Periodontal Disease

Poor dental hygiene, including poor brushing habits and not flossing daily, sets the basis for gingivitis to begin.

Heredity has been shown to play a factor in contributing to a person’s development of gingivitis.

Hormonal changes, including changes during menopause, puberty, and pregnancy, affect the blood supply to the gum tissue. This affects the body’s response to the toxins that plaque releases.

Health factors can directly affect the condition of the gum tissue. These health issues include:

• Cancer
• HIV
• Diabetes
• Immune system deficit

Medications can affect the flow of saliva.

Saliva protects the teeth and gums, and when medication alters the salivas’ ability to function, the gum tissues can be adversely affected.

Smoking adversely affects the gum tissue, making it hard for gum tissue to repair itself.

Stress, especially prolonged stress, has been found to strongly correlate with gum disease. Stress causes the body to release inflammatory hormones, which have been shown to cause or worsen gum disease.

Misaligned or crowded teeth may be a factor in periodontal risk. Whenever the ability to remove plaque from teeth is impeded, the risk of developing gum disease increases.

Improperly fitted dental crowns, bridges, or dental implants may also play a role in causing periodontal disease.

Poor dental work can cause food to be trapped, encouraging bacterial growth.

A poor diet or outright malnutrition is a risk factor for periodontal disease. Healthy diets rich in vitamin C are crucial to staving off gum disease.

The first stage is commonly referred to as gingivitis.

Signs of gingivitis include redness and swelling of the gums.

Gums that bleed while brushing or flossing can also be an important early indication of gingivitis.

Catching periodontal disease in its early form is crucial. Early treatment consisting of improved oral hygiene habits and professional care can help prevent further deterioration and even reverse the damage.

At this stage, untreated periodontitis can still affect the jawbone and surrounding tissue and lead to the separation of the gums and teeth.

This Moderate Periodontitis stage includes the following symptoms:

• Damage to supporting gums
• Teeth in the form of gum recession
• Separated gums
• Loose teeth
• Bad breath
• Possibly signs of pus

Pockets formed from loose gingival tissues can form and deepen over time, making them very difficult to clean. Bacteria that gather in these pockets further accelerate damage to gum tissues and bone. This can cause the disease to progress rapidly and without warning.

At this stage, professional therapies performed by a periodontist are necessary to remove bacteria and monitor symptoms to stop the disease from progressing.

Much of the damage to the gums and teeth is permanent and cannot be reversed at this stage.

Teeth increase their sensitivity to heat or cold, which leads to pain when eating hot or cold foods.

Extensive damage to soft tissues and the bone tissues that support the teeth may eventually lead to tooth loss.

To prevent the disease from spreading, a periodontist may need to remove rotted teeth and infected tissues.

Once a patient reaches Stage 4, the chances of retaining or salvaging their natural teeth are quite slim. As a result of severe receding gums, the remaining teeth are unsupported. Fibers, bone, and ligaments that support the teeth and anchor them are destroyed, resulting in widespread tooth loss.

As described above, standard periodontitis is typically represented by its stages. In general, each stage is based on the severity and complexity of the management required to treat the disease.

Necrotizing periodontitis is a unique form of gingivitis that spreads quickly and leads to rapid tissue death, or necrotization, in the mouth.

Below are three generally recognized types of necrotizing periodontitis.

• Necrotizing gingivitis
  This form of the disease affects only the gums, with patients suffering from bleeding gums, pain, and bad breath.
• Necrotizing periodontitis
  This is indicated by receding gums firmly attached to the teeth. Other symptoms include severe pain, spontaneous bleeding, loss of bone, or exposed bone.
• Necrotizing stomatitis
  Stomatitis refers to sores in the mouth. This is an aggressive form of gum disease resulting in mucosal and bone loss to the gums and tissue that surround the teeth. Other symptoms include frequent bleeding, severe pain, multiple affected teeth, and gaps between teeth.

Periodontal disease does not operate in a vacuum. While it is often initiated by bacteria infection and exacerbated by an overabundance of bacteria, many cases of periodontal disease can be tied to other underlying systemic health issues. According to Nature, periodontal disease is associated with several other systemic diseases, including respiratory disease, chronic kidney disease, rheumatoid arthritis, cognitive impairment, obesity, metabolic syndrome, and cancer.

