PERIODONTAL DISEASE

DEFINITION

Periodontal disease affects the tissues that support and anchor the teeth. Left untreated, periodontal disease results in destruction of the gums, parts of the jawbone, and portions of the tooth root.

DESCRIPTION

In a healthy person, teeth are held in place by a combination of soft tissue and bone. The soft tissue is known as the gums. Periodontal disease can attack any part of the gums or bone. The most common forms of periodontal disease are gingivitis, periodontitis, and trench mouth.

Gingivitis

The gingiva is the outermost part of the gums. Gingivitis is an inflammation of the gingiva. The gingiva becomes red and loses its normal shape. Bleeding occurs easily, during toothbrushing, for example. Gingivitis may be present for many years without becoming a serious medical problem. In some cases, however, it may become more severe. It may become very painful and lead to loss of tissue between the teeth. Poor oral (mouth) hygiene, fatigue, a poor diet, and stress may all lead to gingivitis.

Periodontitis

Periodontitis is a more serious form of gingivitis. Periodontitis is also called pyorrhea. Plaque and tartar sometimes form on the outer surfaces of teeth. Plaque and tartar are thin films of food particles and saliva. They provide a home for bacteria that cause tooth decay.

The decay caused by these bacteria sometimes extends down into the gums. There may be damage to the bone structure that holds teeth in place. The teeth become loose and may fall out. Periodontitis in adults is the most serious form of periodontal disease. It is the main cause of tooth loss in adults.

Periodontitis also occurs in children, but it is much less common than in adults. If not treated, periodontitis in children can become chronic. That is, it does not get better but is always present as a health problem. In some cases, it may become much worse in adulthood, leading to tooth loss.

Trench Mouth

Gingivitis can also lead to a condition known as trench mouth. The most common cause of trench mouth is poor oral hygiene. Stress, a poor diet, and lack of sleep may also be factors.

CAUSES

How bacteria in the periodontal pocket cause tissue destruction is not fully understood. Researchers to know that bacteria that live in plaque and tartar produce acids when they digest foods. These acids can destroy tooth enamel and bone. The bacteria also produce toxins (poisons) that can kill cells in gum tissue. Finally, when the body's immune system attacks the bacteria, some gum tissue is destroyed at the same time.

The most basic cause of periodontal disease is poor oral hygiene. Regular toothbrushing and flossing remove most of the plaque and tartar on which bacteria live. They can greatly reduce the risk for any form of periodontal disease. Regular dental checkups are also important. Dental hygienists can remove any of the plaque and tartar that may still remain.

Gingivitis is usually the first stage in all other periodontal diseases. If it can be prevented or controlled, the more serious forms of the disease are unlikely to occur.

SYMPTOMS

The initial symptoms of periodontal disease are bleeding and inflamed gums and bad breath. Periodontitis follows cases of gingivitis. The key characteristic of periodontitis is a large pocket that forms between the teeth and gums. Pain is often absent until late in the disease. It occurs then when a tooth becomes loose or infected.

The symptoms of trench mouth often appear suddenly. They include pain, fever, fatigue, and foul breath. Trench mouth results in the formation of open sores on the gums and death of tissues surrounding the teeth. The gums may bleed easily, especially when chewing. The pain may become so bad that the patient cannot eat or swallow. The inflammation may spread to nearby tissues of the face and neck.

DIAGNOSIS

Dentists can usually diagnose a periodontal disease quite easily. The most important clues are inflamed gums and the presence of an opening between gums and teeth. The specific form of periodontal disease usually depends on the nature of the opening. In gingivitis, the pocket tends to be small and shallow. As the disease progresses, the pocket becomes larger and deeper. Bone loss can be detected on an x-ray photograph.

TREATMENT

Gingivitis can usually be treated simply. Plaque and tartar are removed from teeth, depriving bacteria of their home. The inflamed tissues around a tooth usually heal quickly and completely.

More serious cases of periodontitis cannot be treated by routine dental procedures. Dental surgery may be necessary to remove plaque, tartar, and infected gum tissue. Treatment with antibiotics may be necessary if infection is present.

Treatment for trench mouth starts with a complete cleaning of the teeth. All plaque, tartar, and dead gum tissue are removed. Regular visits to the dentist and use of mouthwash containing hydrogen peroxide may be needed to ensure that the gums heal completely. Surgery may be needed if damage to the gums is extensive and they do not heal properly.

PROGNOSIS

Periodontal disease is easily treated. The gums usually heal quickly and resume their normal shape and function. In more difficult cases, surgery may be necessary. But the surgery is relatively simple and usually successful.

PREVENTION

Most forms of periodontal disease can be prevented with good dental hygiene. Daily brushing and flossing are sufficient to prevent most cases of periodontal disease. Tartar-control toothpastes help prevent the formation of tartar. But they do not remove tartar once it has formed.

An extreme case of juvenile periodontitis. (Photograph by

Edward H. Gill

. Reproduced by permission of

Custom Medical Stock Photo

.)

FOR MORE INFORMATION

Books

Berns, Joel M. Understanding Periodontal Diseases, 2nd edition. Carol Stream, IL: Quintessence Publishing Company, 1993.

Sheldon, Sydney. Ignore Your Teeth and They'll Go Away : The Complete Guide to Gum Disease, 3rd edition. Pikesville, MD: Devida Publications, 1998.

Organizations

The American Academy of Periodontology. 737 N. Michigan Avenue, Suite 800, Chicago, IL 60611–2690. (312) 787–5518. http://www.perio.org.

Web sites

"Dental Health: Periodontal Disease." Dental Review Online. [Online] http://www.dentalreview.com/tooth_periodontitis.htm (accessed on October 28, 1999).

"What Are Periodontal Diseases?" [Online] http://www.perio.org/consumer/2a.html (accessed October 28, 1999).