Periodontitis is an infection and inflammation of the periodontium, the tissues supporting the dental organ: the alveolar bone, the gingiva (gums), the surface layer of the tooth root (cementum), the nerves and blood vessels of the gums.
Unlike gingivitis, periodontitis is a serious disease that can lead to major complications. In addition to inflammation and destruction of the alveolar bone (alveolitis), periodontitis can cause cardiovascular problems and even stroke.
In addition, periodontitis is a risk factor for many systemic diseases. It was demonstrated in many studies that the risk of premature labor (preterm birth) may be increased in pregnant women with periodontal infection. Although controversial, some scientists believe that development of diabetes is also fostered by periodontitis.
Periodontitis Causes and Risk Factors
Periodontitis is often due to inadequate dental hygiene, which gives rise to tartar and bacterial plaque. Persistent build up of those harmful substances on the teeth can lead to development of pocket between the gums and the teeth, the main sign of periodontitis. Therefore, it is important to prevent or remove bacterial plaque before it damages your teeth and gum. To do so, you need to practice a good oral hygiene: visit your dentist regularly, brush your teeth after each meal and floss every day. If you already have periodontitis, it is important to treat the infection at early stage; in the absence of treatment, evolution of the disease can lead to tooth loss or destruction of the alveolar bone.
Environmental and local factors
Majority of periodontitis patients tend to neglect the environmental and local factors in the development of their illness, yet those factors play an important role. Some of the risk factors of Periodontitis include:
Smoking – smoking reduces the body’s immune system, destroys the cells of the gums and promotes formation of oral lesions; persistent cigarette smoking can lead not only to periodontitis but also oral cancer.
Certain medications – all drugs that cause dry mouth have adverse effects on teeth and gums; limit them as much as possible.
Malnutrition – your body needs a balanced nutrition to function properly; prolonged deficiency of calcium, vitamin D vitamin C, and certain B vitamins may be responsible for periodontal infection.
Stress – stress plays a role in the development of many deadly diseases that ravage our society; it weakens the immune system and dries up the bones. In addition, stress can cause dry mouth, leading to periodontitis.
Certain diseases – some systemic diseases such as cancer (including leukemia), HIV/AIDS and diabetes are considered as causative agents of periodontitis.
Ill-fitting dental restorations – problems associated with dental crown or a filling can promote accumulation of plaque and increase the risk of gum and tooth disease.
Gingivitis – untreated chronic gingivitis represents a high risk of periodontitis.
Age – as you get older, your risk of having oral problems is higher.
Some people with periodontitis have a history of:
- Abnormality of epithelial tissues
- Abnormal polymorphonuclear function,
- Decreased of alkaline phosphatase (an enzyme produced in the liver, bone and the placenta)
- Excess production of a group of proteins released by cells of the immune system called cytokines.
If you have periodontitis, you will experience at least one of these problems:
- Gingivitis – inflammation of the gums
- Bleeding of the gums when brushing
- Loose tooth
- Tooth sensitivity
- Gum retraction/recession
- Change in color of the gums
- Tooth mobility.
It is necessary to treat periodontitis in its genesis phase; complication of the disease can lead to:
- Tooth loss
- Chronic bad breath
- Cardiovascular disease, including heart attack
- Premature birth or low birth weight babies
- Diabetes complications
- Respiratory problems.
Most often, sophisticated tests are not important in the diagnosis of periodontitis. Your dentist will examine your mouth and search for the typical signs of the disease. In case of complications, however, physical examination may be associated with radiographic exams to confirm the diagnosis. Although rare, your dentist may recommend microbiological cultures to detect the bacteria in question.
In the event of a mild periodontitis, the treatment involves scaling and root planning to eliminate the bacterial deposit. If periodontitis is severe, taking the drugs and surgery may be necessary to eliminate the periodontal pockets.
Scaling and root planning – the first step in treating the periodontitis is to reduce the inflammation by removing all harmful microorganisms causing plaque and tartar, two common methods your doctor can choose to get rid of those etiologic agents are scaling and root planning, two non-surgical therapies commonly used in periodontal diseases (gum diseases). If you have bleeding gum, the cleaning may be a little painful or uncomfortable, but the pain is usually minor.
Antibiotherapy – Your dentist may recommend that you take antibiotics orally or topically to combat the periodontitis. Oral antibiotics are sometimes necessary to completely eliminate the bacteria leading to the infection. However, to avoid antibiotic resistance, they are rarely used. Therefore, if you are prescribed antibiotics, follow your treatment as indicated.
Surgical treatment – surgical intervention is performed when the other methods fail to uproot the disease.
Gingival flap surgery – this is a procedure used to treat moderate or advanced periodontitis. It is performed especially when the non-surgical treatment (scaling and root planning) has been unable to successfully cure the periodontitis.
Soft tissue grafts – In case of gingival recession (loss of gum tissue), your surgeon dentist can perform soft tissue grafts to reduce the poor quality of the gums and cover the roots of teeth. This procedure is also important to prevent tooth loss, and improve your smile.
Bone grafting – if the periodontitis has damaged the alveolar bone (bone surrounding your teeth root), Bone grafting will be necessary. This is a serious procedure during which the surgeon will replace the infected bone with a healthy bone, which can be yours or donated.
Guided bone regeneration (GBR) – also called guided tissue regeneration (GTR), GBR is performed to direct the growth of new bone and soft tissue that have been damaged or destroyed by the periodontitis. Used in conjunction with sound surgical technique, guided bone regeneration is reliable and validated procedure.
Regular use of dental floss and anti tartar toothpaste can prevent not only gingivitis and tartar, but also many other oral diseases including periodontitis. Here are some tips that can help you prevent all oral problems and maintain a good oral health:
- Chew sugar-free chewing gum
- Avoid snacking between meals
- Visit your dentist regularly or every six months
- Check your gums regularly, and look for signs of plaque, gingivitis and other dental problems
- Report immediately to your dentist symptoms of sensitive teeth or bleeding gums
- Eat a healthy diet rich in vitamin C and vitamin B3 (niacin)
- Brush your teeth and your tongue twice a day or after each meal
- Use dental floss once a day to remove plaque between your teeth
- Avoid too much sugar in your diet; it is a major cause of dental problems
- Do not smoke; cigarette smoke is one of the leading factors of developing dental problems and oral cancer
- Soft drinks, syrups and fruit juices are highly cariogenic (can produce or promote the development of tooth decay); they decrease your oral pH, and increase your risk of cavity. Therefore, brush your teeth right away after eating them.
- PLarsen, Peter; G. E. Ghali (2004). Peterson’s Principals of Oral and Maxillofacial Surgery. Hamilton, Ont: B.C. Decker. ISBN 1-55009-234-0.
- Hurley LA, Stinchfield FE, Bassett AL, Lyon WH (October 1959). “The role of soft tissues in osteogenesis. An experimental study of canine spine fusions”. J Bone Joint Surg Am 41-A: 1243–54. PMID 13852565.