A general periodontal examination should be performed to characterize the periodontal status as part of the overall treatment plan. The aim is to provide a basic screening of the tissues and to obtain an indication of the treatment requirements of the patient.

Approximately 50% of all adults in the United States have some form of gingivitis, and 80% have experienced some degree of periodontitis. Despite the use of fluoride, a critical element in the prevention of periodontal disease, many children and adults still suffer needlessly from this "silent" destroyer of the gum tissue and its underlying bone structures.

WHAT IS PERIODONTAL DISEASE

and How Do You Treat It?

  • Overview
  • Diagnosis and Tests
  • Management and Treatment
  • Prevention
  • Outlook & Prognosis
Gingivitis, also called gum disease or periodontal disease, describes the events that begin with bacterial growth in your mouth and may end -- if not properly treated -- with tooth loss from destruction of the tissue that surrounds and supports your teeth. Gingivitis and periodontitis are two distinct stages of gum disease.  

What's the difference between gingivitis and periodontitis?

Gingivitis usually comes before periodontitis. However, it is important to know that not all gingivitis progresses to periodontitis. In the early stage of gingivitis, bacteria in plaque build up and cause the gums to become inflamed (red and swollen) and often bleed during tooth brushing. Although the gums may be irritated, the teeth are still firmly planted in their sockets. No irreversible bone or other tissue damage has occurred at this stage. When gingivitis is left untreated, it can advance to periodontitis. In a person with periodontitis, the inner layer of the gum and bone pull away from the teeth (recede) and form pockets. These small spaces between teeth and gums collect more bacteria and debris and can become infected. The body's immune system fights the bacteria as the plaque spreads and grows below the gum line. Toxins, or poisons, produced by the bacteria in plaque as well as the body's "good" enzymes (involved in fighting infections), turn against the body and actually start to break down the bone and connective tissue that hold teeth in place. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. When this happens, teeth are no longer anchored in place, they become looser, and tooth loss occurs. Gum disease, in fact, is the leading cause of tooth loss in adults.

What causes gingivitis/periodontal disease?

  • Hormonal changes, such as those occurring during pregnancy, puberty, menopause, and monthly menstruation, make gums more sensitive. This makes it easier for gingivitis to develop.
  • Illnesses, which may affect the condition of your gums. This includes diseases, such as cancer or HIV, that interfere with the immune system. Because diabetes affects the body's ability to use blood sugar, patients with this disease are at higher risk of developing infections, including periodontal disease.
  • Medications can affect oral health because they lessen the flow of saliva, which has a protective effect on teeth and gums. Some drugs, such as the anticonvulsant medication diphenylhydantoin (marketed as Dilantin®) and the anti-angina drug nifedipine (marketed as Procardia® or Adalat®), can cause abnormal growth of gum tissue.
  • Bad habits, such as smoking, make it harder for gum tissue to repair itself by upsetting the balance of repair and breakdown of oral tissues.
  • Poor oral hygiene habits, such as not brushing and flossing on a daily basis, make it easier for gingivitis to develop resulting in a buildup of soft bacteria and calculus known as tartar.
  • A family history of dental disease can be a contributing factor in the development of gingivitis. This is usually a result of the type of bacteria (normal flora) acquired during early life making it more important to control it with brushing and flossing.
 

Periodontitis Diagnosis:

Review Your Medical History
Identify any factors that could be contributing to your symptoms, such as smoking or taking certain medications that cause dry mouth.
Examine Your Mouth
Look for plaque and tartar buildup and check for easy bleeding.
Measure the Pocket Depth
Evaluate the grooves between your gums and teeth by placing a dental probe beside your tooth beneath your gumline, usually at several sites throughout your mouth. In a healthy mouth, the pocket depth is usually between 1 and 3 millimeters. Pockets deeper than 4millimeters may indicate periodontitis. Pockets deeper than 6 mm cannot be cleaned well.
Take Dental X-Rays
Check for bone loss in areas where your dentist observes deeper pocket depths.

