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What is Periodontitis?

Periodontitis (periodontal disease, known years and years ago as Pyorrhea or trench mouth) is a severe form of gingivitis in which the inflammation of the gums extends to the supporting structures of the tooth.

Periodontitis is one of the main causes of tooth loss in adults and the main cause in older people. Infection erodes the jawbone, which holds the teeth in place. The erosion weakens the attachments and loosens the teeth. An affected tooth may eventually fall out or have to be extracted.

Causes

Most periodontitis results from a long-term accumulation of plaque (a film-like substance composed of a mixture of bacteria, saliva, and dead cells that is continually being deposited on teeth, day and night) and tartar (hardened plaque) between the teeth and the gums.

Pockets form between the teeth and gums, and extend downward between the root of the tooth and the underlying bone. These pockets collect plaque in an oxygen-free environment, which promotes the growth of aggressive forms of bacteria. If the disease continues, so much jawbone near the pocket is eventually destroyed that the tooth loosens and could fall out.

The rate at which periodontitis develops differs considerably, even among people with similar amounts of tartar. That is because plaque contains different types and numbers of bacteria and people have different responses to the bacteria. Periodontitis may produce bursts of destructive activity that lasts for months followed by periods when the disease apparently causes no further damage.

Recent developments have suggested that periodontal disease and the specific bacteria that causes it may possibly be related to heart disease and other general health problems.

Many diseases and disorders — including diabetes mellitus, Down syndrome, Crohn’s disease, leukopenia, and AIDS — can predispose a person to periodontitis. In people with AIDS, periodontitis progresses quickly.

Symptoms

The early symptoms of periodontitis are bleeding, red gums, and bad breath (halitosis). Dentists measure the depth of the pockets in the gums with a thin probe, and X-rays show how much bone has been lost.

As more and more bone is lost, the teeth loosen and shift position. Frequently, the front teeth tilt outward. Periodontitis usually does not cause pain until the teeth loosen enough to move during chewing or until an abscess (a collection of pus) forms.

Treatment

Treatment for periodontitis is usually divided into two phases. First and foremost home care, brushing, and flossing, along with any other prescribed home care products must be done flawlessly in order to give the periodontium a chance to heal. Another part of the first phase of treatment involves the hygienist performing a periodontal scaling and root planing, which can be done in several appointments with anesthesia if required.

Six weeks after this first phase of treatment is completed, Dr. Jude and/or a hygienist will re-evaluate the health of the gums to determine if further treatment is required. If further treatment is required, many dentists will refer patients to a specialist called a periodontist: a dentist who has completed a two- or three-year specialty training program that addresses the treatment of gum and bone disease.

Unlike gingivitis, which usually disappears with good self-care, periodontitis requires repeat and ongoing professional care. A person who uses good oral hygiene can clean only two to three millimeters (1/12 inch) below the gum line. A dentist can clean pockets up to four to six millimeters deep (1/5 inch), using scaling and root planing, which thoroughly remove tartar and the diseased root surface.

For pockets of 5 millimeters (1/4 inch) or more, surgery is often required. A dentist or periodontist may access the tooth below the gum line surgically (periodontal flap surgery) to clean the teeth thoroughly and correct bone defects caused by the infection.

A dentist or periodontist may also remove part of the infected and separated gum (a gingivectomy) so the rest of the gum can reattach tightly to the teeth and the patient can remove the plaque at home.

Dr. Jude may prescribe antibiotics, especially if an abscess has developed. Dentists may also insert antibiotic-impregnated materials (filaments or gels) into deep gum pockets, so that high concentrations of the drug can reach the diseased area. Periodontal abscesses cause a burst of bone destruction, but immediate treatment with surgery and antibiotics may allow much of the damaged bone to grow back.

The most important things to remember is:

  1. Your home care (brushing, waterpik use, flossing, and others as discussed) must be superb.
  2. You must be diligent in keeping your hygiene appointments with us.
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