Treatments

Periodontitis (gum disease) is a very common condition where the gums become swollen, sore or infected.

Periodontitis is a serious gum infection that damages the soft tissue and destroys the bone that supports your teeth. Periodontitis can cause tooth loss or worse, an increased risk of heart attack or stroke and other serious health problems.

Periodontitis is common but largely preventable. Periodontitis is usually the result of poor oral hygiene. Brushing at least twice a day, flossing daily and getting regular dental checkups can greatly reduce your chance of developing periodontitis.

 

Signs and symptoms of periodontitis can include:

  • Swollen gums
  • Bright red or purplish gums
  • Gums that feel tender when touched
  • Gums that pull away from your teeth (recede), making your teeth look longer than normal
  • New spaces developing between your teeth
  • Pus between your teeth and gums
  • Bad breath
  • Bad taste in your mouth or metallic taste
  • Loose teeth
  • A change in the way your teeth fit together when you bite

 

Early symptoms

The initial symptoms of gum disease can include:

  • red and swollen gums
  • bleeding gums after brushing or flossing your teeth

This stage of gum disease is called gingivitis.

 

Advanced symptoms

If gingivitis is untreated, the tissues and bone that support the teeth can also become affected. This is known as periodontitis.

 

Symptoms of periodontitis can include:

  • bad breath (halitosis)
  • an unpleasant taste in your mouth
  • loose teeth that can make eating difficult
  • gum abscesses (collections of pus that develop under your gums or teeth)

Acute necrotising ulcerative gingivitis (ANUG)

In rare cases, a condition called acute necrotising ulcerative gingivitis (ANUG) can develop suddenly. The symptoms of ANUG are usually more severe than those of gum disease.

There are different types, or classes, of periodontitis. Chronic periodontitis is the most common class, affecting mostly adults, though children can be affected, too. Aggressive periodontitis usually begins in childhood or early adulthood and affects only a small number of people.

When to see a dentist

Healthy gums are firm and pale pink. If your gums are puffy, dusky red and bleed easily, or show other signs or symptoms of periodontitis, see your dentist soon. The sooner you seek care, the better your chances of reversing damage from periodontitis, potentially preventing other serious health problems.

Causes

It's thought that periodontitis begins with plaque — a sticky film composed mainly of bacteria. Plaque forms on your teeth when starches and sugars in food interact with bacteria normally found in your mouth. Brushing and flossing your teeth removes plaque. But plaque re-forms quickly, usually within 24 hours.

Plaque that stays on your teeth longer than two or three days can harden under your gumline into tartar (calculus). Tartar also may form as a result of the mineral content of your saliva. Tartar makes plaque more difficult to remove and acts as a reservoir for bacteria. You can't get rid of tartar by brushing and flossing — you need a professional dental cleaning to remove it.

The longer that plaque and tartar remain on your teeth, the more damage they can do. Initially, they may simply irritate and inflame the gingiva, the part of your gum around the base of your teeth. This is called gingivitis, the mildest form of periodontal disease.

Ongoing inflammation eventually causes pockets to develop between your gums and teeth that fill with plaque, tartar and bacteria. Bacteria deposit endotoxin — a byproduct of their own metabolism — which is responsible for much of the inflammation around teeth. In time, these pockets become deeper and more bacteria accumulate, eventually advancing under your gum tissue. These deep infections cause a loss of tissue and bone. If too much bone is destroyed, you may lose one or more teeth.

 

Risk Factors that can increase your risk of periodontitis include:

  • Gingivitis
  • Heredity
  • Poor oral health habits
  • Tobacco use
  • Diabetes
  • Older age
  • Decreased immunity, such as that occurring with leukemia, HIV/AIDS or chemotherapy
  • Poor nutrition
  • Certain medications
  • Hormonal changes, such as those related to pregnancy or menopause
  • Substance abuse
  • Poor-fitting dental restorations
  • Problems with the way your teeth fit together when biting

Complications

Some complications associated with gum disease include:

  • Tooth loss
  • Coronary artery disease
  • Stroke
  • Premature, low birth weight babies
  • Poorly controlled diabetes
  • Respiratory problems
  • Rheumatoid arthritis
  • Asthma

Some research suggests that the bacteria responsible for periodontitis can enter your bloodstream through your gum tissue, affecting your lungs, heart and other parts of your body. For instance, bacteria may travel to the arteries in your heart, where they might trigger a cycle of inflammation and arterial narrowing that contributes to heart attacks.

 

Nonsurgical treatments

If periodontitis isn't advanced, treatment may involve less invasive procedures, including:

  • Scaling. Scaling removes tartar and bacteria from your tooth surfaces and beneath your gums. It may be performed using instruments or an ultrasonic device.
  • Root planing. Root planing smoothes the root surfaces, discouraging further buildup of tartar and bacterial endotoxin.
  • Antibiotics. Your periodontist or dentist may recommend using topical or oral antibiotics to help control bacterial infection. Topical antibiotics can include antibiotic mouth rinses or insertion of gels containing antibiotics in the space between your teeth and gums or into pockets after deep cleaning.  However, oral antibiotics may be necessary to completely eliminate infection-causing bacteria.

Surgical treatments

If you have advanced periodontitis, your gum tissue may not respond to nonsurgical treatments and good oral hygiene. In that case, periodontitis treatment may require dental surgery, such as:

  • Flap surgery (pocket reduction surgery). In this procedure, your periodontist makes tiny incisions in your gum so that a section of gum tissue can be lifted back, exposing the roots for more effective scaling and root planing. Because periodontitis often causes bone loss, the underlying bone may be recontoured before the gum tissue is sutured back in place. After you heal, it's easier to clean these areas and maintain healthy gum tissue.
  • Soft tissue grafts. When you lose gum tissue to periodontal disease, your gumline recedes. You may need to have some of the damaged soft tissue reinforced. This is usually done by removing a small amount of tissue from the roof of your mouth (palate) or another donor source and attaching it to the affected site. This procedure can help reduce further gum recession, cover exposed roots and give your teeth a more pleasing appearance.
  • Bone grafting. This procedure is performed when periodontitis has destroyed the bone surrounding your tooth root. The graft may be composed of small fragments of your own bone, or the bone may be synthetic or donated. The bone graft helps prevent tooth loss by holding your tooth in place. It also serves as a platform for the regrowth of natural bone.
  • Guided tissue regeneration. This allows the regrowth of bone that was destroyed by bacteria. In one approach, your dentist places a special piece of biocompatible fabric between existing bone and your tooth. The material prevents unwanted tissue from entering the healing area, allowing bone to grow back instead.
  • Enamel matrix derivative application. Another technique involves applying a special gel to a diseased tooth root. This gel contains the same proteins found in developing tooth enamel and stimulates the growth of healthy bone and tissue.
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