Frequently Asked Questions
UNDERSTANDING PERIODONTAL DISEASE
What is Periodontal Disease?
Periodontal (gum) diseases, including gingivitis and periodontitis, are bacterial infections that attack the gums and the jawbone supporting the teeth. While there are many diseases that can affect the tooth supporting structure (gums and jawbone), plaque induced inflammatory lesions make up the majority of periodontal issues. These are divided into two categories: gingivitis and periodontitis.
Dental plaque is the primary cause of gingivitis. Plaque is a sticky, colorless film composed primarily of food particles and various types of bacteria. This plaque can adhere to your teeth at and below the gum line. Plaque constantly forms on your teeth even minutes after brushing. Bacteria found in the plaque produce toxins and poisons that irritate the gums. Gums may become inflamed, red, swollen, and bleed easily. This is the first stage of periodontal disease and is termed “gingivitis”. Literally translated, gingiva means your gums and itis means inflammation or “inflammation of your gums”. Gingivitis is often caused by inadequate home care. The good news is that gingivitis is reversible with professional treatment and good oral hygiene.
If the gingivitis is left untreated and the irritation of the gums is prolonged, the gums can separate from the teeth and cause pockets (spaces between the teeth and gums). The bacteria and plaque continue to spread and grow below the gum line and release toxins that further irritate the gum and the jawbone. Gingivitis has now progressed to periodontitis. Literally translated periodontitis is “inflammation around the tooth”. As perodontitis progresses, the supporting gum tissue and bone that hold the teeth in place deteriorate. The body tries to wall off this progressing infection and essentially turns on itself resulting in additional destruction of the gum and bone. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. If daily brushing and flossing are neglected, plaque can also harden into a rough, porous substance known as calculus or tartar. This can further spread below the gum line and enhance the breakdown of the supporting bone. Eventually teeth can become loose and may have to be removed.
Because this process often presents with very mild symptoms, you may not even be aware of the condition until it has caused a significant amount of damage. The fact that periodontal disease is often painless and without symptoms makes it very dangerous. 80% of Americans will be afflicted with periodontal disease by age 45 and 4 out of 5 patients with the disease are unaware that they have it.
As noted above, the main cause of periodontal disease is bacterial plaque, which is a sticky colorless film that constantly forms on the teeth. There are other factors, however, that can also affect the health of the gums:
Besides the link between tobacco use and lung disease, cancer and heart disease, smoking can place people at an increased risk for periodontal disease. Cases of periodontal disease are more severe in smokers and tobacco users than those of non-users of tobacco. There is a greater incidence of calculus (tartar) formation on teeth, deeper pockets between the gums and teeth, and a greater loss of the bone and fibers that hold the teeth in your mouth. In addition, your chance of developing oral cancer increases with the use of smoking and smokeless tobacco. Chemicals in tobacco such as nicotine and tar also slow down healing and the predictability of success following periodontal treatment. Quitting smoking and tobacco use can have numerous benefits for your periodontal and overall health.
Genetics may also impact the development of periodontal disease. Research suggests that up to 1/3 of the population may be genetically susceptible to gum disease. If you have been diagnosed with periodontal disease, it would be beneficial for family members to have a periodontal examination to help detect any problems. Early treatment will help them keep their teeth healthy and comfortable for a lifetime.
Stress has been linked to many serious health problems, and it is considered a risk factor for periodontal disease. Research demonstrates that stress can make it more difficult for the body to fight off infections including periodontal diseases.
Some medications can have side effects that affect your oral health. These include but are not limited to some heart medications and oral contraceptives.
Clenching and Grinding of Teeth (Bruxism)
Clenching and grinding of your teeth can put excessive force on the supporting tissues of the teeth and add to the destructive force of periodontal disease. If you think you may be clenching or grinding your teeth at night or during the day, fabrication of an oral bite guard or night guard would be indicated. This is an appliance that is easily worn by patients and helps to protect the teeth from the destructive forces we place on our teeth, gums and bones.
Research has proven that there is a strong connection between periodontal disease and other chronic conditions such as diabetes, heart disease and osteoporosis. In addition, there is a direct correlation with the risk of stroke, complications during pregnancy, and respiratory diseases such as COPD (chronic obstructive pulmonary disease).
Diabetes is a serious, incurable disease that is characterized by too much glucose, or sugar, in the blood. Type II diabetes occurs when the body is unable to regulate insulin levels, meaning too much glucose stays in the blood.
