Periodontal Disease (Gum disease): Symptoms, Causes, Treatment & Prevention

 

Gum disease, also known as periodontitis (per-e-o-don-TIE-tis), is a serious gum infection that damages the soft tissue surrounding teeth.

Periodontal disease is characterized by inflammation and infection of the gums and bone-supporting teeth. Although certain people are more susceptible to this type of infection, it can also be caused by poor hygiene. Some possible symptoms include bad breath, loose teeth, bleeding, and swollen gums.Depending on the severity of the disease, there are many treatment options. 

Although frequent, periodontitis is typically preventable. It frequently results from not taking care of your mouth and teeth. You should brush and floss at least twice a day and get frequent dental examinations to help avoid periodontitis or increase your chances of  successful treatment.

Also Read: Gingivitis: Symptoms, Causes, Risk factors, Diagnosis, Treatment & Prevention

What is periodontal disease?

Gum disease, another name for periodontal disease, is an infection and inflammation of the tissues that hold your teeth in place. Gum disease can be brought on by poor oral hygiene. However, even with good brushing and flossing, some people are more susceptible to this problem than others.

 Symptoms:

Symptoms of periodontal disease can include:

• Purplish or reddish gums

• Bleeding

• Discomfort

• Halitosis, or bad breath

• Tastes bad

• Pain during chewing

• Gum recession is the term for gums that separate from your teeth

• Loose teeth

• The way your teeth fit together has changed

Stages of periodontal disease:

Gums in good health feel firm to the touch. They do not swell or bleed. However, periodontal disease can result in bleeding, swelling, and discolored (purplish or reddish) gums. Gum disease has the potential to destroy your underlying jawbone and result in tooth loss if left untreated.

The tissues surrounding your teeth eventually break down. Most people with gum disease, especially in its early stages, don't feel any pain. Therefore, it's important to recognize the warning indicators.


Gum disease progresses through four stages:

1. Gingivitis. is the initial stage of gum disease is this one. Gums that are red and swollen and may bleed when you brush or floss are the first signs. There isn't any bone loss at this point. Therefore, with the right care, gingivitis is completely reversible.
2. Mild case of periodontitis. The supporting bone has been impacted by the bacteria that has permeated behind your gums. Your gums can separate from your teeth, creating pockets around them. Because your toothbrush and floss cannot reach these pockets, plaque and germs prefer to hide there.
3. Periodontitis that is moderate. The ligaments, soft tissues, and bones that support your teeth in place are eroded by germs if treatment is not received. Around your gum line, you might observe pus (infection) and foul breath. At this point, some people start to feel pain.
4. Advanced periodontal disease. Bone loss persists when periodontal disease gets worse. Your teeth may get loose and finally fall out as a result of this.

Gum disease can be reversed with early treatment. However, the illness is too severe to be reversed if the infection has already caused bone loss around your teeth. But with the right care and regular, careful dental hygiene, you can control it.

Causes:

The primary cause of periodontal disease is the accumulation of dental plaque. Many of the bacteria found in plaque can infect your gums. Because of this, poor oral hygiene increases your risk of developing gum disease. Genes can contribute to gum disease in certain individuals by altering how their immune system reacts to microorganisms.

Risk factors for gum disease:

Anything that raises your likelihood of contracting an illness or condition is called a risk factor. The following are potential risk factors for periodontal disease:

• Using tobacco products, such as smoking

• Inadequate dental care

• Diabetes

• Autoimmune conditions, such as Crohn's disease, lupus, and scleroderma

• Hormonal shifts, especially during menopause, pregnancy, and puberty

• Stress

• Genetics, if your parents, grandparents, or siblings have gum disease, you're more likely to have it yourself

• Heart disease

How is periodontal disease diagnosed by dentists?

During a normal checkup, a dentist can determine whether you have gum disease. They will interview you about your symptoms and check your teeth for plaque accumulation. For additional assessment and care, they could recommend that you see a periodontist, or gum expert.

Using a tool known as a periodontal probe, a dentist or periodontist will measure the spaces surrounding your teeth. This indicates to them the amount of bone loss surrounding your teeth. The severity of your gum disease increases with the depth of your pockets. Your periodontist will examine your teeth, your bite, and the extent to which your gums are receding from your teeth.

Is it possible to cure periodontal disease?

Although gum disease cannot be cured, it can be controlled with the right care. It cannot be cured since you typically do not regain all of the structural support that surrounds your teeth. Treatment for periodontal disease, however, can lessen inflammation and partially restore your bone and tissue.

Genetics is another factor. Oral bacteria come in a variety of forms. The type that causes gum disease is just more common in some persons.

Gingivitis, or very early periodontal disease, is one stage of gum disease that is completely curable. Regular dental cleaning and careful oral hygiene can reverse gingivitis if it is identified early enough.

What is the treatment for periodontal disease?

There are numerous options for treating periodontal disease. Your condition's severity and several other factors will determine which is best for you, including:

• Your health

• if you smoke

• What previous treatments have you received?

