Periodontal Disease

Plaque is the primary cause of periodontal disease. However, other factors can contribute to gum disease. These include:

Hormonal changes - such as those occurring during pregnancy, puberty, menopause, and monthly menstruation-make gums more sensitive, which makes it easier for gingivitis to develop.

Illnesses may affect the condition of your gums. This includes diseases such as:

cancer or HIV that interfere with the immune system. Because diabetes affects the body's ability to use blood sugar, patients with this disease are at higher risk of developing infections, including periodontal disease.

Medications can affect oral health because some lessen the flow of saliva, which has a protective effect on teeth and gums. Some drugs, such as the anticonvulsant medication Dilantin and the anti-angina drug Procardia and Adalat, can cause abnormal growth of gum tissue.

Bad habits such as smoking, make it harder for gum tissue to repair itself.
Poor oral hygiene habits such as not brushing and flossing on a daily basis, make it easier for gingivitis to develop.

Family history of dental disease can be a contributing factor for the development of gingivitis.

Periodontal disease may progress painlessly, producing few obvious signs, even in the late stages of the disease. Although the symptoms of periodontal disease often are subtle, the condition is not entirely without warning signs. Certain symptoms may point to some form of the disease. They include:

Gums that bleed during and after tooth brushing
Red, swollen, or tender gums
Persistent bad breath or bad taste in the mouth
Receding gums
Formation of deep pockets between teeth and gums
Loose or shifting teeth
Changes in the way teeth fit together upon biting down, or in the fit of partial dentures.

During a periodontal exam, your dentist or periodontist typically checks for these things:

Gum bleeding, swelling, firmness, and pockets (the space between the gum and tooth; the larger and deeper the pocket, the more severe the disease)

Teeth movement and sensitivity and proper teeth alignment

Your jawbone to help detect the breakdown of bone surrounding your teeth

Nonsurgical treatments of gum disease include:

Professional dental cleaning. During a typical checkup your dentist or dental hygienist will remove the plaque and tartar (plaque that builds up and hardens on the tooth surface and can only be removed with professional cleaning) from above and below the gum line of all your teeth. If you have some signs of gum disease, your dentist may recommend more than twice-a-year cleanings.

Scaling and root planing. This is a deep-cleaning, nonsurgical procedure, done under a local anesthetic, whereby plaque and tartar from above and below the gum line are scraped away (scaling) and rough spots on the tooth root are made smooth (planing). Smoothing the rough spots removes bacteria and provides a clean surface for the gums to reattach to the teeth. Scaling and root planing is done if your dentist or periodontist determines that you have plaque and calculus (hardened plaque, also called tartar) under the gums that needs to be removed.

Surgical treatments of gum disease include:

Flap surgery/pocket reduction surgery. Involves lifting back the gums and removing the tartar. In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. The gums are then placed so that the tissue fits snugly around the tooth. This method reduces the size of the space between the gum and tooth, thereby decreasing the areas where harmful bacteria grow and decreasing the chance of serious health problems associated with periodontal disease.

Bone grafts. Involves using fragments of your own bone, synthetic bone, or donated bone to replace bone destroyed by periodontal disease. The grafts serve as a platform for the regrowth of bone, which restores stability to teeth. New technology, called tissue engineering, encourages your own body to regenerate bone and tissue at an accelerated rate.

Soft tissue grafts. Reinforces thin gums or fills in places where gums have receded. Grafted tissue, most often taken from the roof of the mouth, is stitched in place, adding tissue to the affected area.

Guided tissue regeneration. Performed when the bone supporting your teeth has been destroyed, this procedure stimulates bone and gum tissue growth. Done in combination with flap surgery, a small piece of mesh-like fabric is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow to better support the teeth.

Bone surgery. Smoothes shallow craters in the bone due to moderate and advanced bone loss. Following flap surgery, the bone around the tooth is reshaped to decrease the craters. This makes it harder for bacteria to collect and grow.