Periodontal Disease

Feb 24th, 2015 | By | Category: Dental News

Periodontal disease, or gum disease, is a chronic inflammatory condition of the periodontal structures like Picture of periodontal diseasegingiva (gum tissue), periodontal ligament, surface of the root( cementum) and the alveolar bone (the bones surrounding the tooth structure). The word periodontal literally means “around the tooth.”  The prevalence of periodontal disease in the United States is significantly high.

The implication is that more American adults may suffer from moderate to severe gum disease than previously thought, and understanding the relationships between periodontal disease and other systemic diseases in the adult population is more crucial than ever.

Normally, the gums are firm, tightly adapted and contoured to the teeth. Between the crowns, it should fill the entire interdental space. Healthy gingiva presents a pink color and stippled texture. A tongue depressor should express no blood or pus from the gingiva.

Periodontal disease typically is a disease of adulthood, but significant disease can occur in children and young adults. The types of gum disease varies from: Localized juvenile periodontitis, Prepubertal periodontitis, Rapidly progressive periodontitis, HIV -associated periodontitis. Periodontitis is always proceeded by gingivitis.

In addition to diabetes, periodontal disease has been linked to other systemic diseases, including cardiovascular disease, rheumatoid arthritis, and Alzheimer’s disease.

Both periodontal disease and diabetes present serious public health problems, with millions of Americans affected by one or both of these conditions.

The main source of periodontal disease is bacteria in dental plaque, caused by poor oral hygiene but patterns of premature gum disease can also be the result of a complex interaction between genetic alterations of the immune system combined with a specific bacterial challenge.

Periodontal disease is the leading cause of tooth loss in patients older than 35 years, with high levels of dental plaque, smoking, diabetes mellitus,  Down syndrome, Crohn’s disease and decreased use of professional care.

 Symptoms and Signs 

Your bone and gum tissue should fit snugly around your teeth like a turtleneck around your neck. When you have periodontal disease, this supporting tissue and bone is destroyed, forming “pockets” around the teeth.

The classic clinical presentation usually begins with gingivitis, enlargement and inflamation of the gum area, a band of red, inflamed gingiva along the necks of one or more teeth, with swelling and bleeding after minimal injury.  The plaque (the sticky, colorless film that constantly forms on your teeth) causes the gums to become inflamed.

Abundant calculus deposits beneath the gingival margin are present. The gingiva progressively lose their attachment to the teeth, and bone loss begins so that the periodontal pockets deepen.

Over time, these pockets become deeper, providing a larger space for bacteria to live. As bacteria develop around the teeth, they can accumulate and advance under the gum tissue. These deep pockets collect even more bacteria, resulting in further bone and tissue loss.

Destruction of supporting bone is evident radiographically. With progressive bone loss, teeth may loosen and gingiva recede. Tooth migration is common in later stages. Pain is ussualy absent unless an acute infection (eg, abscess formation in one or more periodontal pockets) supervenes. Impaction of food in the pockets can cause discomfort and pain at meals. At this point halitosis (bad breath) may occur.

Treatment

For all forms of periodontal disease, the first phase of treatment consists of oral hygiene instruction, thorough scaling and root planing to remove calculus deposits, elimination of anatomic abnormalalities that could harbor bacteria, and reevaluation after 3 months Use of systemic antibiotics and nonsteroidal anti-inflammatory medications slows the progression of the disease but typically is reversed for patients who do not respond to conventional therapy.

In refractory cases, microbial identification of disease sites associated with evaluation of antibiotic sensitivity and administration of appropriate antimicrobial therapy has led to a dramatic remission of the disease progression.

Another approach is to surgically eliminate the pocket and recontour the bone so that the patient can clean the depth of the sulcus. Regenerative surgical and biologic techniques may be attempted for alveolar bone growth. Splinting of loose teeth and selective reshaping of tooth surface to eliminate traumatic occlusion (bite) may be necessary. Extractions are often unavoidable in advanced disease.

Treatment of periodontal disease in patients with diabetes has been shown to improve control of the disease.

Routine brushing and flossing, and seeing a periodontist, dentist, or dental hygienist for a comprehensive periodontal evaluation may decrease the chance of complications.

By maintaining your periodontal health, you are not only supporting your overall health, to ensure a safe and healthy life .

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