What is Periodontal Disease?|
About 80% of adults suffer some form of gum disease some time in their lives. The term "gum disease" covers a range of conditions from mild gingivitis (inflammation of the gums) to bone loss in adult periodontitis. The cause of gum disease is thought to be both bacterial and lack of hygiene - however, smoking is thought to aggravate the condition as well.
Gingivitis is the name given to the inflammation of the gums, commonly this refers to the swelling and redness of the gum line in people suffering from gingivitis. This swelling occurs when food gets caught at the gum line and you fail to clean effectively. Over a period of time bacteria congregate to the site and bind the food to the tooth. This causes plague, which is the whitish substances that collects on the surfaces of unclean teeth. As bacteria uses the food substance, they release toxins and metabolic byproducts which irritates the gums and causes them to swell. This is gingivitis.
Depending on how well you keep you keep your teeth clean, gingivitis may be localised (around one or two teeth) or generalised (around most teeth).
If the cause of gingivitis is not resolved or kept under control - eg you fail to keep your teeth and gumline clean - a chronic inflammatory process occurs. The periodontium is the name given to the gums (alveolar mucosa), the strip of tissue supporting the tooth (periodontal ligament) and the bone surrounding and supporting the tooth (alveolus). These support structures can become affected by the buildup of plague and chronic gingivitis.
The first phase of periodontitis involves the detachment of the gums from the surface of the tooth. At first this is only slight, with loss of about 2-5mm of attachment. A small pocket between the gums and the tooth surface forms and this allows more food to get trapped and stuck at the gum line. The inflammatory process is mild and there may be bleeding on brushing.
If nothing is done, the pocket depends and the ligament supporting the tooth (the periodontal ligament, PDL) becomes involved. The inflammatory process destroys the PDL's attachment to the tooth and the pocket deepens. As food accumulates, bacterial action binds calcium to plague forming calculus or tartar, this hard and rough substance binds to the tooth surface making the surface rougher and causing more plague to form! You may suffer some gum recession here - that is the gums seem to shrink down (or up) the tooth surface.
Following on from the loss of the PDL, the support alveolar bone starts to degenerate as chronic inflammation persists. It is here that gum recession becomes obvious and the root of the tooth is visible. If bone loss is extensive, your teeth may start to become loose and this may affect eating and chewing. You may also get bad breath due to the food stuck beneath the gum line, within the pockets.
If allowed to progressed unchecked, late periodontitis leads to tooth loss and periodontal or gum abscesses. At this stage treatment may be difficult and expensive!
How Is It Diagnosed?
Gum disease is dentistry's silent foe. Because it rarely displays any symptoms until the later stages, you should ensure that you attend regular examinations with your dentist. If you gums bleed off and on for more that a couple of weeks, you should have your dentist look at your gum condition. A diagnosis of active periodontal disease is made when:
- There is gingivitis present.
- There is evidence of pocketing with or without bone loss.
- There is evidence of bone loss - eg recession with root exposure, mobility.
Regular and thorough check-ups and cleans are the best way to ensure good gum health. Get your dentist to show you how to keep your teeth and gums