What is Periodontal Disease?

In this section you will find the answers to your questions on periodontal disease – what causes it, how it’s treated and how to prevent it. There is an explanation on the relationship between gum disease and overall health, a detailed breakdown on the three steps involved in treating periodontal disease, a discussion of the merits of antibiotic therapy, a look at some common myths and much more.

The following page contains general information about periodontal disease. For detailed information on related subjects please click on the links in the sidebar and follow the subsection headings. If you are looking for information on a specific topic and are having trouble locating it, you may look in the index or site map or email me at benrussell@eastside-perio.com.

What is Periodontal Disease?

The work “periodontal” refers to the gum tissue and bone around the teeth. Periodontal disease, also known as gum disease, is caused by the chronic inflammatory response to bacteria under the gums around the teeth. The bacteria irritate the gums and generate an inflammatory response which over time can break down and destroy the gums and bone that support the teeth. When the periodontal disease is left untreated, it is one of the primary causes of adult tooth loss. Also several research studies have found a relationship between periodontal disease and other serious health problems such as heart disease, diabetes and rheumatoid arthritis.

In a periodontally healthy environment, the root of the tooth is firmly secured within the jawbone and surrounded by a ligament which keeps the tooth tightly attached to the bone. Gum tissue covers the bone, and like skin, keep bacteria and other pathogens from invading your body. In addition to the gum tissue covering the bone it also is attached to the teeth with a band of fibers inserting just above the bone into the root. In a healthy situation, the edge of the gum tissue is higher than the fiber attachment, forming a space around the tooth. This is similar to having a turtleneck sweater, and this sulcus should be 2-3 millimeters in depth.

Your mouth is significantly different from the rest of your body in terms of the bacteria insult. Your teeth and gums are constantly bathed in saliva which contains varying amounts and types of bacteria. These bacteria aggregate on all surfaces, forming colorless, sticky colonies called plaque. This plaque also forms in the space beneath the edge of the gums. If the plaque is not removed (via brushing and flossing) it will begin to cause an infection in the gums. Plaque that remains on the tooth for an extended period of time absorbs minerals from saliva and becomes hardened. These accretions, called calculus or tartar, cannot be removed by brushing and flossing and require therapy provided by a dental professional.

The Stages of Periodontal Disease

The first stage of periodontal disease is gum inflammation, or gingivitis (from “gingival”, meaning gum and “itis”, meaning inflammation). The body reacts to the bacteria by forming new blood vessels and recruiting cells to the area to help fight the infection. This alters the appearance of the gum tissue causing it to look red and, often times, swollen. Patients may notice bleeding when cleaning their teeth. The hallmark of gingivitis is that there has been no permanent destruction to the supporting structures of the teeth. Once the plaque and calculus are removed, in conjunction with meticulous hygiene by the patient, the situation usually resolves.

If the gingivitis is not corrected, the bacteria may destroy the healthy attachment of the gums to the underlying tooth and bone, and start moving down the tooth surface. The advancing bacteria cause a significant amount of inflammation. The inflammation is a direct response by your body, which is attempting to fight the infection. Unfortunately, this inflammatory response which is aimed at destroying the bacteria also causes the destruction of healthy tissue, particularly the supporting bone. Once there has been bone loss around a tooth the diagnosis changes from gingivitis to peridontitis. There are many factors that influence how well your body defends against the bacterial invasion. These can be explored in the Host Resistance section.

As the bacteria advances down the tooth, the inside lining of the gum and the bone are destroyed. This penetration of bacteria forms a periodontal pocket, or deepened space between the gum and tooth. These pockets, measured with a periodontal probe, are an indication of the amount of bone loss that has occurred. If the condition is left untreated, the bone loss progresses and the support is continually weakened. The tooth will become loose, and if the disease continues, may become abscessed and eventually lost.

For more information on the role of inflammation in oral health, tips on how to prevent or treat gum disease, to find out if you are at risk, or to find a local periodontist, visit perio.org.

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