This new understanding of how oral diseases, such as periodontitis, may be linked to other chronic diseases has changed the way periodontists and doctors view periodontal disease.

As a result, doctors now categorize cases of periodontitis that arise from an existing condition in a separate group.

Understanding the underlying health causes driving or exacerbating periodontal disease can help periodontists develop a holistic therapy that addresses not only the symptoms of periodontitis but also the root causes.

Flossing helps to keep gums healthy by reaching the in-between places that brushing misses. It leaves bacteria with no place to hide.

Each tooth has five surfaces, and it’s important to remember that flossing reaches two of those areas. It strengthens your gums and prevents plaque buildup.

Use a mouthwash to reduce the risk of gum disease and improve your overall oral health. Mouthwash removes food particles, kills harmful bacteria, strengthens tooth enamel, and helps control plaque and gingivitis. This is an additional protection that can be added to your oral hygiene routine.

You’ll also want to eat a well-balanced diet that incorporates fruits, vegetables, and lean proteins into your meals. Avoid sugar and starches, which cause tooth decay and bacterial growth.

Drink water instead of sugary drinks.

Finally, try to schedule regular dental exams every six months to a year.

Professional cleanings remove bacteria and plaque from your teeth and gums, which can prevent gingivitis and slow periodontitis.

Plaque and bacterial buildup along your gums can lead to gum infection, leading to periodontal disease.

Dental checkups are critical in spotting early signs of gum disease and preventing any existing damage from getting worse.

Inadequate oral hygiene is the most common cause of gingivitis.

The buildup of bacterial plaque along and below the gumline can trigger the inflammatory response that leads to gingivitis.

If left untreated, gingivitis can progress into a more serious form of gum disease known as periodontitis.

Inadequate oral hygiene, typically over a long period of time, is the most common cause of periodontal disease.

Like gingivitis, the ultimate causes of periodontitis revolve around bacteria and inflammation.

As discussed in the previous section, Gingivitis: Symptoms and Causes, bacteria on the gums and beneath the gum line trigger a destructive immune response in the form of chronic inflammation. In the beginning, this chronic inflammation is typically only mildly irritating. This phase of the development of gum disease is known as gingivitis.

Over time, gingivitis progresses into periodontitis. At this stage, the bacteria and subsequent inflammatory response have caused significant and irreversible damage to your gums and underlying bone tissues.

Anyone can be susceptible to gum disease, but several factors increase the risk of developing periodontitis. Understanding these risk factors is just as crucial as establishing good oral hygiene habits.

Some factors include the following:

• Older age
• Smoking or chewing tobacco
• Hormonal fluctuations, especially during pregnancy
• People with underlying medical conditions such as diabetes or cancer
• Genetics
• Using medications that cause dry mouth
• Stress

Pocket reduction surgery is a more invasive version of scaling and root planing. Your periodontist will make a minimal incision in your gum and pull back the section to completely expose the roots. This way, your periodontist can work with a more effective scaling and root planing process.

If there is bone loss, the underlying bone can also be accessed for contouring or smoothing before suturing the gum tissue back in place.

Periodontitis is a severe form of gum disease that can cause major issues with your oral health. Sometimes, periodontitis destroys the bone that surrounds the root of your tooth. When this happens, bone grafting may be necessary.

The graft used is made out of fragments of your old bone or donated bone. This bone graft will decrease the chances of further bone loss and promote possible regrowth of natural bone.

Periodontitis can destroy your gum tissues causing gum recession. Receding gums exposes your dental roots and negatively affects your appearance as well as your teeth. To repair receded gums, a small amount of tissue from the roof of your mouth or a donor can be grafted to the affected site.

Like bone grafting, guided tissue regeneration promotes bone growth and maximizes healing. When the bacteria destroy your bone, your periodontist will place a piece of biocompatible fabric between your tooth and the existing bone. This will help ensure the area heals and your bone grows back.

Periodontitis causes your gum line to recede due to gum tissue loss. Soft tissue grafts will be necessary to ensure the tissue can be reinforced.

Soft tissue grafting uses a piece of tissue collected at the roof of your mouth, also known as the palate, or donor tissue can be used and placed at the site of infection. This will help your overall appearance by covering the exposed roots and reducing the chances of the gums receding further.

