Periodontal Disease and Treatment

Periodontal Disease and Treatment

Periodontal Disease. Mobile Phone Number 01797522136, 01987073965. Periodontal disease refers to infections of the gum tissues and bone that support the teeth, primarily caused by plaque, a sticky film of bacteria. The main types are Gingivitis, the reversible mildest form causing red, swollen, bleeding gums, and Periodontitis, a chronic, irreversible condition leading to bone loss and potentially tooth loss. Other forms include aggressive periodontitis, necrotizing periodontitis, and periodontitis associated with systemic diseases.  

Definition of Periodontal Disease

Periodontal disease, or gum disease, is an infection of the tissues that hold your teeth in place. It starts with the accumulation of bacteria in plaque, which leads to inflammation. 

Types of Periodontal Diseases

The two most common forms of periodontal disease are stages of the same disease process: 

• Gingivitis: This is the mildest and earliest stage, where the gums become red, swollen, and may bleed easily. If treated with improved oral hygiene, it is reversible. 
• Periodontitis: This is a more severe, chronic inflammatory condition that develops from untreated gingivitis. It causes a breakdown of the bone and connective tissue that support the teeth, leading to the formation of pockets between the teeth and gums. Periodontitis can lead to tooth loss and is generally irreversible, though it can be managed with professional treatment. 

Other Classifications and Related Conditions of Periodontal Disease

• Aggressive Periodontitis: This type involves rapid loss of bone and attachment, with bone destruction that is not commensurate with the amount of plaque present. 
• Necrotizing Periodontitis: This severe form, often seen in individuals with compromised immune systems (such as those with HIV), can cause rapid destruction of gum tissue and bone. 
• Periodontitis Associated with Systemic Diseases:Certain diseases, such as diabetes, can affect the periodontium and increase the risk or severity of periodontal disease. 
• Periodontitis Associated with Systemic Diseases:Certain diseases, such as diabetes, can affect the periodontium and increase the risk or severity of periodontal disease. 
• Systemic Illnesses:Periodontal disease can have manifestations related to other systemic conditions, including genetic disorders, immune system problems, and certain types of cancer. 

Location of Treatment for Periodontal Disease

HRTD Medical and Dental Services, Abdul Ali Madbor Mansion, Plot No. 11, Folpotty Mosjid Goli, Metro Rail Piller No. 249, Mirpur-10 Golchattar, Dhaka-1216. Mobile Phone Number 01797522136, 01987073965. Hotline Number 01969947171.

Training Center for Management of Periodontal Diseases

HRTD Medical Institute Provides some Dental Trainings which are very useful for the Management of Dental Diseases, Periodontal Diseases. The Courses are Diploma in Dental Technology, Post Diploma Training in Dental Surgery, Post Diploma Training in Dental Management. All Courses are available in HRTD Medical Institute. This Institute is an Organization of HRTD Limited ( A Medical Training Based Limited Company Registered by The Govt of the People Republic of Bangladesh.

Gingivitis is a Common Periodontal Disease

Gingivitis is inflammation of the gums caused primarily by bacterial plaque buildup from poor oral hygiene. Its clinical features include red, swollen, and tender gums that bleed easily during brushing or flossing, and bad breath. Diagnosis involves a dental professional examining the mouth for signs of plaque, measuring gum pocket depth, and reviewing the patient’s medical history.  

Causes of Gingivitis

• Bacterial Plaque: The most common cause, plaque is a sticky film of bacteria that irritates the gums. 
• Poor Oral Hygiene: Inadequate daily brushing and flossing allow plaque to build up and harden into tartar, which cannot be removed by brushing alone. 
• Hormonal Changes: Pregnancy, puberty, and menopause can increase gum sensitivity and the risk of gingivitis. 
• Certain Medications: Some drugs, such as anticonvulsants and oral contraceptives, can cause abnormal gum tissue growth or affect salivary flow, increasing risk. 
• Underlying Health Conditions: Diabetes, HIV, and certain blood disorders can increase susceptibility. 
• Vitamin Deficiencies: A lack of certain vitamins, like Vitamin C, can be linked to gingivitis. 
• Lifestyle Factors: Smoking can hinder the healing of gum tissue and increase the risk of gingivitis. 