Type I diabetics cannot produce any insulin at all. Diabetes affects between 12 and 14 million Americans and can lead to a variety of health issues, such as heart disease and stroke.
Research has shown people with diabetes are more likely to develop periodontal disease more frequently and severely than those who have good management over their diabetes.
The connection between diabetes and periodontal disease results from a variety of factors. Diabetes sufferers are more susceptible to all types of infections, including periodontal infections. Diabetes also reduces the body’s overall resistance to infection, which increases the probability of the gums becoming infected.
Moderate to severe cases of periodontal disease elevate sugar levels in the body, increasing the amount of time the body has to function with high blood sugar. Diabetics with periodontitis are more likely to suffer from increased blood sugar levels, making it difficult to keep control of their blood sugar. Further, high glucose levels in saliva also promote the growth of gum disease-causing bacteria.
As stated earlier, smoking and tobacco use is detrimental to anyone’s oral and overall health, but it is particularly harmful to diabetics. Diabetic smokers 45 and older are in fact 20 times more likely to develop periodontal disease than those who do not smoke.
Heart Disease and Stroke
Coronary heart disease is the leading cause of death in the United States for both men and women. Coronary heart disease occurs when fatty proteins and a substance called plaque builds up on the walls of your arteries. This causes the arteries to narrow, constricting blood flow. Oxygen is restricted from traveling to the heart, which results in shortness of breath, chest pain, and even heart attack.
The link between periodontal disease and heart disease is a direct correlation. Patients with periodontal disease are nearly twice as likely to suffer from coronary artery disease than those with healthy mouths. Periodontal disease has also been proven to exacerbate existing heart conditions. Patients with periodontal disease have been known to be more susceptible to strokes. A stroke occurs when the blood flow to the brain is suddenly stopped. This may occur, for example, when a blood clot prevents blood from reaching the brain.
One of the causes of the connection between periodontal disease and heart disease is oral bacteria entering the bloodstream. There are many types of periodontal bacteria. Certain periodontal bacteria enter the bloodstream and attach to the fatty plaques in the coronary arteries. This attachment leads to clot formation and increases the risk of a stroke and heart attacks.
Inflammation caused by periodontal disease also creates an increase in white blood cells and C-reactive proteins (CRP). CRP is a protein that has long been associated with heart disease. When levels are increased in the body, it amplifies the body’s natural inflammatory response. Bacteria from periodontal disease may enter the bloodstream, causing the liver to produce extra CRP, which then leads to inflamed arteries and possibly blood clots. Inflamed arteries can lead to blockage, which can also cause strokes and heart attacks.
Respiratory disease occurs when fine droplets are inhaled from the mouth and throat into the lungs. These droplets contain germs that can spread and multiply within the lungs to impair breathing. Recent research had also proven that bacteria found in the mouth and throat can be drawn into the lower respiratory tract and cause infection or worsen existing lung conditions.
Bacteria that grow in the oral cavity and travel into the lungs can cause respiratory problems such as pneumonia. This occurs mostly in patients with periodontal disease. Periodontal disease has also been proven to have a role in contracting bronchitis and emphysema. Chronic obstructive pulmonary disease (COPD), a respiratory condition characterized by blockage of the airways, and caused mostly by smoking, has been shown to worsen if the patient has periodontal disease.
Osteoporosis is a condition common in older patients, particularly women, which is characterized by the thinning of the bone and loss of bone density over time. Osteoporosis occurs when the body fails to form enough new bone or when the body absorbs calcium from our existing bone structure. The leading cause of osteoporosis is a drop in estrogen in menopausal women or a drop in testosterone among men. Sufferers of osteoporosis must take extra care in daily activities as they are at increased risk for bone fracture.
Because periodontal disease can lead to bone loss, the two diseases have been investigated for possible connections. Studies have indicated that post-menopausal women who suffer from osteoporosis are 86% more likely to develop periodontal disease. Furthermore, research conducted over a 10 year period discovered that osteoporosis patients could significantly reduce tooth loss by controlling periodontal disease.
If you are diagnosed with osteoporosis, it is extremely important to take preventative measures against periodontal disease to protect your teeth and oral bone structure.
Women and Periodontal Health
Throughout a woman’s life, hormonal changes affect tissue throughout the body. Fluctuations in hormonal levels occur during puberty, pregnancy and menopause. At these times, the chance of periodontal disease may increase, requiring special care of your oral tissues and bone.
During puberty, there is increased production of sex hormones. These higher hormone levels increase gum sensitivity and lead to greater irritation from plaque and food particles. The gums can become swollen, turn red in color, and feel tender.
