Periodontal (Gum) Disease: An Overview for Patients

The word periodontal literally means "around the tooth." Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth. It can affect one tooth or many teeth, and it begins when the bacteria in plaque cause the gums to become inflamed.

According to the CDC, 47% of adults aged 30 years and older have some form of periodontal disease. Prevalence increases with age — over 70% of adults 65 and older have it.

Gingivitis (the mildest form)

In gingivitis, the gums become red, swollen, and bleed easily. There is usually little or no discomfort. Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with professional treatment and good oral home care.

Factors that may contribute to gingivitis include:

• Diabetes
• Smoking
• Aging
• Genetic predisposition
• Stress
• Inadequate nutrition
• Pregnancy
• Substance abuse
• HIV infection
• Certain medications

Periodontitis (more advanced)

Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body essentially turns on itself, and 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 the disease progresses, the pockets deepen, and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.

There are many forms of periodontitis. The most common ones include:

• Chronic periodontitis — results in inflammation within the supporting tissues of the teeth, progressive attachment, and bone loss. This is the most frequently occurring form and is characterized by pocket formation and/or recession of the gingiva. It is most prevalent in adults but can occur at any age.
• Aggressive periodontitis — a highly destructive form of periodontal disease that occurs in patients who are otherwise clinically healthy.
• Periodontitis as a manifestation of systemic diseases — often begins at a young age. Systemic conditions such as heart disease, respiratory disease, and diabetes are associated with this form of periodontitis.
• Necrotizing periodontal disease — an infection characterized by necrosis (death) of gingival tissues, periodontal ligament, and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions such as HIV infection, malnutrition, and immunosuppression.

Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless plaque on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form tartar that brushing doesn't clean. Only a professional cleaning by a dentist or dental hygienist can remove tartar.

Risk factors

• Smoking — one of the most significant risk factors associated with the development of periodontitis. Smoking can also lower the chances for successful treatment.
• Hormonal changes in girls/women can make gums more sensitive and make it easier for gingivitis to develop.
• Diabetes — people with diabetes are at higher risk for developing infections, including periodontal disease.
• Other illnesses and their treatments — diseases such as AIDS and its treatments can negatively affect the health of gums, as can cancer treatments.
• Medications — there are hundreds of prescription and over-the-counter medications that can reduce the flow of saliva, which has a protective effect on the mouth. Without enough saliva, the mouth is vulnerable to infections.
• Genetic susceptibility — some people are more prone to severe periodontal disease than others.

During a dental exam, the dentist or dental hygienist will:

• Examine your gums and note any signs of inflammation
• Use a tiny ruler called a probe to check for and measure any pockets. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimeters. This test for pocket depth is usually painless.
• Ask about your medical history to identify conditions or risk factors (such as smoking or diabetes) that may contribute to periodontal disease
• Take an X-ray to see whether there is any bone loss

The dentist may refer you to a periodontist, a specialist in the diagnosis and treatment of gum disease.

The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home.

Deep cleaning (scaling and root planing)

The dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather and helps remove bacteria that contribute to the disease.

Medications

Medications may be used with treatment that includes scaling and root planing, but they cannot always take the place of surgery. Depending on how far the disease has progressed, the dentist or periodontist may still suggest surgical treatment.

Surgical treatments

• Flap surgery (pocket reduction surgery). Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications. The gums are lifted back and the tartar is removed.
• Bone and tissue grafts. In addition to flap surgery, your periodontist or dentist may suggest procedures to help regenerate any bone or gum tissue lost to periodontitis.

Here are some things you can do to prevent periodontal disease:

1. Brush your teeth twice a day (with fluoride toothpaste)
2. Floss regularly to remove plaque from between teeth
3. Visit the dentist routinely for a check-up and professional cleaning
4. Don't smoke

Remember: you have a lot to do with keeping your mouth healthy throughout your life.

This article is adapted from public-domain content published by the U.S. National Institute of Dental and Craniofacial Research (NIDCR), part of the U.S. National Institutes of Health. CDC prevalence data is also public domain.