Periodontitis is a severe gum disease where tartar build-up and plaque have taken over the gums, causing infection, which causes bleeding, swelling, and overall pain in the gums.

Antibiotics help control the bacterial infection that is causing your periodontitis. Topical or oral antibiotics are available to you, but oral antibiotics are the most necessary for eliminating the infection.

These antibiotics come in the form of gels or mouth rinses. Your periodontist will know which one will work best for your specific case.

Root planing is a treatment option where we smooth out the gum line to remove plaque and tartar build-up that has grown, preventing any further build-up in the area. If this is not done, the infectious bacteria will spread and cause inflammation in the gums.

In addition, you will delay the healing process regardless of the other steps taken if this is missed.

Scaling removes any tartar or plaque attached to your gums and the surface of your teeth. Scaling goes hand in hand with root planing and must be done with a dental instrument like a laser or ultrasonic device.

Gum disease is a prevalent oral health issue that affects many people.

According to the CDC, 47% of adults older than 30 suffer from periodontal disease, and 70% of adults 65 or older have periodontitis. Therefore, it is vital to monitor your oral health to try and prevent gum disease and catch it in its earliest stage.

Periodontal disease is not only dangerous for your oral health and dentition, but it can indirectly cause other severe health issues. Apart from tooth loss, receding gums, and deteriorating bone and tooth roots, periodontitis can be a factor in the following health issues:

• Heart Disease
• Strokes
• Diabetes
• Forms of Dementia, including Alzheimer’s
• Pregnancy Complications

Cavities and periodontitis do not go hand in hand. Each of these diseases is caused by a different bacteria:

• Cavities are caused by the bacteria Streptococcus Mutans
• Gum disease is caused by the bacteria Porphyromonas gingivalis

Even if you have never had cavities or do not currently have cavities, your teeth can still loosen and fall out due to the effects of gum disease. So never rule out gum disease if your dentist doesn’t find any cavities.

Proper dental hygiene: brushing, flossing, and mouthwash help prevent periodontal disease but does not eliminate its chances of occurring.

The pockets that form around your gums become more profound and deeper as untreated periodontitis progresses. Once they become deeper than 4mm, you can’t clean the affected area yourself. This is where regular dental cleanings become vital. Other factors like tobacco use, genetics, and diabetes can cause periodontitis no matter how often you practice proper dental hygiene.

So often, people don’t realize they are suffering from periodontal disease. Initial gum disease is not painful so much as it can cause tender, bleeding gums and loose teeth. People usually associate bleeding gums with a lack of flossing and intense brushing and don’t immediately assume it is gum disease. Likewise, don’t assume that you will start to feel pain if you suffer from periodontal disease. Here are a few early signs to look for so you can be vigilant:

• Bleeding and tender gums
• Loose teeth
• Bad breath
• Pain when chewing
• Receding gums

It doesn’t feel good to say, but severe periodontitis cannot be cured. However, in its beginning form of gingivitis, you can reverse it with proper at-home oral care and regular dental checkups.

However, once it surpasses that, you can only manage it.

Do not get discouraged.

If you have passed the gingivitis stage and are suffering from moderate or severe periodontitis, there are treatments that help maintain it to prevent tooth loss and other health issues.

Periodontal disease, also known as periodontitis or gum disease, is the number one concern of a periodontist. Periodontal disease is an infection in the gums that causes inflammation and weakens the soft tissue, supporting bone, and tooth roots. Extreme tooth and bone loss is often the consequence of severe periodontal disease.

The earliest stages of periodontitis are known as gingivitis, which can still be reversible and treated. It is vital to consult a periodontist once gingivitis turns into periodontitis. It is not possible to reverse periodontitis. Instead, it can only be managed so that it does not progress. A periodontist can adequately handle the treatment of gingivitis and periodontitis.

The swelling of the gums indicates that they are inflamed and likely infected. This is often the first stage of periodontitis known as gingivitis.

A dentist will most likely refer you to a periodontist to treat gingivitis and avoid it worsening since it is still treatable. Leaving gingivitis untreated will lead to permanent damage and tooth decay.

Although these issues aren’t as dramatic as others, they can develop into much worse ones in the future. Although each of these issues can be considered non-emergent, if they are chronic, then early gum disease or tooth loss may develop. If these issues persist, speak with your dentist to be correctly referred to a periodontist.

