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Periodontitis, The Leading Cause of Gum Disease

According to information from the American Dental Association, three out of four Americans over age 35 have some form of periodontal disease, the major cause of tooth loss and bad breath (halitosis) in adults. Gingivitis is the mildest form of periodontal disease that, if left untreated, can progress to periodontitis, the loss of bone and tissues that support the tooth.

Periodontal disease has three stages, categorized by the extent of bone loss: mild moderate, and advanced. If only one or a few teeth are effected, it is localized. If all the teeth are involved, it is generalized.

Bacteria that accumulate at and below the gum line cause periodontitis. The bacteria release toxic substances that trigger the breakdown of the gum and bone. The body responds with an inflammatory response in which it essentially turns on itself and destructs the bone and tissues around the teeth. This is the body's way of warding off infectious agents.

When this happens the gum separates from the teeth, forming a gap called a periodontal pocket. If left untreated, periodontitis can lead not only to tooth loss but can also aggravate systemic illnesses. The signs of periodontitis may include:

• Bleeding gums when brushing or flossing
• Red, tender or swollen gums
• Bad breath (halitosis) or bad taste
• Receding gums (gums that have pulled away from the teeth)
• Loose teeth
• Teeth that have migrated from their original positions
• Tooth loss

Very often, however, people are not aware that they should see a periodontics professional because gum disease can progress without pain. It is possible to not exhibit warning signs and still have periodontitis. That is why it is very important to have routine periodontal screenings so that the early signs of the disease can be detected and treated before it becomes a major problem.

Periodontal Treatment

Periodontitis is treated in three phases. The first phase involves stopping the disease activity and progression of bone loss. The bacterial deposits (plaque and tartar) that formed above and underneath the gums need to be removed and the root surfaces of the teeth smoothed to enhance healing and deter future plaque retention.

This periodontal treatment is called scaling and root planing. During this phase, a dentist will review the patient's oral hygiene techniques, and give them advice on how to modify certain risk factors associated with periodontal disease.

If the periodontal disease is more advanced, surgical treatment may be needed. The purpose of this phase of periodontal treatment is to create an environment that is more amenable to health and, if possible, bring back some of the bone that was lost to the disease. In some forms of periodontitis, antibiotic treatment may be used. If this is the case, a bacterial culture may be required to test for harmful bacteria and to establish what antibiotics they are susceptible to.

Periodontal disease is a chronic condition that, like many others, has to be closely monitored, even after active treatment.

The third (maintenance) phase is crucial to the success of any periodontal treatment. Daily brushing and flossing is essential in controlling ever-developing plaque and bad breath, as is periodic periodontal maintenance care with a professional scaling of the teeth. Periodontal status will be closely monitored, so that changes can be identified and treated as early as possible.

Everyone should be routinely screened for periodontitis. All dentists are qualified in detecting and treating the early stages of periodontitis, but if an individual suspects that they are at risk, or they know they have gingivitis, they may want to see a periodontist who has advanced training in the diagnosis and treatment of periodontal conditions.

By Laura Minsk, DMD

The Lowdown on Gum Disease

Dentistry has surely shifted its focus from cavity control, thanks to fluoride and early dental care. Now we are learning more about periodontal disease, and for good reason. These days, tooth loss is the likely result of gum disease.

Q. I used to come in twice a year for cleanings. Now the dental hygienist says I need more attention, more often. My insurer limits coverage to six-month visits. What's up?

A. First, we know more about diagnosing the disease and have come upon some very dangerous systemic relationships to other conditions. That is, if you have heart problems, diabetes, or you're expecting a baby, we'll have to watch you closer than the next patient. Ongoing treatment for advanced mouth disease (periodontitis), too, should be scheduled more often.

Q. OK. What will periodontal treatment cost? I want to keep all the teeth I have.

A. You'll have to contact your periodontist's office for specific pricing but to treat a light case of gingivitis - the very first stages of disease - is the least expensive. Deep pockets around teeth and apparent bone loss - a complex case - will cost more. Periodontitis that requires surgery, and maybe the services of a specialist, costs much, much more. A good argument for early gum disease treatment and prevention.

Q. When you're done with me, am I cured?

A. Periodontal and gum disease prevention is the best defense because nobody walks away from it. Unfortunately, periodontal disease is incurable. But with your help, we can keep it under control. So much of your tissue health depends on how much work you're willing to put in. There's nothing magical about brushing and flossing. You just have to do it.

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.