Periodontics: The importance of periodontal health

Periodontics is a dental specialty that includes the prevention, diagnosis and treatment of diseases of the tissues surrounding and supporting the teeth. These dental specialists are called periodontists, and they also are involved with periodontal plastic surgery and placing dental implants.

Periodontal diseases are bacterial infections of the gums, bone and periodontal ligament (fibers that support the teeth and hold them in the jaw). They destroy the gums and supporting bone that hold your teeth in your mouth. As a result, teeth may loosen and fall out or need to be removed and replaced with dental bridges or implants.

Periodontal plastic surgery may be required to cover exposed tooth root surfaces, correct gum and jawbone indentations or reshape and repair the gum tissue. Dental implants are placed to provide an artificial tooth root to support dental restorations that will later be created by your dentist or prosthodontist.

Causes of Periodontal Disease

The primary cause of periodontal diseases is bacterial plaque, a sticky, colorless coating that forms on your teeth. If left untreated – generally as a result of poor oral hygiene habits – the bacteria in plaque infect the gums, release toxins that redden and inflame the tissue, and gradually destroy the tissues supporting the teeth and underlying bone. When this happens, the gums separate from the teeth, forming pockets that fill with more plaque and cause additional infection.

Other factors that can affect the health of your gums include:

Plaque Traps. Decayed teeth, broken or badly fitting partial dentures, crowded/crooked teeth and improperly filled teeth can “trap” plaque buildup, making it difficult to remove by routine oral hygiene methods.

Negative Behaviors and/or Practices. Your periodontal health can suffer due to poor personal oral hygiene practices, oral piercings, smoking, and drug and/or alcohol abuse. A stressful lifestyle and poor nutritional habits, both of which can diminish your body’s ability to fight infection, also can make you more susceptible to periodontal disease.

Systemic Factors. People with diseases such as diabetes and leukemia, on certain medications or with systemic conditions such as human immunodeficiency virus (HIV) infection, malnutrition or immunosuppression, may be especially vulnerable to gum disease due to lower resistance levels.

Hormonal Factors. Predominantly true for women, hormonal fluctuations during key life stages – puberty, pregnancy and menopause – can trigger tissue changes throughout the body, including the mouth. At such times, a woman’s chances for developing periodontal disease may increase.

Genetic Influences. Genes and family history can indicate a predisposition for developing periodontal diseases.

Tobacco Use. Tobacco users show a greater incidence of calculus formation on teeth, deeper pockets between gums and teeth, and more loss of bone and fibers that hold teeth. Chemicals in tobacco (tar and nicotine) diminish the healing process and likelihood of success after periodontal treatment. Smokeless tobacco users also are at higher risk of developing oral cancer.

Medications. You should inform your dentist of any medicines you are taking, as certain medicines (e.g., oral contraceptives, antidepressants and some heart medicines) can adversely affect your gums or have contraindications for antibiotics.

Who Treats Periodontal Diseases?

Regular professional dental checkups to evaluate the state of your oral health are essential for detecting and managing periodontal disease. Your general dentist usually detects gum disease and treats it in the early stages. While some general dentists have the expertise to treat more advanced forms of periodontal disease, more frequently, gum disease requires specialized treatment. In such cases, your general dentist may refer you to a periodontist. However, you do not need a referral to see a periodontist. You can visit one directly.

Types of Periodontal Diseases

Periodontal diseases/conditions include:

Gingivitis. An inflammation of the gums surrounding the teeth, gingivitis is the mildest form of periodontal disease. At this stage, there is typically no discomfort. If not properly treated, it may progress to periodontitis.

Periodontitis. There are various forms of periodontitis, including the following.

Chronic periodontitis, the most common form, results in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss. It is diagnosed by bone loss (through dental X-rays), pocket formation and/or gum recession. It typically affects adults who are 35 or older, but it can occur at any age. Attachment loss may progress slowly, but periods of rapid progression also can occur.

Aggressive periodontitis, a less common form, is characterized by rapid attachment loss and bone destruction. It usually occurs in patients who are otherwise clinically healthy. There are two forms of aggressive periodontitis: localized aggressive periodontitis, which most often occurs near puberty and usually involves attachment loss around first molars and/or front teeth; and generalized aggressive periodontitis, which usually affects people under 30 years old and involves attachment loss on three or more permanent teeth as well as first molars and incisors.

Periodontitis stemming from systemic diseases often begins at a young age. It is associated with systemic conditions such as heart disease, respiratory problems and diabetes.

Necrotizing periodontal disease is an infection characterized by the death of cells in the gingival tissues, periodontal ligament and alveolar bone (part of the upper or lower jaw that contains roots of teeth). It most commonly occurs in patients with systemic conditions such as Human Immunodeficiency Virus (HIV) infection, malnutrition and immunosuppression. These types of periodontal diseases cause ulcers in the gums between the teeth. Stress, smoking and poor oral hygiene sometimes can contribute to this problem.

Symptoms of Gum Disease

You may have gum disease and not even know it. Often, there is no pain and periodontal diseases may not exhibit symptoms until serious bone loss has taken place. However, it is important to see your dentist or periodontist at the first sign of these common symptoms of periodontal disease:

Red, swollen or tender gums
Gums that bleed easily when brushing or flossing
Gums that pull away from teeth
Loose or separating teeth
Pus between gums and teeth
Persistent bad breath
Change in your bite (occlusion) and/or fit of removable dentures

Ongoing Periodontal Monitoring and Maintenance

Periodontal diseases are chronic diseases. Without vigilant, meticulous and ongoing treatment, periodontal diseases can and often do recur. Once your periodontal health has been evaluated, your periodontist will work with you to customize the best treatment plan to control your periodontal disease.

Treatment can vary depending on how far the periodontal disease has progressed. If diagnosed and treated in its early stages, simple non-surgical periodontal therapy may be enough. If periodontitis has progressed to the extent where you have deep periodontal pockets and considerable bone loss, surgical therapy may be required.

Even when your periodontitis is under control you will still need to follow ongoing periodontal procedures to maintain your oral health. This ongoing treatment lets your periodontist evaluate your periodontal health and ensures that your infection stays under control. During these re-evaluation appointments, your mouth will be examined, new plaque and calculus will be removed, your teeth will be professionally polished and your bite will be checked.