What is Periodontitis (Gum Disease)?
Periodontitis is an infection of tissues (gums and bone) that support the teeth in the mouth. If untreated, periodontitis causes progressive bone loss around teeth, looseness and eventual tooth loss. It is thought to occur in people who have preexisting gingivitis - an infection that is limited to the gums surrounding the tooth and does not cause bone loss.
• Periodontitis is a very common disease affecting approximately 90% of adults over the age of 50 years. Severe forms of the disease though affect less than 10% of the adult population.
• It is site-specific > specific teeth will be affected.
• It is usually a chronic infection which progresses continuously with brief episodes of localized exacerbation and occasional remission.
Aetiology
The major cause of gingivitis is the accumulation of bacteria at the gum line in the form of a sticky, yellowish film which is called dental plaque. If left undisturbed, bacterial plaque calcifies to form dental calculus (tartar).
Other risk factors
1. Particularly potent(virulent) bacteria
2. Smoking: increases the rate of bone loss, compromises the healing and thus the response to the treatment
3. Stress: compromises the immune (defence) system
4. Systemic diseases such as a) Diabetes, b) Leukemias, c) HIV
5. Family history > indicates genetic susceptibility
Symptoms
• occasional redness or bleeding of gums while brushing teeth, using dental floss or biting into hard food (e.g. apples)
• occasional gum swellings
• pus coming from the gums and between the teeth
• bad breath or persistent bad taste in the mouth
• recession of gums resulting in longer teeth
• pockets between the teeth and the gums (sites where the jaw bone has been destroyed gradually or by repeated swellings)
• loose, shaky, drifting teeth
• exfoliation of teeth in later stages
Patients should realize that the gingival inflammation and bone loss are largely painless. Hence, painless bleeding after toothbrushing could be a symptom of periodontitis that is progressing.
Treatment of established disease.
1. Good oral hygiene
Toothbrushing twice a day and interdental cleaning (using floss or interdental brushes) once a day should consist the standard hygiene practices.
2. Professional cleaning Hand scalers and curettes are used to remove bacterial plaque and calculus (tartar) from the tooth surfaces. There are also devices (cavitrons) that use a powerful ultra-sonic vibration and irrigation system to disrupt the bacterial plaque and calculus deposits around the teeth and below the gum-line. Local anesthetic is commonly used to prevent discomfort during this process.
More than one course of deep scaling may be needed in order to combat gum disease. In the case of residual inflammation gingival-periodontal surgery could be the next step of treatment.
Gingival surgery is performed to access the root surfaces close to the bone level and improve visibility so removal of any deposits and inflammatory tissue is facilitated. Moreover, surgery could be used for bone augmentation. This is achieved by using bone grafts (animal or synthetic derivatives) in vertical bony defects. The latter are areas of localized bone loss where there might be a sufficient "hole" to support the bone grafting material.
3. Maintenance Once the gums become healthy again, frequent maintenance visits will be necessary to ensure that the disease won't be established again.
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