Clinical Features of Gingivitis

• Redness: Gums appear red or dark red, rather than their usual healthy pink color. 
• Swelling: Gums may look puffy or swollen. 
• Bleeding: Gums bleed easily during activities like brushing or flossing. 
• Tenderness: The gums may feel tender to the touch. 
• Bad Breath: An unpleasant odor can be a sign of gingivitis. 
• Furry Gums: A “furry” or fuzzy feeling on the gums when you run your tongue over them can indicate plaque buildup. 

Diagnosis of Gingivitis

• Clinical Examination:A dentist will visually inspect your teeth and gums for signs of plaque, inflammation, swelling, and bleeding. 
• Medical and Dental History:The dentist will review your medical and dental history to identify any contributing factors or systemic conditions. 
• Pocket Depth Measurement:The dentist may measure the depth of the space (pocket) between your gums and teeth using a periodontal probe. 
• Professional Cleaning:During the exam, the professional may also perform a dental cleaning to remove plaque and tartar. 

Investigation for Gingivitis

A dentist will investigate for gingivitis through several steps:

• Dental Examination:They will look for signs of gum inflammation, such as redness, swelling, and bleeding, which are characteristic of gingivitis. 
• Pocket Depth Measurement:A dental probe is used to measure the depth of the pockets between the teeth and gums; deeper pockets can signal more advanced periodontal disease. 
• Medical History:Your dentist will ask about your medical history to identify any risk factors or contributing conditions like diabetes or smoking that can increase the risk of gum disease. 
• Dental X-rays:X-rays are taken to determine if the jawbone has been affected by gum disease and to assess the overall extent of the condition. 

Treatment of Gingivitis

The goal of treatment is to control the infection and restore gum health. 

• Professional Cleaning:A dentist will thoroughly clean your teeth to remove plaque (bacterial film) and tartar (hardened plaque) from above and below the gum line. 
• Scaling and Root Planing:This is a deeper professional cleaning procedure that removes tartar and bacteria from the tooth roots and smooths the root surfaces to prevent bacteria from reattaching. 
• Improved Oral Hygiene:You will be taught proper home care techniques, including brushing twice a day and flossing once a day, to effectively remove plaque and prevent its accumulation. 
• Antimicrobial Mouthwash:An antimicrobial mouthwash may be prescribed to help kill bacteria in the mouth and control the infection. 
• Referral to a Periodontist: In more advanced cases, a periodontist, a gum disease specialist, may be consulted for specialized treatment options. 

Complications of Gingivitis

If left untreated, gingivitis can progress to more serious issues:

• Periodontitis:This is the most common and severe complication, where inflammation spreads to the tissues and bone that support the teeth, leading to gum recession, loose teeth, and eventual tooth loss. 
• Periodontal abscesses:These are painful infections in the gum tissue, characterized by swelling, pain, and pus, requiring urgent medical attention. 
• Systemic health problems:Periodontal disease has been linked to an increased risk of other conditions, including cardiovascular disease (heart attacks, strokes) and complications for people with diabetes, making blood sugar control more difficult. 
• Quality of life impact:Persistent bad breath, discomfort, and bleeding gums can make it difficult to eat, drink, and talk. 

Prevention of Gingivitis

Good oral hygiene is the most effective way to prevent gingivitis:

• Brush and floss regularly:Brush at least twice a day and floss daily to remove plaque and food particles that cause inflammation. 
• Use fluoride toothpaste: Fluoride toothpaste helps strengthen teeth and protect against gum disease. 
• Get regular dental checkups:Visit your dentist for professional cleanings and to have your oral health assessed. 
• Maintain a healthy diet:Avoid sugary and fatty foods and eat a balanced diet to support overall oral health. 
• Don’t smoke:Smoking increases the risk of developing gingivitis and can worsen gum disease. 
• Replace your toothbrush:Switch to a new toothbrush every three to four months to ensure its effectiveness. 

