Periodontal Disease

Periodontal diseases are a group of diseases that affect the tissues that support and anchor the teeth. Left untreated, periodontal disease results in the destruction of the gums, alveolar bone (the part of the jaws where the teeth arise), and the outer layer of the tooth root.

Gingivitis is an inflammation of the outermost soft tissue of the gums. The gingivae become red and inflamed, loose their normal shape, and bleed easily. Gingivitis may remain a chronic disease for years without affecting other periodontal tissues.  This form of gingivitis is characterized by painful, bleeding gums, and death (necrosis) and erosion of gingival tissue between the teeth. It is thought that stress, malnutrition, fatigue, and poor oral hygiene are among the causes for acute necrotizing ulcerative gingivitis.

Adult periodontitis is the most serious form of the periodontal diseases. It involves the gingiva, periodontal ligament, and alveolar bone. A deep periodontal pocket forms between the teeth, the cementum, and the gums. Plaque, calculus, and debris from food and other sources collect in the pocket. Without treatment, the periodontal ligament can be destroyed and resorption of the alveolar bone occurs. This allows the teeth to move more freely and eventually results in the loss of teeth. Most cases of adult periodontitis are chronic, but some cases occur in episodes or periods of tissue destruction.

Pericoronitis is a condition found in children who are in the process of producing molar teeth. The disease is seen more frequently in the lower molar teeth. As the molar emerges, a flap of gum still covers the tooth. The flap of gum traps bacteria and food, leading to a mild irritation. If the upper molar fully emerges before the lower one, it may bite down on the flap during chewing. This can increase the irritation of the flap and lead to an infection. In bad cases, the infection can spread to the neck and cheeks.

Periodontitis is a condition in which gingivitis has extended down around the tooth and into the supporting bone structure. Periodontitis is also called pyorrhea. Plaque and tarter buildup sometimes lead to the formation of large pockets between the gums and teeth. When this happens, anaerobic bacteria grow in the pockets. The pockets eventually extend down around the roots of the teeth where the bacteria cause damage to the bone structure supporting the teeth. The teeth become loose and tooth loss can result. Some medical conditions are associated with an increased likelihood of developing periodontitis. These diseases include diabetes, Down syndrome, Cohn's disease, AIDS, and any disease that reduces the number of white blood cells in the body for extended periods of time.

Several factors play a role in the development of periodontal disease. The most important are age and oral hygiene. The number and type of bacteria present on the gingival tissues also play a role in the development of periodontal diseases. The presence of certain species of bacteria in large enough numbers in the gingival pocket and related areas correlates with the development of periodontal disease. Also, removal of the bacteria correlates with reduction or elimination of disease. In most cases of periodontal disease, the bacteria remain in the periodontal pocket and do not invade surrounding tissue.
The mechanisms by which bacteria in the periodontal pocket cause tissue destruction in the surrounding region are not fully understood. Several bacterial products that diffuse through tissue are thought to play a role in disease formation. Bacterial endotoxin is a toxin produced by some bacteria that can kill cells. Studies show that the amount of endotoxin present correlates with the severity of periodontal disease. Other bacterial products include proteolytic enzymes, molecules that digest protein found in cells, thereby causing cell destruction. The immune response has also been implicated in tissue destruction. As part of the normal immune response, white blood cells enter regions of inflammation to destroy bacteria. In the process of destroying bacteria, periodontal tissue is also destroyed.
Gingivitis usually results from inadequate oral hygiene. Proper brushing of the teeth and flossing decreases plaque buildup. The bacteria responsible for causing gingivitis reside in the plaque. Plaque is a sticky film that is largely made from bacteria. Tartar is plaque that has hardened. Plaque can turn into tartar in as little as three days if not brushed off. Tartar is difficult to remove by brushing. Gingivitis can be aggravated by hormones, and sometimes becomes temporarily worse during pregnancy, puberty, and when the patient is taking birth control pills. Interestingly, some drugs used to treat other conditions can cause an overgrowth of the gingival tissue that can result in gingivitis because plaque builds up more easily. Drugs associated with this condition are phenytoin, used to treat seizures; cyclosporin, given to organ transplant patients to reduce the likelihood of organ rejection; and calcium blockers, used to treat several different heart conditions. Scurvy, a vitamin C deficiency, and pellagra, a niacin deficiency, can also lead to bleeding gums and gingivitis.
The initial symptoms of periodontitis are bleeding and inflamed gums, and bad breath. Periodontitis follows cases of gingivitis, which may not be severe enough to cause a patient to seek dental help. Although the symptoms of periodontitis are also seen in other forms of periodontal diseases, the key characteristic in periodontitis is a large pocket that forms between the teeth and gums. Another characteristic of periodontitis is that pain usually does not develop until late in the disease, when a tooth loosens or an abscess forms.
Diagnosis is made by observation of infected gums. Usually, a dentist is the person to diagnose

Healthy gums support the teeth. When gingivitis goes untreated, the gums become weak and pockets form around the teeth. Plaque and tartar build up in the pockets, the gum recedes, and periodontitis occurs.

Tartar can only be removed by professional dental treatment. Following treatment, periodontal tissues usually heal quickly. Gingivitis caused by vitamin deficiencies is treated by administering the needed vitamin. There are no useful drugs to treat herpetic gingivostomatitis. Because of the pain associated with the herpes lesions, patients may not brush their teeth while the lesions are present. Herpes lesions heal by themselves without treatment. After the herpetic lesions have disappeared, the gums usually return to normal if good oral hygiene is resumed. Pericoronitis is treated by removing debris under the flap of gum covering the molar. This operation is usually performed by a dentist. Surgery is used to remove molars that are not likely to form properly.

Treatment for trench mouth starts with a complete cleaning of the teeth, removal of all plaque, tartar, and dead tissue on the gums. For the first few days after cleaning, the patient uses hydrogen peroxide mouth washes instead of brushing. After cleaning, the gum tissue will be very raw and rinsing minimizes damage to the gums that might be caused by the toothbrush. For the first few days, the patient should visit the dentist daily for checkups and then every second or third day for the next two weeks. Occasionally, antibiotic treatment is used to supplement dental cleaning of the teeth and gums. Surgery may be needed if the damage to the gums is extensive and they do not heal properly.

Most forms of periodontal disease can be prevented with good dental hygiene. Daily use of a toothbrush and flossing is sufficient to prevent most cases of periodontal disease. Tartar control toothpastes help prevent tartar formation, but do not remove tartar once it has formed.



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