Periodontitis (Gum Disease)

Periodontitis is an inflammatory disease that affects the periodontium, the surrounding tissues that provide support for teeth. Periodontitis is caused by specific microorganisms or groups of specific microorganisms, which results in progressive destruction of the periodontal ligament and alveolar bone (bone supporting the teeth) with pocket formation, recession or both. The destruction of tissue is caused by an exaggerated immune response to microorganisms, and any foreign material that is capable of eliciting an immune reaction. To diagnose periodontal disease a clinician evaluates the condition of tooth supporting structures by probing around the teeth. Evaluation of dental radiographs also helps determine the severity of disease, location, as well as the possible treatment options.

Chronic and Aggressive Periodontitis

Periodontal disease can be classified into two forms chronic or aggressive. The aggressive differs from chronic form by the rapid rate of disease progression seen in otherwise healthy individuals, an absence of large accumulations of plaque and calculus, and a family history of aggressive disease, which suggests a genetic trait.

Chronic periodontitis is the most commonly seen form. It is most prevalent in adults but can occur in children. In chronic periodontitis the amount of tissue destruction is consistent with local factors. Calculus or hard build up is often seen above and below the gum line. The disease has a slow to moderate rate of progression with periods of rapid advancement. Chronic periodontitis can be modified or associated with systemic diseases such as diabetes mellitus and HIV. It can also be affected by local factors such as accumulation of heavy plaque or calculus as well as environmental factors such as cigarette smoking and emotional stress.

Aggressive periodontitis is seen in an otherwise healthy patient. The condition is usually present in close relatives. Patients will exhibit rapid bone destruction. Aggressive forms of periodontitis usually affect young individuals at or after puberty and may be observed during the second and third decade of life. The disease can be localized, affecting only certain areas in the mouth or generalized, which affects most or all of the teeth.

Smoking and Periodontal Disease

Smoking is a major risk factor for periodontal disease. It can affect the extent and severity of the disease. Smoking can also influence the clinical outcome of nonsurgical and surgical therapy. It can also affect the long-term success of implant placement. Smokeless tobacco use has been associated with oral leukoplakia and carcinoma. However, no generalized effects on periodontal disease progression seem to occur, except for localized tissue attachment loss and recession at the site of tobacco placement.

Treatment of Periodontal Disease

Treatment of periodontal disease is aimed at stopping the progression of soft and hard tissue destruction. The treatment that will be completed depends on the severity of the disease and the overall condition of the surrounding tissue. The first stage of treatment consists of scaling and root planing. Scaling of the teeth removes any calculus, hard build-up that is present below the gum tissue. Root planing smooths the root surface to allow for healing and good approximation of the previously diseased surrounding tissue.

After the scaling and root planing is completed the teeth and supporting structures are evaluated about 6 weeks after initial therapy is completed. After the evaluation the dentist will compare initial findings with the present. At this point a determination can be made as to any further treatment that might be beneficial to the patient.

The second stage of treatment, if required, consists of gum surgery called apically repositioned flap. During this treatment the gum tissue that covers the bone and surrounds the teeth is opened up to allow for direct access to the teeth and surrounding bone. At this point the teeth are scaled and root planed again and the surrounding bone is re-contoured to favor good healing of the tissue. In cases with extensive alveolar bone loss some of the gum tissue may be removed as well to reduce the gingival pocketing (this will decrease probing depth and allow the patient to keep surrounding areas clean with basic home care). In some localized cases a bone graft can be performed to allow regeneration of bone in defective areas. Each treatment and response to therapy is unique to each patient. What works for some may not work for others.