Periodontitis is the most common form of periodontal disease, affecting approximately 75% of all Americans over the age of 35. This disease affects both sexes equally. It is caused by inflammation and infection of the gums and is defined by bone loss around the teeth. Signs may occur as early as adolescence, but due to its progressive, cumulative nature, the disease is often diagnosed in the fourth to fifth decade of life.
Over time and without treatment, the infection begins to erode the jawbone that supports the teeth. The erosion weakens the ligaments (attachments) and loosens the teeth, which may eventually fall out on their own or need to be pulled out.
Deep pockets that are filled with plaque can contribute to a foul taste in the mouth and are very difficult to clean. As the disease progresses, the exposed root surfaces of the teeth become very sensitive to hot and cold. Furthermore, the exposed root surfaces lack protective enamel and are more prone to developing cavities.
Types of Periodontitis
There are five types, although chronic periodontitis is the most common. Here is a brief description of each:
1) Chronic Periodontitis – This form involves periodontal pockets that gradually form. It is further classified into localized or generalized forms, as well as mild, moderate, or severe amount of destruction.
2) Aggressive Periodontitis – This form involves loss of periodontal attachment at a rapid pace relative to the patient’s age. It is further classified into localized or generalized forms, as well as mild, moderate, or severe amount of destruction. Often it is seen in adolescence and may run in families. There may be an underlying immune system defect involved.
3) Periodontitis as a Manifestation of Systemic Disease-Patients with certain blood diseases (e.g. leukemia) or genetic diseases (e.g. Down syndrome), are more likely to have periodontitis. Often this is due to the body’s decreased ability to fight infection (immunosuppression).
4) Necrotizing Ulcerative Periodontitis (NUP)-This form is associated with a rapid onset of pain and bone loss, ulcerations of the gums, and bad breath. Malnutrition, psychological stress, smoking, lack of sleep, and overall lack of ability to fight infection are contributing factors. NUP was called “trench mouth” after it was seen in soldiers returning from the trenches of World War I.
5) Periodontitis Associated with Endodontic Lesions-when a tooth is infected and requires a root canal, or endodontic therapy, bone loss can occur at the tip of the root.
Symptoms of Periodontitis
During the early stages, periodontitis is asymptomatic. Signs of disease during this time may resemble those of gingivitis (bleeding, red gums and bad breath). As the disease progresses, symptoms may include[ii]:
Loosening of the teeth
Teeth that ache when exposed to temperature changes
Sore, swollen gums that bleed easily
Pain when touching the gums or teeth
Shiny, bright red, or reddish-purple gums
Bad breath that does not go away after brushing and flossing
If left untreated, symptoms of periodontitis will worsen over time.
What Causes Periodontitis?
Periodontitis is caused by the formation of plaque on the teeth. Over time, the plaque hardens and turns into calculus (tartar) that cannot be removed by brushing and flossing. Bacteria that live within the plaque and calculus infect the gums. At this point, the disease is termed gingivitis (“infection of the gums”). However, if the plaque and calculus remains on the teeth of a susceptible individual, the disease progresses and becomes periodontitis (“infection around the tooth”).
Certain plaque bacteria produce toxins that erode the bone. As the bone erodes, the gum tissue follows it and deep pockets form between the teeth and gums. These bacteria also enter the bloodstream, where they can spread to other parts of the body.
Hormones may also play a role in the progression of periodontitis, especially in pregnant women. Medical conditions, such as diabetes and heart disease, have been proven to play contributing roles to periodontal disease as well.
Factors that may increase one’s risk of developing periodontitis include:
Poor dental hygiene
Weak immune system due to illness or drugs
Poor nutrition (read more about nutrition and a health mouth)
Family history of gum disease and/or periodontitis
Tongue or lip piercing
If you are experiencing symptoms of periodontitis, you should contact your dentist for a check-up. Your dentist will ask you questions related to your family medical history and symptoms. An oral examination of your teeth, gums, and supporting bones will take place. During this exam, your dentist will measure the depth of the pockets in the gums. X-rays will be taken to check for bone loss.
Unlike gingivitis, which usually can be eliminated by good oral hygiene and a professional cleaning, periodontitis may require repeat visits to the dentist. Brushing and flossing only clean 1-3 millimeters below the gum line and periodontal pockets are 4-10 millimeters. Therefore, when deep pockets are present, deeper cleaning is necessary. This treatment is called scaling and root planing and thoroughly removes plaque and calculus below the gumline and primes the root for reattachment of the gums. It is similar to a regular cleaning, but is more meticulous and goes further below the gumline. For this reason, local anesthetic may be given to numb the gums.
You should be checked by your dentist or periodontist 4-6 weeks after the deep cleaning to check the healing of the gums. If there are any remaining pockets deeper than 5 millimeters, surgery is usually recommended. In most cases, open flap surgery is the procedure used and involves surgically accessing the tooth below the gum line, thoroughly cleaning the teeth, and if needed, correcting bone defects that were caused by the infection. This may or may not include placement of bone graft material. Sutures will be used to hold the gum tissue in place while it heals. Immediately after surgery, chlorhexidine mouth rinse is used as a temporary replacement for brushing and flossing.
Antibiotics may be prescribed in conjunction with scaling and root planing or gum surgery, especially if an abscess is present. In some cases, antibiotic-impregnated materials, such as gel or filament, are inserted into the deep gum pockets. You may also be prescribed a low-dose antibiotic to be taken over several months.
After initial therapy (i.e. deep cleaning and/or surgery), you will be placed on periodontal maintenance. This means having your teeth cleaned and mouth examined every 3-4 months. Due to your risk for periodontal breakdown, you require closer monitoring than someone who has never had periodontal disease.
Complications of Periodontitis
If left untreated, periodontitis will progress. Complications include[iv]:
Abscess (infection) of:
Tooth or gum tissue
Soft tissue (facial cellulitis)
Deep jawbone (osteomyelitis)
Here are some tips to help you prevent periodontitis and other forms of periodontal disease from developing:
1) Practice good oral hygiene, including brushing gently with a soft toothbrush for at least 2 minutes twice a day and flossing beneath the gumline.
2) Visit a dentist or periodontist on a regular basis. For most patients this is every 6 months. If you have certain risk factors, you may require more frequent visits.