Periodontitis – Explained!
Periodontitis – Explained!
What is gingivitis?
Gingivitis means inflammation of the gums. It commonly occurs because of films of bacteria that accumulate on the teeth, called plaque. Gingivitis is a non-destructive type of periodontal disease. If left untreated, gingivitis can progress to periodontitis, which is more serious and can eventually lead to loss of teeth.
A patient with gingivitis will have red and puffy gums, and they will most likely bleed when they brush their teeth. Generally, gingivitis resolves with good oral hygiene – longer and more frequent brushing, as well as flossing. Some people find that using an antiseptic mouthwash, alongside proper tooth brushing and flossing also helps.
In mild cases of gingivitis, patients may not even know they have it. However, the condition should be taken seriously and addressed immediately.
What is Periodontal (Gum) Disease?
Periodontal disease (also known as periodontitis and gum disease) is a common inflammatory condition which affects the supporting and surrounding soft tissues of the tooth and can extend to the jawbone when in its most advanced stage.
Periodontal disease is most often preceded by gingivitis which is a bacterial infection of the gum tissue. A bacterial infection affects the gums when the toxins contained in plaque begin to irritate and inflame the gum tissues. Once this bacterial infection colonizes in the gum pockets between the teeth, it becomes much more difficult to remove and treat. Periodontal disease is a progressive condition that eventually leads to the destruction of the connective tissue and jawbone. If left untreated, it can lead to shifting teeth, loose teeth and eventually tooth loss.
Periodontal disease is the leading cause of tooth loss among adults in the developed world and should always be promptly treated.
Types of Periodontal Disease
When left untreated, gingivitis (mild gum inflammation) can spread to below the gum line. When the gums become irritated by the toxins contained in plaque, a chronic inflammatory response causes the body to break down and destroy its own bone and soft tissue. There may be little or no symptoms as periodontal disease causes the teeth to separate from the infected gum tissue. Deepening pockets between the gums and teeth are generally indicative that soft tissue and bone is being destroyed by periodontal disease.
Here are some of the most common types of periodontal disease:
- Chronic periodontitis – Inflammation within supporting tissues cause deep pockets and gum recession. It may appear that the teeth are lengthening, but in actuality, the gums (gingiva) are receding. This is the most common form of periodontal disease and is characterized by progressive loss of attachment, interspersed with periods of rapid progression.
- Aggressive periodontitis – This form of gum disease occurs in an otherwise clinically healthy individual. It is characterized by rapid loss of gum attachment, chronic bone destruction and familial aggregation.
- Necrotizing periodontitis – This form of periodontal disease most often occurs in individuals suffering from systemic conditions such as HIV, immunosuppressant and malnutrition. Necrosis (tissue death) occurs in the periodontal ligament, alveolar bone and gingival tissues.
- Periodontitis caused by systemic disease – This form of gum disease often begins at an early age. Medical condition such as respiratory disease, diabetes and heart disease are common cofactors.
Treatment for Periodontal Disease
There are many surgical and nonsurgical treatments, depending upon the exact condition of the teeth, gums and jawbone. A complete periodontal exam of the mouth will be done before any treatment is performed or recommended.
Some of the more common treatments for periodontal disease are:
Scaling and root planing – In order to preserve the health of the gum tissue, the bacteria and calculus (tartar) which initially caused the infection, must be removed. The gum pockets will be cleaned and treated with antibiotics as necessary to help alleviate the infection. A prescription mouthwash may be incorporated into daily cleaning routines.
Tissue regeneration – When the bone and gum tissues have been destroyed, regrowth can be actively encouraged using grafting procedures. A membrane may be inserted into the affected areas to assist in the regeneration process.
Pocket elimination surgery – Pocket elimination surgery (also known as flap surgery) is a surgical treatment which can be performed to reduce the pocket size between the teeth and gums. Surgery on the jawbone is another option which serves to eliminate indentations in the bone which foster the colonization of bacteria.
Pregnancy – Oral Considerations
Many pregnant women show some signs of gingivitis during pregnancy. Gingivitis is defined as the inflammation or swelling of the gum tissues. Most cases of gingivitis are the result of poor oral hygiene. If plaque (the bacterial film that builds up on your teeth) is not removed daily by brushing and flossing, the plaque can irritate the gums, making them bright red, tender, swollen, sensitive and bleed readily.
