Plain Facts about Periodontal Disease

Learn what it might mean to have swollen gums and what can be done about it.

What is Periodontitis?

Periodontitis (per-e-o-don-TIE-tis), also called Gum Disease, is defined as a serious gum infection that damages the gum tissue and can, over time, destroy the bone that supports your teeth. Healthy gums are generally firm, pale pink, and wrap closely around teeth.

Symptoms of periodontitis can include:

• Swollen gums
• Bright red to purplish gum tissue
• Tender gums
• Blood when flossing or brushing
• Bad breath
• Pus between teeth and gums
• Painful chewing
• Gums pulling away from teeth
• New spaces between teeth
• Loose teeth
• Loss of tooth/teeth
• Changes to how your teeth fit together when you bite

What Causes Periodontitis?

According to the Centers for Disease Control and Prevention, 46% of Americans age 30 and over show signs of periodontal disease. Periodontitis is common, but usually preventable. It starts with plaque - the sticky film you find on your teeth each day, composed of food particles, saliva, and bacteria.

If you don't remove all of the plaque from around your gum line when you brush or floss, that plaque will eventually harden into tartar (calculus). Tartar is filled with bacteria and requires a professional cleaning to be removed. Without routine professional cleanings, plaque and tartar will eventually build up, working its way below your gum line. The presence of this tartar can irritate your gums, causing inflammation. The longer this plaque and tartar remain on your teeth, the more damage is done. As tartar and plaque buildup beneath your gums, the more irritated your gum tissue will become, eventually pulling away (receding) from your teeth, leaving pockets between your gums and teeth, which fill with even more plaque and tartar.

Risk Factors for Periodontitis

According to the Mayo Clinic, factors that can increase your risk of periodontitis include:

• Gingivitis
• Poor oral health habits
• Smoking or chewing tobacco
• Hormonal changes, such as those related to pregnancy or menopause
• Obesity
• Inadequate nutrition, including vitamin C deficiency
• Genetics
• Certain medications that cause dry mouth or gum changes
• Conditions that cause decreased immunity, such as leukemia, HIV/AIDS and cancer treatment
• Certain diseases, such as diabetes, rheumatoid arthritis, and Crohn's disease

What are the Stages of Periodontitis?

There are three stages of Periodontal Disease:

Stage 1: Gingivitis (jin-ji-VI-tis)

• First and most common phase
• Red and swollen gums
• Blood while brushing and flossing
• Gum recession
• Bad breath

Stage 2: Periodontitis (per-e-o-don-TIE-tis)

• More advanced than gingivitis
• Bright Red, swollen gums
• Tender gums
• Periodontal pockets forming between teeth
• Buildup of pus between teeth/gums
• Bad breath/bad taste
• Loose teeth
• Can lead to bone loss in the jaw

Stage 3: Advanced Periodontitis

• Chronic bad breath
• Swollen and bleeding gums
• Severe gum recession
• Deep periodontal pockets
• Loose and misaligned teeth
• Usually requires surgical treatment

Diagnosing Periodontal Disease

When you visit your dentist, they will perform an exam to check the condition of your teeth and gums. Additionally, the dentist will use a periodontal probe to measure the depth of the periodontal pockets around each side of your tooth, and check for bleeding. The depth of the pockets around your teeth as well as the presence of blood will tell your dentist whether you have periodontal disease.

X-rays are also helpful for diagnosis, as they can show the dentist the amount of tartar on the roots of your teeth, and show if you have had any bone loss in your jaw. If your dentist diagnoses a more severe form of periodontal disease, you may be referred to a Periodontist (gum specialist) to have an exam and develop a treatment plan.

Treatment for Periodontal Disease

Treatment for your periodontal disease can vary depending on the severity of your symptoms. For example, treating gingivitis, the first phase of periodontal disease, isn't as intensive as treating advanced periodontal disease.

Treatments may include:

• Increased frequency for cleanings
• Antibiotics
• Deep cleaning (scaling and root planning) - this is a type of dental cleaning that will clear away tartar and plaque from below the gum line, along tooth roots.
• Periodontal pocket reduction surgery
• Gum tissue graft surgery
• Bone graft surgery

Make sure to check your benefit coverage on your dental plan before making a final decision on your treatment plan.

Risks of Not Treating Periodontal Disease

Though it might be easy to ignore a little blood when flossing, or just work through pain felt while brushing, the sooner you bring either to your dentist's attention, the better. The only way to remove hardened plaque or plaque that has made its way into periodontal pockets along your tooth root is through professional cleaning.

Without professionals stepping in,

• The plaque and tartar will continue to work its way down the tooth root, enlarging the periodontal pockets and moving your gum tissue down and away from your teeth.
• The bacteria in this plaque and tartar can eventually eat away at your jawbone, and the part of your jaw that holds your teeth in place (alveolar complex), allowing teeth to loosen or even fall out.
• Eventually, once enough teeth are lost and a denture or partial is needed to replace the lost teeth, there can be additional difficulty and cost, if there isn't enough of the jaw bone left to hold a denture in place.

Aside from the risk of a mild case of gingivitis turning into advanced periodontal disease, and the need for several gum surgeries in order to treat it, there are several other risks associated with untreated gum disease:

• Gum disease makes it more difficult for diabetics to control their blood sugar
• Inflammation caused by periodontitis can increase your risk of heart attack or stroke
• Transplant patients must be in good oral health, without gum disease before they are eligible to receive a transplant
• Recent studies have linked the bacteria that causes gum disease to issues with gut health, lung problems, and low birth weight in babies

Prevention of Periodontal Disease

The easiest way to prevent periodontitis is to practice good oral hygiene - brushing twice daily, for two minutes, using a soft bristled brush and flossing daily.

Regular dental visits with cleanings are also necessary to maintain a healthy mouth. Cleanings should generally occur every six to 12 months, however, if you are at a higher risk for periodontal disease (see Risk Factors), your dentist.