Additionally, periodontists can help reverse receding gum lines. There is no direct correlation between receding gums and periodontal disease, but it is often caused by improper brushing and brushing too hard. In such cases, a periodontist can perform gum grafts for cosmetic purposes.

In the absence of improper brushing techniques, if your gums are receding, it may be an indication of moderate to severe periodontitis. A periodontist can determine whether a receding gum line is caused by an underlying issue and develop a treatment plan.

Periodontitis, periodontal disease, or severe gum disease is an infection and inflammation of the gums and bone surrounding and supporting the teeth. It starts at its first stage, gingivitis and if not treated, progressively gets worse and more severe. Once it worsens, the gums will go from puffy and swollen to completely pulling away from the teeth. As this happens, the bone begins to decay, and the teeth loosen and eventually fall out.

According to the CDC, 47% of adults 30 and older and 70% of adults 65 and older suffer from severe gum disease. It is essential to see the warning signs when gingivitis has turned into periodontitis:

• Inflammation of the gums or bleeding gums
• Having discomfort while chewing
• Teeth are beginning to loosen
• Extreme teeth sensitivity
• An unpleasant taste in the mouth or chronic bad breath
• Gums are incredibly swollen and red
• A change in your bite
• Partial dentures no longer fit correctly

The symptoms of gingivitis overlap with many of these, so it’s important to see a dentist or periodontist as soon as possible. Periodontal disease is not reversible. Immediately schedule an appointment with your dentist or periodontist if you notice any of these symptoms.

A gum graft involves taking tissue from the roof of the mouth where the connective tissue is located or using surface-level tissue or local gum tissue to cover the receding gum line and stimulate regeneration. It consists of taking tissue from the roof of your mouth and covering receded gums with it.

Among the different types of grafts are:

• Connective Tissue Graft
• Free Gingival Graft
• Pedicle graft

You and your periodontist will decide which procedure is most appropriate based on your unique situation.

In gum surgery, a laser produces concentrated, pinpointed beams of light with thermal energy. In periodontal treatment, they are most commonly used to:

• Ensure that the treated area is sterilized
• Coagulate blood vessels to form solid clots
• Germs and bacteria are eliminated
• Removing and disposing of diseased tissue

The laser changes the energy in atoms by creating a laser beam. The laser beam excites atoms from their resting states, emitting energy spontaneously. In a resting form, atoms emit photons. This process generates power for specific tasks, like cutting tissue without a blade.

Regenerative procedures are used to help encourage new tissue and bone growth to occur. This occurs most commonly when utilizing bone graft procedures. Due to the surgical procedure involved in bone grafts, new bone and possibly periodontal ligament and cementum can be produced by placing bone or bone substitute material into a bone defect.

New bone will replace most of the graft material over time.

Before and After Gummy Smile Correction Surgery

In cases where the tooth lacks sufficient structure to support the crown, a crown lengthening may be necessary. A crown may not firmly attach to teeth that are broken or decayed.

As part of crown lengthening, bone is shaved down, and gum tissue is reduced in order to expose more of the tooth. The proper fit of a crown contributes to better oral hygiene and comfort.

Also, crown lengthening may be used to reduce the visibility of gums above the teeth in some people with “gummy smiles.”

Dental implant surgery usually requires a number of appointments and procedures.

The first procedure involves drilling holes into your jawbone, inserting a titanium post, and sewing the gums shut.

In the following step, the foreign but biocompatible substance integrates into the body through osseointegration, allowing the implant to integrate with the jaw bone.

After several months, there will be another appointment to see if the dental implants have been integrated to start work on creating permanent dental crowns to give you your complete smile back. This is also where a digital impression of your mouth will be taken.

Once the dental crowns are made, a final appointment will be created to place the crowns.

Osseous surgery involves removing or reducing pockets caused by gum disease. When antibiotics or root planing cannot treat severe gum disease, your periodontist will most likely recommend performing pocket reduction surgery.

If this is an option for you, here is what to expect.

Your periodontist will perform the surgery, and be sure to use a local anesthetic to numb the area. It will be necessary to make a small incision along the gum line so the gums can be folded back in order to remove the bacteria.

In the event that the bone is damaged, the periodontist will smooth down the area, but if it is severely damaged, then other treatment techniques, like a bone graft, may be necessary.

