of the gums and heavy accumulations of plaque and calculus. Eventually it can cause the teeth to become loose.

 

Four basic signs will alert you to periodontal disease in your child:

 

Bleeding

Bleeding gums during tooth brushing, flossing or any other time.

 

Puffiness

Swollen and bright red gums.

 

Recession

Gums that have receded away from the teeth, sometimes exposing the roots.

 

Bad breath

Constant bad breath that does not clear up with brushing and flossing.

 

IMPORTANCE OF GOOD DENTAL HYGIENE IN ADOLESCENCE

Hormonal changes related to puberty can put teens at greater risk for getting periodontal disease. During puberty, an increased level of hormones, such as progesterone and possibly estrogen, cause increased blood circulation to the gums. This may cause an increase in the gum's sensitivity and lead to a greater reaction to any irritation, including food particles and plaque. During this time, the gums may become swollen, turn red and feel tender.

 

As a teen progresses through puberty, the tendency for the gums to swell in response to irritants will lessen. However, during puberty, it is very important to follow a good at-home dental hygiene regimen, including regular brushing and flossing, and regular dental care. In some cases, a dental professional may recommend periodontal therapy to help prevent damage to the tissues and bone surrounding the teeth.

 

ADVICE FOR PARENTS

Early diagnosis is important for successful treatment of periodontal diseases. Therefore, it is important that children receive a comprehensive periodontal examination as part of their routine dental visits. Be aware that if your child has an advanced form of periodontal disease, this may be an early sign of systemic disease. A general medical evaluation should be considered for children who exhibit severe periodontitis, especially if it appears resistant to therapy. The most important preventive step against periodontal disease is to establish good oral health habits with your child. 

 

There are basic preventive steps to help your child maintain good oral health:

 

1. Establish good dental hygiene habits early. When your child is 12 months old, you can begin using toothpaste when brushing his or her teeth.   When the gaps between your child's teeth close, it's important to start flossing.

 

2. Serve as a good role model by practicing good dental hygiene habits yourself.

 

3. Schedule regular dental visits for family checkups, periodontal evaluations and cleanings.

 

4. Check your child's mouth for the signs of periodontal disease, including bleeding gums, swollen and bright red gums, gums that are receding away from the teeth and bad breath.

PERIODONTAL DISEASE IN MEN

Periodontal health for men is extremely important as it may impact a variety of other health factors. Research has found that periodontal disease is higher in men (56.4 percent) than in women (38.4 percent). This may be because men are less likely to go to the dentist or because men have worse indicators of periodontal health than women, including higher incidence of dental plaque, tartar, and bleeding on probing. However, periodontal health for men is extremely important as it may impact a variety of other health factors.

 

PROSTATE HEALTH

Prostate-specific antigen (PSA) is an enzyme created in the prostate that is normally secreted in very small amounts. However, when the prostate becomes inflamed, infected, or affected by cancer, PSA levels rise. Research has shown that men with indicators of periodontal disease such as red, swollen or tender gums as well as prostatitis (inflammation of the prostate) have higher levels of PSA than men with only one of the conditions. This means that prostate health may be associated with periodontal health, and vice versa.

 

HEART DISEASE

Research indicates that periodontal disease and cardiovascular disease are associated; having periodontal disease may actually increase your risk of cardiovascular disease. Both diseases are chronic inflammatory conditions, and researchers believe that inflammation is the connection between gum disease and heart disease. Since men are already more likely to develop heart disease than women, maintaining periodontal health is another way to reduce this risk.

 

IMPOTENCE

Men with periodontal disease, especially those younger than 30 or older than 70, are at increased risk of developing impotence, according to research. Researchers believe that inflammation may be the link between the two conditions; prolonged chronic inflammation (the same type of inflammation that is associated with periodontal disease) can damage blood vessels leading to impotence.

 

CANCER

Research has found that men with a history of gum disease are 14 percent more likely to develop cancer than men with healthy gums. Specifically, men with periodontal disease may be 49 percent more likely than women to develop kidney cancer, 54 percent more likely to develop pancreatic cancer, and 30 percent more likely to develop blood cancers.

PERI-IMPLANT DISEASES

Peri-implant diseases are inflammatory conditions affecting the soft and hard gum tissues around dental implants. Similar to a natural tooth, bacteria can build up on the base of the implant, below the gum line. Over time, the bacteria irritate the gum tissue, causing it to become inflamed, damaging the tissue and if not caught early, causing the bone structure below the implant to deteriorate. Like your teeth, implants require regular tooth brushing and flossing and regular check-ups from a dental professional. It is essential to routinely monitor dental implants as part of a comprehensive periodontal evaluation. With a proper oral health routine, your dental implant can last a lifetime. 

 

In peri-implant mucositis, gum inflammation is found only around the soft tissues of the dental implant, with no signs of bone loss. Generally peri-implant mucositis is a precursor to peri-implantitis. Evidence suggests that peri-implant mucositis may be successfully treated and is reversible if caught early.

 

In peri-implantitis, gum inflammation is found around the soft tissue and there is deterioration in the bone supporting the dental implant. Signs of peri-implant diseases are similar to symptoms of gum disease: red or tender gums around the implants, or bleeding when brushing. Other risks factors for developing peri-implant disease include previous periodontal disease diagnosis, poor plaque control, smoking, and diabetesPeri-implantitis usually requires surgical treatment. 

Source:

European Federation of Periodontology http://www.efp.org/public

Canadian Academy of Periodontology www.cap-acp.ca

American Academy of Periodontology www.perio.org

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