Periodontal disease is an infectious disease that affects the supporting tissues around every tooth. It is commonly called gum disease but it can involve other structures as well. The teeth are embedded in the jaw bone that surrounds the roots of the teeth. Covering the bone is a layer of gum tissue that fits like a collar around each tooth, with a small space or crevice called the sulcus between the gum and tooth right at the gumline. This space is normally about 2 or 3 millimeters deep and is easily cleanable with the bristles of a toothbrush and with floss between the teeth. When periodontal disease occurs, the bacteria that can live in the sulcus cause damage to the gum tissue which leads to the creation of pockets, which are spaces deeper that the usual 2-3 millimeter and are a result of a loss of the attachment of the gum to the tooth. This allows bacteria to grow deeper into the bone around the roots, causing damage to and eventual loss of bone support around one or more teeth. Once these pockets form it becomes much more difficult to clean the bacteria from the teeth because the normal devices used to clean teeth do not generally reach far enough into the pockets to be effective. As bone loss progresses, the tooth becomes loose and may eventually require extraction.
In otherwise healthy individuals, this disease process is slow, usually taking years or decades to advance to the point of tooth loss and it is also usually relatively painless, which is why patients are often unaware that it is occurring until it is fairly far advanced. For patients with other health issues, particularly ones that affect their immune systems, such as diabetes, this disease can progress much more rapidly and can lead to tooth loss at an early age. This group of patients should be very regular with their dental visits so that their periodontal health can be monitored and any early signs of disease can be treated. Some early sign of disease include gums that bleed when eating or cleaning the teeth, red, puffy or tender gums, bad breath that doesn’t respond to regular cleaning, visible discoloration between the teeth or debris that won’t come off with brushing and shifting or loosening of the teeth.
The main cause of periodontal disease is bacteria. There are many types of bacteria in everyone’s mouth but certain types are responsible for this disease. They produce enzymes and toxins that cause the actual damage to gum and bone. Good oral hygiene will reduce the amount of bacteria in the mouth and prevent it from producing the damaging toxins. If not regularly removed, the film of plaque bacteria can harden into rough, porous deposits called tartar (also known as calculus). Although not the cause of gum disease, tartar is certainly instrumental in making it worse and progressing faster. The deposits hold the bacteria and toxins on their rough surfaces and it is impossible to remove these from the pores so that they are now in constant contact with the teeth and gums. This increases the inflammation in the area and consequently increases the damage to the bone. Tartar cannot be removed with home care devices and should be regularly cleaned off the teeth by a dentist or hygienist.
Treatment for periodontal disease can vary depending on the extent of the damage but it usually involves several visits of a special type of cleaning called scaling and root planning. This is usually done with local anesthetic so that the cleaning devices can more thoroughly clean the deep pocket areas and hard to reach places between the roots without discomfort. This will remove the tartar, reduce the inflammation and sometimes reduce the pocket depth and make it easier for the patient to keep the teeth clean. If the pockets are deep enough and/or there has been more significant bone loss, then gum surgery may be needed. This procedure is usually done by a gum specialist (periodontist) and allows for even better access to the root surfaces to clean them, it may involve some recontouring of the existing, diseased, bone and in some cases bone grafting can be done to help restore the bone to some degree. Once periodontal treatment is completed, it is very important for patients to maintain the health of there gums with regular dental visits for professional cleanings, often on a more frequent schedule than that for healthy patients, and also with diligent home care.
Current research is suggesting that there may be a connection between periodontal disease and other diseases that affect the body, such as diabetes, heart disease, stroke, pneumonia and pregnancy complications. Although this connection is not yet fully understood, further research is ongoing and it is likely that we will discover that the mouth is not an isolated area of the body but instead is a pathway through which other systems and organs are affected.