Finally, the periodontist will sew the gums back in place and apply gauze to manage any bleeding that may be occurring.

A periodontist may be referred to you by your dentist, either within your network or by whoever they work with, to help you manage your periodontal disease. Dentists are specialists in teeth, while periodontists are specialists in the teeth’s supporting tissues. A periodontist can tell you how advanced your periodontal disease is and what your options are.

Periodontal disease has four stages:

• Initial – Gingivitis
• Mild periodontitis
• Moderate periodontitis
• Severe with possible tooth loss, or
• Severe with complete tooth loss

Based on the findings, your periodontist will devise a plan for you to maintain your periodontitis and prevent it from getting worse. The goal is to protect as much of the bone, gums, and teeth as possible when diagnosed with periodontal disease to avoid unnecessary tooth loss.

Periodontal disease can be treated surgically or non-surgically. To determine what’s best for you and your periodontal situation, your periodontist will discuss the pros and cons of both treatment types. Unless periodontal disease is in its most severe stages, most people choose non-surgical options.

Non-surgical Treatment Options

• Antibiotics
  Inflammation of your gums and decaying bones are all symptoms of periodontal disease, which is a bacterial infection. When possible, an antibiotic helps eliminate the infection. Depending on your case, your periodontist will know whether this is an option for you.
• Scaling
  Scaling is similar to a deep dental cleaning. Initially, tartar and plaque buildup on the gums and teeth is removed using an ultrasonic or laser device.
• Root Planing
  Often, scaling is performed alongside root planing. Root planing involves smoothing out all tartar and plaque buildup along the gum line. In this way, you can prevent any future bacterial infection from spreading.

Periodontal disease should be treated with regular dental checkups. The American Dental Association recommends a dental visit every three months to ensure the infection does not spread or worsen. Regular monitoring of this disease is necessary because of its effects on gums and jawbone.

In addition to scaling and root planing, these visits may involve deep dental cleanings. With the help of your dentist and periodontist, you can devise a timeline.

It is very important to maintain good at-home dental hygiene at all times. Once periodontitis is diagnosed, it becomes even more critical. Keeping up with your oral care at home can be achieved in several ways:

• Brush your teeth twice daily with a soft-bristled toothbrush: in the morning and at night. As a result, any bacteria that have grown throughout the day will be cleaned and removed.
• Floss your teeth daily; it is often recommended to do this before bed to remove any food or bacteria missed when brushing.
• For difficult-to-reach areas of the mouth, such as the tongue, cheeks, roof of the mouth, and gums, use mouthwash. Also, this will eliminate all unwanted bacteria. Use a mouthwash that breaks down tartar and plaque.
• Stop smoking and eat a balanced diet with fewer acidic foods and sugars.

Brushing your teeth is often overlooked. As a result, many people don’t understand how important it is to brush their teeth regularly.

Regardless of the foods we eat during the day; our mouth collects bacteria. You must remove this bacteria by brushing your teeth. This bacteria can spread infection to the gums and the bones if left unattended.

Brushing your teeth should be part of your daily routine, not just something you do quickly. To maintain good gum health, you should follow these steps:

• First, make sure you brush at the gum line in a circular motion.
• After waking up and before going to sleep, brush your teeth twice a day
• To remove bacteria from your tongue, brush it along with your teeth.

The hard-to-reach spots between teeth are not easily reached with a toothbrush. Food can easily get stuck between the teeth, especially in the gum pocket. Removing food and particles between the teeth is impossible if floss is not used daily.

The use of mouthwash does not excuse the need to floss. To keep the gums healthy and free of infection, flossing is essential.

Using mouthwash, you can remove any leftover bacteria that brushing and flossing did not remove. The purpose of using mouthwash with fluoride is to help strengthen the enamel on your teeth and clean your tongue, cheeks, gums, and the roof of your mouth.

First, rinse your mouth with water after using mouthwash to remove any bacteria left behind.

Then, finalize the process by using mouthwash.

Dental checkups are a great way to determine not only the condition of your teeth but also the condition of your gums. When your dentist or periodontist examines your gums, they look for swelling, discoloration, bleeding, inflammation, and other signs of gum disease.

Unfortunately, almost no one realizes they have gum disease until it is too late since it is not a very painful infection. However, a dentist or periodontist can help you resolve the issue if it’s caught early enough.