Better oral hygiene and dental cleaning

With regular dental cleanings and better oral hygiene, those with very early periodontal disease (gingivitis) may be able to reverse the illness. This cautious method eliminates dangerous oral bacteria before the disease has a chance to worsen because there isn't any bone loss yet.

Brushing and flossing twice or three times a day, as well as going to the dentist for routine examinations and cleanings, are all part of good oral hygiene.

Root planning and scaling

Regular dental cleaning is comparable to scaling and root planing. However, it cleans more beneath your gums, removing bacteria and plaque that your toothbrush and floss cannot get to. For those with minor gum disease, periodontists advise this course of treatment.

In order to prevent germs from reattaching, a dental hygienist first removes the plaque from your teeth by scaling them and then smoothing out the surfaces of your roots. Under local anesthetic, the treatment is often completed in two or more visits.

Surgery for pocket reduction

Pocket reduction surgery, also known as osseous surgery, may be necessary for patients with moderate to advanced gum disease. Plaque and tartar that are so far behind the gums that your hygienist cannot reach them should be removed. A periodontist makes a cut or incision in your gums and forms a flap during this surgery. This enables them to temporarily separate your gums from the roots of your teeth.

They will next smooth out any rough spots and remove germs, tartar, and plaque from the roots of your teeth. After finishing, they will sew the incision shut and realign your gums.

Periodontists frequently mix guided tissue regeneration, bone grafting, gum grafting, and pocket reduction surgery with other regenerative procedures.

Laser-assisted new attachment process, or LANAP

Additionally, certain periodontists provide LANAP pocket reduction. This procedure uses a portable laser to treat periodontitis. The laser preserves healthy gum tissue while focusing on unhealthy gum tissue.

A less intrusive option to conventional pocket reduction surgery is LANAP. However, the outcomes are not all the same.

Grafting of bones

To replace bone loss due to gum disease, your periodontist may recommend a dental bone graft. The regions where the bone has deteriorated will be filled with bone grafting material when the infection has been cleared. This substance serves as a space-holder or scaffold, allowing your body to gradually rebuild its bone.

Grafting gum

Your dentist could suggest gum graft surgery, also known as tissue grafting, if periodontal disease has caused you to lose gum tissue. This process thickens your gum line and hides exposed tooth roots.

A periodontist will apply tissue to the gum recession areas throughout this surgery. Your provider may buy this tissue from a licensed bone and tissue bank, or it may originate from the roof of your mouth.

GTR, or guided tissue regeneration

Periodontists typically combine a bone graft with directed tissue regeneration. GTR stops soft tissue from developing into periodontal deficiencies, which are regions of broken-down bone and aids in their recovery.

An artificial membrane is positioned between your gums and the freshly inserted bone grafting material by a periodontist during GTR. The membrane maintains that gap open so that new bone can grow there in place of soft tissue since soft tissue regenerates more quickly than bone.

PRP (platelet-rich plasma) and PRF (platelet-rich fibrin)

Growth factors found in platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) promote tissue regeneration and repair. A tiny sample of your blood can be used by a periodontist to obtain PRF and PRP. To separate the plasma from your red blood cells, they will spin the sample in a centrifuge, a laboratory device that spins quickly using centrifugal force. After that, they will apply fibrin or platelet-rich plasma to the surgical site.

This type of therapy not only promotes healing but also speeds up recovery and lessens discomfort following surgery. It's also totally safe because it originates from your own blood.

Prevention:  

To lower your chance of developing gum disease:

• Make use of mouthwash that is antibacterial.

• Abstain from tobacco usage, including smoking.

• See your dentist for routine examinations and cleanings.

• Flossing at least once a day and cleaning your teeth for two minutes at least twice a day, in the morning and right before bed. You can remove bacteria and food particles by flossing before brushing. Maintaining proper oral hygiene removes the bacteria that cause periodontal disease and keeps your teeth and gums healthy.

References:

• Periodontitis (pyorrhea). Merck Manual Professional Version. https://www.merckmanuals.com/professional/dental-disorders/periodontal-disorders/periodontitis?redirectid=433?ruleredirectid=30. Accessed Dec. 27, 2022.

• American Academy of Periodontology. Periodontal Treatments and Procedures (https://www.perio.org/consumer/periodontal-treatments-and-procedures). Accessed 4/10/2023.

• Periodontal (gum) disease. National Institute of Dental and Craniofacial Research. https://www.nidcr.nih.gov/health-info/gum-disease. Accessed Dec. 27, 2022.

• U.S. National Institute of Dental and Craniofacial Research. Periodontal (Gum) Disease (https://www.nidcr.nih.gov/health-info/gum-disease). Accessed 4/10/2023.

• U.S. Centers for Disease Control and Prevention. Periodontal Disease (https://www.cdc.gov/oralhealth/conditions/periodontal-disease.html). Accessed 4/10/2023.