Periodontics

A periodontal assessment is one of the most important things you can do to prevent or treat gum disease!

Periodontal (gum) diseases, including gingivitis and periodontitis, are serious infections that occur when a bacterial infection develops where the gums join the teeth.

Oral bacteria release toxins and enzymes that can cause a number of problems with the tissues that surround and support your teeth. If left uncontrolled or untreated, these bacteria can trigger inflammatory responses which can lead to bone loss, receding gums, and eventually, tooth loss. Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the thick, sticky, colourless substance that constantly forms on your teeth) causes the gums to become inflamed.

Gingivitis is the mildest form of the spectrum of periodontal diseases. It is an inflammation that is limited to the gums.  Gingivitis is characterized by gums that are red, swollen and bleed easily. The person experiences little or no discomfort. Gingivitis is often caused by inadequate oral hygiene (poor flossing and brushing habits). Gingivitis is reversible with professional treatment and good oral home-care.

If left untreated, gingivitis can progress to periodontitis resulting in irreversible bone loss and damage to the other structures that support the teeth. When plaque is not removed regularly and thoroughly, it can spread and grow below the gumline. Toxins and enzymes produced by the bacteria in plaque irritate the supporting structures, and eventually stimulate a chronic inflammatory response whereby the body, in essence, turns on itself.  The tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected as more bacteria make their way down below the gumline.

As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. In most cases, this chronic destructive process is very mild and has no symptoms that the person can easily identify.  It can, therefore, go unnoticed unless the individual visits their dentist or dental hygienist regularly (every 3-6 months). Eventually, this progressive bone loss can cause teeth to become loose and, if left untreated, the teeth may ultimately be lost.

Causes of Periodontal Disease

The main cause of periodontal disease is bacterial plaque; a sticky, colourless substance that constantly forms on your teeth. This substance triggers an immunologically-mediated inflammatory response in the tissues surrounding and supporting the teeth.  If the plaque is not removed throroughly through regular flossing and brushing, it will harden into what professionals call calculus (a.k.a. tartar).  This hard deposit cannot be removed through home-care methods, and must be removed by a dental professional or it will perpetuate the inflammation.  It is this inflammation that eventually destroys the bone around your teeth, causing tooth loss.  This explains why comprehensive, meticulous care by your dentist and dental hygienist is indispensable.

It cannot be stressed enough:  the number one cause of periodontal disease is inadequate oral hygiene! In addition, the following factors also contribute to the development of periodontal disease:

SMOKING/TOBACCO USE

As you probably already know, tobacco use is linked with many serious illnesses such as cancer, lung disease and heart disease, as well as numerous other health problems. What you may not know is that tobacco users are at a higher risk of developing periodontal disease. In fact, recent studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease.

GENETICS

Research proves that up to 30% of the population may be genetically susceptible to gum disease. Despite aggressive oral care habits, these people may be six times more likely to develop periodontal disease due to innate problems with their immune cells. Identifying these individuals through the use of a genetic test before they manifest signs of the disease, and getting them into early interceptive treatment, may help them keep their teeth for a lifetime.

PUBERTY, PREGNANCY, MENSTRUATION, MENOPAUSE AND THE PILL

As a woman, you know that your health needs are unique. You know that brushing and flossing daily, a healthy diet, and regular exercise are all important to help you stay in shape, and more importantly, in optimal health. You also know that at specific times in your life, you need to take extra care of yourself. Times when your body matures or changes, such as puberty or menopause, and times when you have special health needs, such as menstruation or pregnancy all result in hormonal changes. These changes can affect many of the tissues in your body, including your gums. Your gums actually contain estrogen receptors and can become swollen, sensitive or bleed when your estrogen levels change. This may make you more susceptible to gum disease. In addition, recent studies suggest that pregnant women with gum disease are seven times more likely to deliver pre-term, low birth-weight babies! The science is clear:  it is very important for you to maintain the health of your gums, since they can also influence your health and the health of your unborn child.

