Clark B. Hicken, D.D.S., P.C.
312 North Main Street
Spanish Fork, UT 84660
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Periodontitis means "inflammation around the tooth" - it is a serious gum infection that damages the soft tissue and bone that supports the tooth. All periodontal diseases, including periodontitis, are infections which affect the periodontium. The periodontium are the tissues around a tooth, tissues that support the tooth. With periodontitis, the alveolar bone around the teeth is slowly and progressively lost. Microorganisms, such as bacteria, stick to the surface of the tooth and multiply - an overactive immune system reacts with inflammation.
Untreated periodontitis will eventually result in tooth loss, and may increase the risk of stroke, heart attack and other health problems. Bacterial plaque, a sticky, colorless membrane that develops over the surface of teeth, is the most common cause of periodontal disease.
In dentistry, periodontics deals with the prevention, diagnosis and treatment of diseases involving the gums and structures which support teeth. There are eight dental specialties, of which periodontics is one. If you want dental implants, you see a periodontist.
In most cases, periodontitis is preventable. It is usually caused by poor dental hygiene.
1. Inflammation of the periodontium.
2. A chronic inflammatory disease of the periodontium occurring in response to bacterial plaque on the adjacent teeth; characterized by gingivitis, destruction of the alveolar bone and periodontal ligament, apical migration of the epithelial attachment resulting in the formation of periodontal pockets, and ultimately loosening and exfoliation of the teeth.
Gingivitis occurs before periodontitis. Gingivitis usually refers to gum inflammation while periodontitis refers to gum disease and the destruction of tissue and/or bone. Initially, with gingivitis, bacteria plaque accumulates on the surface of the tooth, causing the gums to go red and inflamed; teeth may bleed when brushing them. Even though the gums are irritated and bothersome, the teeth are not loose. There is no irreversible damage to bone or surrounding tissue.
Untreated gingivitis can progress to periodontitis. With periodontitis, the gum and bone pulls away from the teeth, forming large pockets. Debris collects in the spaces between the gums and teeth, and infect the area. The patient's immune system attacks bacteria as the plaque spreads below the gum line. Bone and connective tissue that hold the tooth start to break down - this is caused by toxins produced by the bacteria. Teeth become loose and can fall out.
Put simply, Periodontitis involves irreversible changes to the supporting structures of the teeth, while gingivitis does not.
A symptom is something we feel and describe to the doctor, while a sign is something others, including the doctor can see. For example, pain is a symptom while redness or inflammation is a sign.
Periodontitis signs and symptoms can include:
A risk factor is something that increases the risk of developing a condition or disease. For example, obesity is a risk factor for diabetes type 2 - this means that obese people have a higher chance of developing diabetes. The following risk factors are linked to a higher risk of periodontitis:
A qualified dentist should find it fairly straightforward to diagnose periodontitis. The dentist will ask the patient questions regarding symptoms and carry out an examination of his/her mouth.
The dentist will examine the patient's mouth using a periodontal probe - a thin, silver stick-like object with a bend at one end. The probe is inserted next to the tooth, under the gum line. If the tooth is healthy, the probe should not slide far below the gum line. In cases of periodontitis, the probe will reach deeper under the gum line.
Two types of periodontal probes. 1. Michigan O Probe (left). 2. Naber's Probe (right)
The dentist may order an X-ray to see what condition the jaw bone and teeth are in.
The main aim of the periodontist, dentist or dental hygienist, when treating periodontitis, is to clean out bacteria from the pockets around the teeth and prevent further destruction of bone and tissue.
For best treatment results, the patient must maintain good oral hygiene and care. This involves brushing teeth at least twice a day and flossing once per day. If there is enough space between the teeth, an interdental brush (Proxi-brush) is recommended. Soft-picks can be used when the space between the teeth is smaller. Patients with arthritis, and others with dexterity problems may find that using an electric toothbrush is better for a thorough clean.
It is important that the patient understands that periodontitis is a chronic (long-term) inflammatory disease - this means oral hygiene must be maintained for life. This will also involve regular visits to a dentist or dental hygienist.
It is important to remove plaque and calculus (tartar) to restore periodontal health.
The healthcare professional will use clean (non-surgically) below the gumline. This procedure is called scaling and debridement. Sometimes an ultrasonic device may be used. In the past Root Planing was used (the cemental layer was removed, as well as calculus).
If good oral hygiene and non-surgical treatments are not enough, the following surgical interventions may be required:
Experts say it is not possible to predict how successful these procedures are - each case is different. Treatment results also depend on how advanced the disease is, how well the patient adheres to a good oral hygiene program, as well as other factors, such as smoking status.
The most common complication from periodontitis is the loss of teeth. However, patients with periodontitis are also at a higher risk of having respiratory problems, stroke, coronary artery disease, and low birth weight babies.
Pregnant women with bacterial infections that cause moderate-to-severe periodontal disease have a higher risk of having a premature baby.
Periodontitis can make it harder for patients with diabetes to control blood sugar.
The best way to prevent periodontitis is to follow a program of good oral hygiene, one that you begin early and practice consistently throughout life. That means brushing your teeth at least twice daily — in the morning and before going to bed — and flossing at least once a day. Better yet, brush after every meal or snack or as your dentist recommends. A complete cleaning with a toothbrush and floss should take three to five minutes. Flossing before you brush allows you to clean away the loosened food particles and bacteria.
Also, see your dentist or dental hygienist regularly for cleanings, usually every six to 12 months. If you have risk factors that increase your chance of developing periodontitis, you may need professional tooth cleaning more often.
Sources: National Health Service (NHS), UK. National Institutes of Health (NIH), USA. University of Maryland Medical Center. Medical News Today archives.