Periodontitis

Periodontitis is a severe gum infection that damages the tissues and bone supporting your teeth, often starting from untreated gingivitis caused by plaque and tartar. Key causes include poor oral hygiene, smoking, and systemic conditions, while its clinical features range from swollen, bleeding, and receding gums with bad breath to loose, shifting, or lost teeth, and deep pockets between teeth and gums.  

Definition

Periodontitis is an advanced and severe form of gum (periodontal) disease that progresses beyond gingivitis. It results in the inflammation and infection of the periodontium, the structures that hold teeth in place, including the gums, periodontal ligament, and alveolar bone. If left untreated, this infection can cause permanent damage to these supporting structures, leading to tooth mobility and loss. 

Causes of Periodontitis

The primary cause is the buildup of bacterial plaque and hardened plaque (tartar) on teeth and under the gum line. Other contributing factors include: 

• Poor oral hygiene:Inadequate brushing and flossing allow plaque to accumulate and harden, leading to gingivitis and then periodontitis. 
• Uncontrolled inflammation:The host’s immune response to the bacterial biofilm contributes to the disease’s progression. 
• Smoking:Smokers are more prone to periodontitis, experience more rapid tooth and bone loss, and have poorer treatment outcomes. 
• Systemic conditions:Diabetes, weakened immune systems, and certain genetic factors can increase the risk and severity of periodontitis. 
• Nutritional deficiencies:Lack of essential vitamins can impair healing and contribute to gum inflammation. 

Clinical Features of Periodontitis

Symptoms of periodontitis often develop gradually and can be painless until advanced stages, making early detection difficult. 

• Gum changes: Red, swollen, or bright red/dark purple gums that bleed easily. 
• Receding gums: Gums pull away from the teeth, making the tooth roots appear longer. 
• Bad breath: A persistent bad odor (halitosis). 
• Periodontal pockets: Deep pockets form between the gums and teeth, which trap bacteria. 
• Tooth mobility: Teeth become loose or shift. 
• Pus: Pus may be visible between the teeth and gums. 
• Changes in bite: A change in the way your teeth fit together when you bite. 
• Tooth loss: In advanced cases, bone loss is so severe that the teeth become loose and may fall out. 

Clinical Examination/Diagnosis

This involves a detailed assessment of the gums and teeth: 

• Periodontal Probing:A small, calibrated instrument called a periodontal probe is inserted around the teeth to measure the depth of the pockets between the gums and the teeth. Deeper pockets (over 4mm) indicate periodontitis, and deeper pockets correlate with more severe disease. 
• Bleeding on Probing (BOP):The presence of bleeding during probing is a key sign of gum inflammation and is noted. 
• Gingival Assessment:The dentist examines the gums for signs of inflammation, such as redness and swelling. 
• Tooth Mobility:An assessment is made to check how loose the teeth are, which can be a symptom of periodontitis. 
• Gingival Recession:The extent to which the gums have pulled away from the teeth is also evaluated. 
• Furcation Involvement:For multi-rooted teeth, the dentist checks for involvement of the area where the roots divide (furcation). 

Radiographic Assessment

• Dental X-rays: These are used to visualize the underlying bone. 
• Alveolar Bone Loss: X-rays can show the extent of bone loss around the teeth, a critical indicator of periodontitis. 
• Comparison: Older X-rays may be compared with newer ones to track changes in bone over time. 

Patient History and Risk Factors

• Medical and Dental History: The dentist will ask about any relevant medical conditions and the patient’s home care practices. 
• Smoking Habits: A history of smoking is a significant risk factor for periodontitis. 
• Family History: For some forms of periodontitis, a family history can be a factor. 

Salivary Biomarkers 

• Biomarker Analysis: Some research has focused on using salivary biomarkers, such as lactoferrin and specific inflammatory cytokines, to help diagnose periodontitis, though these are not yet standard clinical practice for initial diagnosis.

