Gum Disease
Gum disease (also called Periodontal disease or Periodontitis) is an infection of the tissues that support your teeth. It is a major cause of tooth loss in adults. Because gum disease is usually painless, you may not know that you have it. At each regular checkup, your general dentist or hygienist will measure the depth of the shallow v-shaped crevice (called a sulcus or pocket) between each of your teeth and the gums, so that your general dentist can identify whether you have gum disease. Dr. Held will also measure the sulci of all of your permanent teeth to make sure your gums are healthy enough for tooth movement.
Gum disease is mainly caused by plaque (made of bacteria, carbohydrates, saliva, and acid (the toxic byproduct of the bacteria)). The bacteria in the plaque creates the toxic acid that can damage the underlying bone and other structures, and can cause the gums to become inflamed. Periodontal disease occurs just below the gumline in the sulcus, where the attachment of the tooth and its supporting tissues begins to break down. As the tissues are damaged, the sulcus develops into a deep pocket. Generally, the more severe the disease, the greater the depth of the pocket.
Periodontal problems are classified according to the severity of the disease. The two major stages are gingivitis and periodontitis.
The early stage of gum disease is called gingivitis. In this stage, the gums become red and swollen, and will bleed easily. At this point, the problem is still reversible (as no bone loss has occurred) and can usually be eliminated by brushing daily several times and by flossing, leading back to healthy gums.
The more advanced stage is called periodontitis. When the plaque sits under the gumline long enough, the bone that supports the teeth becomes seriously damaged, resulting in permanent bone loss. Because the gums are attached to the underlying bone, when there is bone loss, the gums will recede. This bone degeneration occurs due to the body's protective mechanism against plaque. When there is bone loss, there is less bone to hold the teeth in place. Thus, the teeth can become loose, can fall out, or may have to be removed by a general dentist or a dental specialist. Periodontitis is irreversible and is considered to be a chronic disease. There is no cure, and only management to prevent further structural damage is possible.
Some factors other than poor oral hygiene increase the risk of developing periodontitis. These include:
- Tobacco smoking or chewing
- System-wide diseases such as diabetes
- Crooked teeth
- Some types of medication such as steroids, some types of anti-epilepsy drugs, cancer therapy drugs, some calcium channel blockers, and oral contraceptives
- Bridges that no longer fit properly
- Fillings that have become defective
- Pregnancy
The following signs are indicative of gum problems and require immediate attention:
- Gums that bleed easily
- Red, swollen, or tender gums
- Gums that have pulled away from the teeth
- Persistent bad breath or bad taste
- Pus between the teeth and gums
- Permanent teeth that are loose or separating
- Any change in the fit of partial dentures
It is possible to have periodontal disease and to have no warning signs. That is one reason it is so important to visit your general dentist for regular checkups and periodontal examinations. Treatment methods depend upon how far the periodontal problem has progressed.
Good oral hygiene at home is essential to keep periodontal disease from becoming more serious or from recurring. You don't have to lose your teeth to periodontal disease. Brush, clean between your teeth, eat a balanced diet, and schedule regular general dental visits for a lifetime of healthy smiles.
Normal, Healthy Gums: Healthy gums and bone anchor teeth firmly in place. Healthy gums are pink (sometimes with normal ethnic coloration) and have "knife-edged papillae." A papilla is the triangular region of gum between the teeth. The papillae should be flat, with a nice sharp edge, and should come to a point. You should easily be able to tell the difference between the tooth and the gum. Additionally, there is no plaque present.
Gingivitis: Gums are red, swollen (i.e. inflamed), bleed easily, and may be sore to the touch or upon brushing and flossing. The papillae are inflamed and no longer "knife-edged." Gingivitis occurs because plaque is left under the unattached gingiva for a prolonged period of time. The gums react to having this acid-ridden plaque there by becoming inflamed; plaque is like a poison to the gums.
But, there is good news. Because soft tissues like gums heal relatively easily, with good brushing and flossing, gingivitis can be reversed in 1-2 weeks.
Periodontitis: Plaque sticks to the calculus (tartar), which is a buildup of the salts in your saliva. As plaque and calculus continue to build up, the body protects itself by melting the surrounding bone away. Because the gums are attached to the bone, they begin to recede (pull away) from the teeth and are still red and swollen. Additionally, the tips of the papillae are lost, and deep pockets form between the teeth and gums.
Periodontitis is irreversible. Once the bone is lost in this fashion, it is permanently lost. Bone is what holds the teeth in place. In periodontitis, the teeth appear to be longer because parts of the roots are exposed. Also, the portion of the teeth near the gumline will often look yellow, as the roots are usually yellower in color than the crowns of the teeth. Sometimes, the calculus will hide the roots, and when it is removed with a deep cleaning, you will be able to see the exposed roots. As in all chronic diseases, periodontitis must me managed for life. Excellent management of periodontal disease can help to prevent it from worsening and usually includes more frequent visits to the general dentist and sometimes, to the periodontist.
Advanced Periodontitis: A significant amount of bone is destroyed, along with portions of the periodontal ligament, and the gums recede farther. Teeth - even healthy teeth - may become loose and fall out or may need to be extracted, as at this point, they may be held in only by the gums or by calculus alone. More of the roots are exposed. Additionally, there are no longer any papillae. Even with excellent care and consistent aide from the general dentist, hygienist, and periodontist, this periodontal state is very difficult to prevent from worsening.
The good news is that you can help to prevent gum disease in the first place by taking excellent care of your teeth and gums every day and by having regular general dental checkups.
