What Causes Periodontal Disease?

Periodontal disease comes in different stages. The earliest stage of periodontal disease is gingivitis, this stage is reversible with proper treatment. If this disease is caught and treated before progressing, there will be no long-term side effects. Although if it advances to the next stage, periodontitis, there will be long-term effects to your smile. These long-term dental issues may include gum tissue recession and bone loss surrounding your teeth. Below, we will discuss what causes periodontal disease and how to bring it under control for good dental health.

What Causes Periodontal Disease?

Bacteria and plaque are the main culprits of periodontal disease. Periodontal disease is a chronic dental infection of the periodontal tissues surrounding our teeth. This can result in the breakdown of the tissue as well as the loss of bone that surrounds and supports the teeth. The disease begins when bacteria and plaque form a sticky film on your teeth. This film acts as an irritant to the surrounding tissues and causes inflammation of the periodontal tissue.

Periodontal disease will continue to progress and become more advanced over time if there is no dental intervention. Periodontal disease is the number one cause of tooth loss in adults. According to the Centers For Disease Control (CDC), it is estimated that 65 million American adults, have mild, moderate or severe periodontitis (the advanced form of periodontal disease). In our senior population, ages 65 and older, the prevalence rates increase to over 70%.

Bacteria That Causes Periodontal Disease

Periodontal disease and tooth decay are caused by different types of bacteria, and are considered to be two separate and distinct disease conditions. However, they work hand in hand to break down our teeth and gum tissues if left untreated. Swollen and receding gums allow the more vulnerable areas of the tooth (root areas) to be exposed, which causes an increased incidence of tooth decay. In patients with extensive tooth decay, the broken down teeth allow for food trap areas, which keep periodontal tissues chronically inflamed.

Stages Of Periodontal Disease

Gingivitis – the earliest stage of what causes periodontal disease. Gingivitis is the inflammation of the periodontal tissues surrounding the teeth. Gingivitis is the mildest form of periodontal disease and is fully reversible with professional care and good dental hygiene. Symptoms of gingivitis include red, swollen gum tissue with inflammation as well as gum tissues bleeding easily upon brushing, flossing, or even eating. Often these symptoms are unnoticed by patients. Bad breath may be another sign of advancing periodontal disease.

There are only a few signs at this stage and most of them are painless. This is what makes periodontal disease so common and concerning. It is silent until it is not. Periodontal disease does not typically become noticeable until the fourth and final stage. The early signs to watch out for include bad breath, swelling and redness of the gums, and bleeding when brushing or flossing. Good overall dental hygiene and regular professional cleanings can treat and reverse gingivitis as well as stop it from progressing further.

This is a critical point for the patient, as gingivitis can be reversed (since the bone and connective tissue that hold the teeth in place have not yet been adversely affected). If it is recognized, diagnosed, and properly treated at the right time by a dental professional. Gingivitis is common during puberty, pregnancy (also called pregnancy gingivitis), times of high stress, and menopause. As for the rest of the population, poor dental hygiene is usually the most common cause, followed by medication and certain medical conditions (like diabetes).

Periodontitis – if left untreated the next phase is early periodontitis. Once it enters this stage, the disease is difficult to control. In this stage, the bone surrounding the teeth is now affected. The bacteria will invade between the tooth and gums causing a separation of connective fibers. The result is what is called a periodontal pocket (normal pocket depth should be about 3 mm without inflammation). These pockets will now reach 4-5 mm in depth and can get filled with bacteria, plaque and food. This will in turn begin to breakdown the bone below the gum line. Simple at home dental hygiene will not be the answer to bring it back to a healthy state. Periodontitis signs include, increased swelling or redness of the gums, increasingly bad breath, bleeding upon brushing or flossing, and pocket depths that are between 4-5 mm.

Advanced Periodontitis – this is where the real danger lies. At least 50% of bone support is lost if not more. The teeth will begin to loosen and shift if they have not already. Deep periodontal cleanings and surgical intervention are necessary to salvage the teeth. This professional cleanings may occur using a periodontal microscope, (Perioscope), grafting of gum tissue or bone, placement of growth factors (Emdogain), periodontal antibiotic regimen (Periostat), placement of antibiotics directly into pockets, (Arestin), open periodontal flap surgery, and, possibly the removal of teeth.

How To Treat Periodontal Disease

Fortunately, the earliest stages of periodontal disease are easily treated. If a patient practices good at home dental hygiene (brushing, flossing, and antibacterial mouthwash), along with regular visits to the dentist we can halt gingivitis in its tracks. Failing to do the above steps will allow periodontal disease to advance, leading to loss of teeth as well as systemic health issues.

Treatment For Periodontal Disease Can Include The Following:

Pocket Reduction Surgery - a surgical procedure to reduce the size of the periodontal pockets around your teeth. This will ensure the ability to keep the areas clean at home. The surgery is made up of tiny incisions in your gum tissues so that a section of the gum tissue can be lifted back, exposing the roots for a more effective teeth cleaning. Since periodontitis often causes bone loss, the supporting bone tissue may be re-contoured before the gum tissue is sutured back in place. This surgery can take from 1-3 hours and is performed under local anesthesia.

Periodontal Tissue Grafts - periodontal or gum tissue is often lost from periodontal disease. When the gums recede, your teeth will appear longer than normal as root surfaces are exposed. You may need to have the damaged tissue replaced for cosmetic as well as functional reasons. It is important to know that root surfaces are not protected by enamel. This procedure can cause extreme tooth sensitivity. This grafting procedure can help reduce further gum recession, cover exposed roots, and give your teeth a more cosmetic lift.

Bone graft - the bone graft helps prevent tooth loss by increasing support structure around our teeth. It also serves as a building block for the regrowth of natural bone.

Antibiotics and Antibacterial Medications: these medications will aid in healing and the removal of bad bacteria from around our teeth. These include:

Peridex – a prescription antibacterial rinse.

Periostat – an oral antibiotic. Another type of antibiotic used is called minocycline.

Arestin – placed directly into the periodontal pocket to help aid in healing.

Chlorhexidine – a prescription antibacterial mouthwash. This is used to control bacteria when treating periodontal disease and after surgery. Patients use it as they would a regular mouthwash.

Guided Tissue Regeneration - this periodontal procedure helps to regrow destroyed bone. Your dentist or periodontist places a special piece of biocompatible fabric between existing bone and your tooth. The material prevents unwanted tissue from entering the healing area, which allows the bone to grow back in a stable environment. The goal is to regenerate periodontal tissue and repair defects that have resulted from the development of periodontitis.

Enamel Matrix Derivative Application - another technique involves the application of a specialized gel to the diseased tooth root. This gel contains the same proteins found in developing tooth enamel and stimulates the growth of healthy bone and tissue. An example of this is the use of emdogain.

Periodontal Disease

Periodontal disease if left untreated can cause an aggressive destruction of your smile. Regular dental visits and good dental hygiene at home can prevent periodontal disease from developing. A good way of looking at this is, that it is far cheaper and less painful to go to your dentist every 6 months, than it is to wait for periodontal disease to develop and chase after your health. Visit your dentist regularly for a happy, healthy smile.