Treatment of Periodontitis

Periodontitis treatment begins with non-surgical cleaning called scaling and root planing to remove plaque and tartar, followed by improved at-home oral hygiene. For more severe cases, surgical procedures such as flap surgery, bone grafts, or soft tissue grafts may be necessary to repair damage. Antibiotics may be used to control infection, and a periodontist (gum specialist) may be involved, with a recommendation for ongoing professional cleanings. 

Non-Surgical Treatments

• Scaling and Root Planing (Deep Cleaning):This is the most common initial treatment for periodontitis.
  • Scaling: Removes plaque and tartar from the tooth surfaces above and below the gum line. 
  • Root Planing: Smoothes the root surfaces of the teeth to discourage the buildup of bacteria and to help the gums reattach. 
• Antibiotics:May be prescribed to kill bacteria or prevent infection. These can be in the form of oral medication, or a topical antibiotic placed directly under the gums. 
• Antimicrobial Mouthwashes:Can be used to help reduce plaque. 
• Improved Oral Hygiene:Your dentist or hygienist will provide instruction on how to properly clean your teeth at home. 

Surgical Treatments

These are used for more severe periodontitis when non-surgical treatments are not enough. 

• Flap Surgery (Pocket Reduction Surgery):A periodontist folds back the gum tissue to allow for thorough cleaning and smoothing of the roots, then secures the gum tissue back into place. 
• Soft-Tissue Grafts:Tissue is taken from the roof of the mouth or another donor area to strengthen or build up gum tissue that has receded. 
• Bone Grafts:Bone-stimulating proteins or bone particles are placed in areas where the jawbone has been lost to encourage new bone growth and regenerate the damaged area. 
• Guided Tissue or Bone Regeneration (GTR/GBR):A surgical approach that uses special membranes to encourage the regrowth of lost bone and tissue. 
• Laser Therapy (LANAP):Uses a specific wavelength of light to remove diseased gum tissue and sterilize the infected area, followed by sealing the gums back against the tooth root. 

Other Important Aspects of Treatment

• Specialist Referral:For more advanced cases, your dentist may refer you to a periodontist, a specialist in gum disease. 
• Supportive Follow-Up Care:Regular professional cleanings and check-ups are crucial for maintaining the results of treatment. 
• Lifestyle Changes:Quitting smoking or tobacco use can significantly improve the success of periodontitis treatment. 

Complications of Periodontitis

• Tooth Loss:The most common serious consequence as the disease progresses and destroys the supporting tissues around the teeth. 
• Gum Recession and Bone Loss:The gums pull away from the teeth, and the bone that anchors the teeth is destroyed. 
• Gum Abscesses:Painful collections of pus can form within the gums. 
• Increased Risk of Systemic Diseases:
  • Cardiovascular Disease: Bacteria from gum disease can enter the bloodstream, contributing to heart disease and stroke. 
  • Diabetes: Periodontitis can worsen blood sugar control and is linked to a higher risk of severe forms of diabetes. 
  • Adverse Pregnancy Outcomes: Gum disease is associated with preterm birth and low-birth-weight infants. 
  • Other Conditions: Linkages have also been observed with respiratory infections and Alzheimer’s disease. 

Prevention of Periodontitis

• Good Oral Hygiene:
  • Brush: your teeth for two minutes twice a day, ideally with a gum-healthy toothpaste. 
  • Floss: at least once a day to remove plaque and food particles from between teeth. 
• Professional Dental Care:
  • Attend regular dental check-ups and professional cleanings to remove plaque and tartar. 
• Healthy Lifestyle:
  • Quit smoking: and limit alcohol consumption. 
  • Maintain a balanced diet and manage other health conditions. 
• Be Aware of Risk Factors:
  • Dry mouth: (often a side effect of medications) can increase plaque buildup. 
  • Hormonal changes, such as those during pregnancy, can increase risk. 
  • Underlying conditions like diabetes, rheumatoid arthritis, and HIV can lower immunity and increase susceptibility to gum disease.