Periodontitis, periodontal disease or gum disease as it is frequently called, is one of the main reasons we end up needing dentures. Depending on the severity, the overall condition of remaining teeth, and side effects of periodontal disease some of us will be able to keep our teeth into the later stages of life. In this article I will go over main causes of periodontal disease, how to slow down or stop active disease process, and potential treatment options at different stages of disease.
Gingivitis or inflammation of the gingiva (gum tissue) is the precursor for periodontitis. The major distinction between gingivitis and periodontitis is that in the former there is no destruction of supporting structures of the teeth, while in the latter there are signs of bone loss as well as destruction of the periodontal ligament, a ligament that holds the the tooth in the socket. When gingivitis is not properly treated or treated within a reasonable period of time it progresses to periodontitis. Periodontal disease can be initiated and propagated by local factors or can be hereditary or systemic in nature. Major local factors that can initiate and propagate the disease process are bacteria, calculus (tartar), accumulated undisturbed plaque, open contacts between teeth and bacterial toxins. Usually but not always, this form of disease is slow progressing. Periodontal disease propagated by systemic factors is usually acute and more aggressive in nature and can be caused by hormonal changes (puberty). Another common name for aggressive periodontitis is juvenile onset periodontitis. It is not entirely understood why some individuals are predisposed to this more aggressive form of periodontitis but we do know that genetics plays a major role. Bone loss occurs very rapidly in aggressive periodontitis, and the severity of disease is not consistent with the presence of local irritating factors.
The primary way to treat periodontal disease is with scaling and root planing (deep cleaning). Scaling and root planing is usually completed by your regular dentist or hygienist. The goal of the therapy is to eliminate any irritating factors from the teeth. This includes reduction in plaque, calculus (tartar), and staining. Treatment is performed under local anesthesia for patient comfort. Antibiotics can be used in conjunction with the scaling and root planing to reduce the level of localized bacteria. After the initial therapy, the condition of the periodontium is re-evaluated. Depending on how severe the initial disease process was and how the patient responded to therapy, additional usually surgical treatment is recommended. This phase two treatment is usually completed by a periodontist or gum specialist. The surgical phase can also include correcting bone defects and re-contouring of the bone to create a healthy periodontium.
Periodontal disease can be treated successfully if it is addressed early. This is why it is very important to get your teeth cleaned on a regular basis. If your dentist detects any type of an issue, they will be able to intervene early and eliminate potential future problems. Treatment of more severe periodontitis usually presents many challenges and even with extensive therapy, can lead to tooth loss and the need for dentures.