Similar symptoms occasionally appear several days before menstruation. Bleeding of the gums, bright red swelling of the gums between the teeth or sores on the inside of the cheeks may occur. These symptoms generally clear up once the period has started.
Your gums and teeth are also affected during pregnancy. Between the second and eighth month, gums may swell, bleed, and become red or tender.
Pregnant mothers with periodontal disease expose their unborn children to a variety of risks and possible complications. Pregnancy causes many hormonal changes in women which increase the likelihood of developing periodontal disease such as gingivitis, or gum inflammation. These oral problems have been linked to preeclampsia, low birth weight of the baby, as well as premature birth. Fortunately, halting the progression of periodontal disease through practicing excellent oral hygiene and treating existing problems can help reduce the risk of periodontal disease-related complications by up to 50%.
There are several factors that contribute to why periodontal disease may affect the mother and her unborn child. One is an increase in prostaglandin in mothers with advanced stages of periodontal disease or periodontitis. Because periodontitis increases the levels of prostaglandin, the mother may go into labor prematurely and deliver a baby with a low birth weight.
Another compound that has recently been linked to premature birth and low birth weights is C-reactive protein (CRP). CRP is a protein that has long been associated with heart disease (refer to above). Periodontal disease increases CRP levels in the body, which then amplifies the body’s natural inflammatory response. Bacteria from periodontal disease may enter the bloodstream, causing the liver to produce extra CRP. Studies have proven that an extremely high CRP count in early pregnancy increases the risk of preeclampsia.
- Oral Contraceptives
Swelling, bleeding, and tenderness of the gums may also occur when you are taking oral contraceptives, which are synthetic hormones.
Changes in the look and feel of your mouth may occur if you are menopausal or post-menopausal. They include but are not limited to: feeling pain and burning in your gum tissue; salty, peppery, sour tastes; and “dry mouths”. Careful oral hygiene at home and professional cleaning may relieve these symptoms.
Types of Periodontal Disease
In a healthy situation, gum tissues are pink and firm, and they do not bleed easily. There is no evidence of loss of bone or other supporting tissues.
Pink, firm tissues throughout with no bleeding present.
Gingivitis is the mildest form of periodontal disease. It causes the gums to become red and swollen. The gums may bleed easily, but there is usually little or no discomfort. Gingivitis is reversible with professional treatment and good home care.
Red, swollen gums, with bleeding and inflammation.
If gingivitis is left untreated, it can advance to periodontitis. In the mild stage, periodontal diseases begin to destroy the bone and supporting tissues of the teeth.
Red, swollen, bleeding gums are evident, and there is bone loss and breakdown of the supporting tissues around the teeth.
Moderate to Advanced Periodontitis
Moderate to advanced periodontitis develops if earlier forms of the disease like gingivitis and mild periodontitis are not treated and controlled. Extensive bone and tissue loss occurs in this most advanced form of the disease.
Extensive bone loss and breakdown of the supporting tissues around the teeth can lead to tooth loss. Note the significant drifting of teeth along with inflammation associated with periodontitis.
What Does This Mean to Me?
You may seek periodontal treatment in several ways. Your general dentist may recommend a consultation with our office if they find signs of periodontal disease through a check up or other dental care appointment. You can also see our office on your own without a referral if you are concerned that you may have one or more of the conditions outlined above.
The fact is, if you experience any of the symptoms listed below, you should schedule an appointment at our office without delay:
- Bleeding while brushing or eating normal foods. Unexplained bleeding while performing regular cleaning or consuming food is the most common sign of a periodontal infection.
- Bad breath. Ongoing halitosis (bad breath), which continues despite rigorous oral cleaning, can point to periodontitis, gingivitis or the beginnings of a gum infection.
- Loose teeth and gum recession. Longer-looking and loose-feeling teeth can indicate recession of the gums and/or bone loss as a result of periodontal disease.
- Pus between the teeth and gums.
- Changes in the way your teeth come together when you bite.
- Sores that develop in your mouth. Any alteration in the normal tissue lining your oral cavity could be a warning sign for a pathologic condition. The most serious of these would be oral cancer.
- Related health concerns. Patients with heart disease, diabetes, osteopenia or osteoporosis are often diagnosed with correlating periodontal infections. The bacterial infection of periodontitis can spread through the body, affecting other areas of the body.
- Interest in exploring dental implants to replace missing teeth and restore optimal chewing.