Signs and Symptoms to Look For During a Periodontal Exam:

  • Gums: for bleeding, swelling, firmness, and measurement of the periodontal pockets for the space between the gum line and the attachment to the bone; the larger and deeper the pocket, the more severe the disease
  • Teeth: for movement and sensitivity caused by bone loss or weakened periodontal fibers
  • Persistent bad breath: caused by bacteria in the mouth.
  • Bite: for proper teeth alignment and new spacing between teeth caused by bone loss
  • Jawbone: we use X-rays to help detect the breakdown of bone surrounding your teeth
 

How is periodontal disease treated?

American Academy of Periodontology treatment guidelines stresses that periodontal health should be achieved in the least invasive and most cost-effective manner. This is often accomplished through non-surgical periodontal treatment. Non-surgical periodontal treatment does have its limitations. When it does not achieve periodontal health, surgery may be indicated to restore periodontal health. The goals of periodontal treatment are to promote reattachment of healthy gums to teeth; reduce swelling, decrease the depth of pockets and the risk of infection, and stop disease progression. Treatment options depend on the stage of disease, how you may have responded to earlier treatments and your overall health. Options range from nonsurgical therapies that control bacterial growth to surgery to restore supportive tissues.

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How can gingivitis be prevented?

Gingivitis can be reversed in nearly all cases when proper plaque control is practiced. Proper plaque control consists of professional cleanings at least twice a year and daily brushing and flossing. Brushing eliminates plaque from the surfaces of the teeth that can be reached. Flossing removes food particles and plaque from in between the teeth and under the gum line.

 

The American Academy of Periodontology says,

30% of Americans may be genetically susceptible to gum disease and may be up to six times more likely to develop some form of gum disease. If anyone in your family has gum disease, it may mean that you are at greater risk as well. If you are more susceptible to gum disease, your dentist or periodontist may recommend more frequent check-ups, cleanings, and treatments to better manage the gum disease.

 
Health and lifestyle changes that will decrease the risk, the severity, and the speed of gum disease development include the following:
  • Stop smoking. Tobacco use is a significant risk factor for the development of periodontitis. Smokers are seven times more likely to get periodontitis than nonsmokers, and smoking can lower the chances of success of some treatments.
  • Decrease your stress. Stress may make it difficult for your body's immune system to fight off infection.
  • Maintain a well-balanced diet. Proper nutrition helps your immune system fight infection. Eating foods with antioxidant properties—for example, those containing vitamin E (including vegetable oils, nuts, green leafy vegetables) or vitamin C (including citrus fruits, broccoli, potatoes) can help your body repair damaged tissue.
  • Avoid clenching and grinding your teeth. These actions may put excess force on the supporting tissues of the teeth and could increase the rate at which these tissues are destroyed.

Is it true that periodontal disease has been linked with other health problems?

According to the Centers for Disease Control and Prevention (CDC), researchers have uncovered potential links between periodontal disease and other serious health conditions. In people with healthy immune systems, the bacteria in the mouth that makes its way into the bloodstream is usually harmless. But under certain circumstances, according to the CDC, these microorganisms are associated with health problems such as stroke and heart disease. Diabetes is not only a risk factor for periodontal disease, but the periodontal disease may make diabetes worse.

OSTEOPOROSIS

Researchers have suggested that a link between osteoporosis and bone loss in the jaw. Studies suggest that osteoporosis may lead to tooth loss because the density of the bone that supports the teeth may be decreased, which means the teeth no longer have a solid foundation.

RESPIRATORY DISEASE

Research has found that bacteria that grow in the oral cavity can be aspirated into the lungs to cause respiratory diseases such as pneumonia, especially in people with periodontal disease.

CANCER

Researchers found that men with gum disease were 49% more likely to develop kidney cancer, 54% more likely to develop pancreatic cancer, and 30% more likely to develop blood cancers.