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Patient Guide to Periodontal Disease: Causes and Symptoms Five things patients should know about periodontal disease

1. What is periodontal disease? Commonly known as “gum disease,” periodontal disease is an infection of the tissues and bones that support our teeth. It is very common – it affects 1 in 2 Americans and is the number one cause of adult tooth loss. Fortunately, with regular checkups and good daily oral hygiene, gum disease is controllable. Unfortunately, since early symptoms are mild, many people don’t know they have a problem until it becomes severe.

2. What causes periodontal disease? The human mouth is full of bacteria – according to estimates, as many as 500 different kinds. Bacteria combine with mucus and food particles to form a sticky substance on our teeth called plaque. If you don’t remove it with thorough daily brushing and cleaning between teeth, it can eventually harden into calculus or tartar. The bacteria in plaque and tartar produce toxins which irritate the gums and cause inflammation or gingivitis.

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The mildest form of gum disease is gingivitis. Most people can prevent or reverse gingivitis with proper oral care. Daily brushing and flossing and regular dental exams and cleanings are recommended. You will not experience bone loss with this mild form of the disease.

Untreated gingivitis can advance to “periodontitis” (which means “inflammation around the tooth”). In periodontitis, gums pull away from the teeth, and form spaces (called “pockets”) that become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.

3. What are the risk factors? Although the primary cause of periodontal (gum) disease is plaque, other factors can increase the risk of developing gum disease. The American Academy of Periodontology identifies the following risk factors:

1. Age. Studies indicate that older people have the highest rates of periodontal disease. More than 70% of Americans 65 and older have periodontitis.

2. Smoking/Tobacco Use. Tobacco users are at increased risk for periodontal disease. Studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease.

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Bacteria in plaque and tartar produce toxins which irritate gums and cause inflammation or gingivitis.

Untreated gingivitis can advance to ‘periodontitis’…. Gums pull away from teeth, forming space that get infected.

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3. Genetics. Some people may be genetically susceptible to gum disease, in spite of healthy oral care habits. Early identification by genetic testing and intervention may prevent tooth loss.

4. Stress. Research shows that stress can increase the body’s susceptibility to infection, including periodontal disease.

5. Medications. Some drugs, such as antidepressants, heart medications, and oral contraceptives can affect your oral health. You should notify your dentist of all medicines you take.

6. Clenching or grinding your teeth. These put excess force on the periodontal tissues and accelerate their destruction.

7. Systemic diseases. Conditions such as cardiovascular disease, diabetes and rheumatoid arthritis that interfere with the body’s inflammatory system can worsen gum disease.

8. Poor nutrition and obesity. Periodontal disease begins as an infection. Poor nutrition can compromise the ability of the immune system to fight infection. Research has shown that obesity is correlated with increased risk.

Additional factors that can increase your risk for gingivitis include:

• Inadequate brushing and flossing• Breathing through the mouth• HIV and AIDS• Improper bite• Pregnancy• Sex: male• Poorly fitting dentures.

Are you at risk? The American Academy of Periodontology’s online risk assessment test will help you see if you are at risk for having or developing periodontal (gum) disease. Millions of people don’t know they have this serious infection that can lead to tooth loss if not treated.

Source: perio.org

4. Are there different stages of periodontal disease? Yes. Gum disease is progressive and develops in stages. Gingivitis is the mildest form of periodontal disease. If untreated, gingivitis can advance to periodontitis. As the disease progresses, plaque by-products lead to the destruction of the tissues that anchor the teeth in the bone. Gums separate from the teeth, forming pockets (spaces between the teeth and

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gums) that become infected. Tooth roots are exposed and may become at risk of decay and sensitive to cold and touch. As the disease progresses, the teeth become loose, and the presence of pus in the deep pockets can lead to pain, swelling and a foul odor. Removal or loss of teeth may occur.

There are many forms of periodontitis. The most common ones include the following:

• Aggressive periodontitis occurs in patients who are otherwise clinically healthy. A characteristic feature is the speed of attachment loss and bone destruction.

• Chronic periodontitis results in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss. This is the most frequently occurring form of periodontitis and is characterized by pocket formation and/or recession of the gingiva. It is prevalent in adults, but can occur at any age.

• Periodontitis as a manifestation of systemic diseases often begins at a young age. Systemic conditions such as heart disease, respiratory disease, and diabetes are associated with this form of periodontitis.

Source: moderndentistry.com

5. What are the symptoms of periodontal disease? The biggest challenge to prevention and treatment is that periodontal disease is often silent, meaning symptoms may not appear until the disease is in an advanced stage.

The American Academy of Periodontology advises patients to look for these warning signs: gum-disease-symptoms

• Red, swollen or tender gums or another pain in your mouth• Bleeding while brushing, flossing, or eating hard food• Gums that are receding or loose and separating teeth.

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• Sores in your mouth or pus between your gums and teeth• Persistent bad breath• A change in the way your teeth fit together when you bite• A change in the fit of partial dentures.

Any of these symptoms may be a sign of a serious problem, which should be checked by a dentist. If you are experiencing any of these conditions, contact my office to schedule an exam.

- Dr. Nishan Halim

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Symptoms may not appear until the disease is in an advanced stage.