STRESS

As you probably already know, stress is linked to many serious conditions such as hypertension, cancer, and numerous other health problems. What you may not know is that stress is also a risk factor for periodontal disease. Research demonstrates that stress can make it more difficult for the body to fight off any infection, including periodontal disease, because it suppresses your immune response, thereby lowering your ability to fight the disease-causing bacteria.

MEDICATIONS

Some drugs, such as oral contraceptives, anti-depressants, anti-convulsants and certain heart medications, can affect your oral health. Just as you notify your pharmacist and other healthcare providers of all medicines you are taking and any changes in your overall health, you should also inform your dental-care provider.  A thorough and complete medical history is essential to a proper assessment and diagnosis.

CLENCHING OR GRINDING YOUR TEETH (BRUXISM)

Has anyone ever told you that you grind your teeth at night? Is your jaw sore from clenching your teeth when you're taking a test or solving a problem at work? Clenching or grinding your teeth can place excessive force on your teeth and their supporting tissues, and could speed up the rate at which these periodontal tissues are destroyed.  Grinding and clenching can also compound and an already existing periodontal condition, causing rapid and irreversible destruction.

DIABETES

Diabetes is a disease that causes altered levels of sugar in the blood. Diabetes develops from either a deficiency in insulin production (a hormone that is the key component in the body's ability to transport blood sugar to the cells for utilization) or the body's inability to use insulin correctly. According to the American Diabetes Association, approximately 16 million Americans have diabetes; however, more than half have not been diagnosed with this disease. If you are diabetic, you are at higher risk for developing infections, including periodontal diseases. These infections can impair the ability to process and/or utilize insulin, which may cause your diabetes to be more difficult to control and your infection to be more severe than a non-diabetic.

POOR NUTRITION

As you may already know, a diet low in important nutrients can compromise the body's immune system and make it harder for the body to fight off infection. Because periodontal disease is a serious infection, poor nutrition can worsen the condition of your gums.  Furthermore, many nutritional deficiencies impact on the oral cavity, and in particular the gums and other soft tissues of the mouth, and manifest as inflammatory changes to the gums and the tongue, encouraging bacterial growth.

OTHER SYSTEMIC DISEASES

Diseases that interfere with the body's immune system may worsen the condition of the gums.

Types of Periodontal Disease

There are many forms of periodontal disease. The most common ones include the following:

GINGIVITIS

Gingivitis is the mildest form of the periodontal diseases. It causes the gums to become red, swollen, and bleed easily. There is usually little or no discomfort at this stage. This often manifests as gums that bleed upon brushing or flossing.  Gingivitis is reversible with professional treatment and good at home oral-care.  Gingivitis most often occurs as a result of poor oral hygiene, but it can also be related to systemic or hormonal issues, as well as with the use of certain medications or nutritional deficiencies.

AGGRESSIVE PERIODONTITIS

This is a form of periodontitis that occurs in patients who are otherwise clinically healthy. It is related to a dysfunctioning of one particular white blood-cell type.  Common features include rapid attachment loss and bone destruction, along with a familial aggregation (disease has been seen in other family members).

CHRONIC PERIODONTITIS

This is a form of periodontal disease resulting in inflammation within the supporting tissues of the teeth, with a slower rate of attachment and bone loss with periods of rapid progression and periods of remission.  It is characterized by pocket formation and/or recession of the gingiva (gums). It is recognized as the most frequently occurring form of periodontitis, affecting some 55-85% of adults over the age of 35. It is prevalent in adults, but can occur at any age.  There is no cure for chronic periodontitis.  Personal and professional efforts are focused on controlling the symptoms, and preventing of further destruction of the tissues.

PERIODONTITIS AS A MANIFESTATION OF SYSTEMIC DISEASES

Early-onset periodontitis (onset at a young age) is often associated with one of several systemic diseases, such as diabetes, Down's Syndrome, Papillon-LeFevre Syndrome and other systemic or developmental conditions.

NECROTIZING PERIODONTAL DISEASES

This is a periodontal infection characterized by necrosis (or death) of the gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions including, but not limited to: HIV infection, malnutrition and immuno-suppression.

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