During pregnancy there is a special need for good oral hygiene because pregnancy may exaggerate the body’s normal response to dental plaque. This is because four basic hormones, vital to the continuation of pregnancy, are produced in large quantities during the gestation period. This hormonal increase exaggerates the way the gum tissues react to the bacteria in plaque resulting in an increased likelihood that a pregnant woman will develop gum disease if her daily plaque control is inadequate. It is important to note, that it is the plaque, and not the increased hormone levels that is the major cause of pregnancy gingivitis. Swelling of the gums is usually first seen in the second month of pregnancy and generally reaches a peak by the middle of the last trimester. It can remain that way for 3-6 months after delivery. The seriousness of the gingivitis can range from mild to severe depending on the gum problems existing before pregnancy. Pregnancy generally worsens pre-existing gum problems, sometimes dramatically.
The wives tale of “a lost tooth for every pregnancy” is based on misconceptions that oral problems during pregnancy are a normal occurrence and cannot be prevented. A mouth that is clean does not develop pregnancy gingivitis. Effectively brush your teeth with fluoridated toothpaste at least once a day. Floss your teeth daily to remove plaque from the tooth surfaces not reached by the toothbrush (like the sides of your teeth). Visit your oral health professional such as your dental hygienist regularly for advice on oral disease prevention and oral health promotion while you are pregnant.
Oral Hygiene Aids
Regular dental checkups are essential for maintaining excellent oral hygiene and diagnosing potential problems, but they are not a “fix-all” solution. Thorough oral homecare routines should be practiced on a daily basis to avoid future dental problems.
Periodontal disease (also called gum disease and periodontitis) is the leading cause of tooth loss in the developed world, and is completely preventable in the vast majority of cases. Professional cleanings twice a year combined with daily self-cleaning can remove a high percentage of disease-causing bacteria and plaque. In addition, teeth that are well cared for make for a sparkling white smile.
There are numerous types of oral hygiene aids on the supermarket shelves, and it can be difficult to determine which will provide the best benefit to your teeth.
Here are some of the most common oral hygiene aids for homecare:
Dental floss is the most common interdental (between the teeth) and subgingival (below the gum) cleaner and comes in a variety of types and flavours. The floss itself is made from either thin nylon filaments or polyethylene ribbons, and can help remove food particles and plaque from between the teeth. Floss should normally be used twice daily after brushing.
Many hygienists recommend interdental brushes to help clean slightly open or larger spaces between teeth. These tiny brushes are gentle on the gums and very effective in cleaning the contours of teeth in between the gums. Interdental brushes come in various shapes and sizes.
There are two basic types of mouth rinse available: Cosmetic rinses which are sold over-the-counter and temporarily mask bad breath, and therapeutic rinses which may or may not require a prescription. Most dentists are skeptical about the benefits of cosmetic rinses because several studies have shown that their effectiveness against plaque is minimal. Therapeutic rinses however, are regulated by Health Canada and contain active ingredients that can help reduce bad breath, plaque, and cavities. Mouth rinses (and preferably alcohol free formulas) should generally be used after brushing.
Oral irrigators, like Water Jets and Waterpiks have been created to clean debris from between the teeth and slightly below the gum line. Water is continuously sprayed from tiny jets into the gum pockets which can help remove harmful bacteria and food particles. Overall, oral irrigators have proven effective in lowering the risk of gum disease but should not be used instead of brushing and flossing. Professional cleanings are recommended at least twice annually to remove deeper debris.
Rubber Tip Stimulators
The rubber tip stimulator is an excellent tool for removing plaque from around the gum line and also for stimulating blood flow to the gums. The rubber tip stimulator should be traced gently along the outer and inner gum line at least once each day. Any plaque on the tip can be rinsed off with tap water. It is important to replace the tip as soon as it starts to appear worn, and to store the stimulator in a cool, dry place.
Tongue cleaners are special devices which have been designed to remove the buildup of bacteria, fungi and food debris from the tongue surface. The fungi and bacteria that colonize on the tongue have been related to halitosis (bad breath) and a great many systemic diseases like diabetes, heart disease, respiratory disease and stroke. Tongue cleaners can be made from metal, wood or plastic and shaped in accordance with the contours of the tongue. Tongue cleaning should be done prior to brushing to prevent the ingestion of fungi and bacteria.
There are a great many toothbrush types available. Electric toothbrushes are generally recommended by dentists because electric brushes can be more effective than manual brushes. The vibrating or rotary motion helps to easily dislodge plaque and remove food particles from around the gums and teeth. The same results can be obtained using a manual brush, but much more effort is needed to do so. Manual toothbrushes should be replaced every one to two months because worn bristles become ineffective over time. Soft bristle toothbrushes are far less damaging to gum tissue than the medium and hard bristle varieties. In addition, an appropriate sized CDA approved toothbrush should be chosen to allow proper cleaning to all the teeth. Teeth should ideally be brushed after each meal, or minimally twice each day.