Periodontitis is a common condition with key signs and symptoms to watch out for. Research suggests possible causes, associated conditions and risk factors.Your dentist can diagnose the disease and recommend appropriate treatment to halt its progression.

When you think about dental health, the focus is likely to be on preventing cavities in your teeth. However, it's essential you pay attention to your gums, too, as they play a fundamental role not only in your dental health but your overall wellbeing as well. Your oral health can even affect your fertility!

Our bodies are full of bacteria (good and bad) and our mouths are no exception. If harmful bacteria are not cleaned from the teeth through flossing or brushing, plaque forms which, over time, can harden and become tartar. The longer plaque and tartar remain on teeth, the more harmful they become because they not only prevent you cleaning your teeth properly but they also harbor the very bacteria that commence the disease process.

Periodontal disease is the term for any disease affecting the structures holding the teeth in place, including gums, ligaments, and bone. In its earliest stage, called gingivitis, the gums become inflamed but as it progresses, soft and hard tissues securing the teeth are affected, which threaten tooth integrity. It is most commonly caused by poor dental hygiene habits that allow bacteria to remain and plaque to build up and form tartar.

Tooth decay is reported to be the most common long-term condition in the US — an estimated 92 percent of American adults and seniors report having had tooth decay, while 59 percent of teens and 42 percent of children aged 11 and under suffer from it. Gum disease is also surprisingly common: it ranges from milder forms such as gingivitis (found in up to 75 percent of American adults), to more severe forms such as periodontitis (around five to 15 percent). Severe periodontitis, such as would lead to tooth loss, is thought to be present in five to 20 percent of most adult populations worldwide.

Reports suggest the following facts about periodontitis:

  • Nearly half of adults aged 30 years plus have periodontal disease in some form.
  • Periodontal disease becomes more likely with age; approximately seven out of 10 adults 65 years and older have the condition.
  • It is more common in men than women, those living in poverty, those with less than high school education, and current heavy smokers.

Common signs and symptoms of periodontitis

Gums that bleed are not to be accepted as a normal part of life, as they are generally indicative of poor gum health or wider systemic issues.

You may notice blood in your saliva when you are brushing your teeth and this may be indicative of gingivitis, which is the mildest form of gum disease reversible with appropriate action. Unfortunately, it may also be a sign of a more chronic issue known as periodontitis, which ultimately can lead to loss of teeth and impact significantly on health and well-being.

Initially, the bacteria cause an inflammation of the gums that is called gingivitis. In gingivitis, the gums become red, swollen and may be prone to bleeding. For many people with gingivitis, this inflammation is not painful but if it is not treated, it can advance to periodontitis (which means “inflammation around the tooth”).

Periodontitis is a condition in which the surrounding structures holding the teeth in place are weakened severely. In periodontitis, gums recede causing spaces (called “pockets”) that become infected. The bacteria on the teeth then release substances that harm your gums and lead to infection and inflammation which become more entrenched and the damage more extensive.

Periodontitis builds up over time owing to poor oral hygiene. In the early stages, the only symptoms may be red, swollen, tender or bleeding gums or discomfort or pain when chewing, but in its advanced form the disease threatens the integrity of the tooth structures and can cause teeth to fall out or need extraction. The disease can affect both soft and hard tissues that hold the teeth in place so gums, ligaments, and bone are all under threat. People may even lose sensation in these areas after bacteria have built up in pockets between the gum and teeth.

The following signs and symptoms can be suggestive of the presence of gum disease:

Periodontosis: Causes and risk factors

The main causes of gum disease are bacteria, plaque, and tartar. However, there are other risk factors that influence the health of your gums and teeth. The association between poor oral health and poor general health is strong so it is perhaps not surprising that there appears to be an increased incidence of serious health conditions in those with periodontitis.

While children are at low risk of periodontitis, years of entrenched gum disease lays the foundations for periodontitis to present as they approach adulthood; therefore the early years are the time to establish good oral hygiene habits that will last for life. Typically periodontitis presents as people reach their thirties and forties and risk for periodontal disease increases to as much as 70 percent of the population over 65.

Risk factors and health conditions associated with periodontitis

There are several risk factors for gum disease, but smoking is considered the most significant risk factor for periodontitis, and the one that has the biggest impact upon subsequent treatment outcomes. Hormonal changes in females, medications and genetic susceptibility are all risk factors as are systemic inflammatory conditions and use of medications.

Research suggests that treating gum disease can have a positive impact upon the progression of diseases as well as possibly being implicated in their development.

Periodontitis appears to be strongly associated with a number of conditions:

  • Pulmonary and respiratory disease
  • Diabetes
  • Heart disease
  • Osteoporosis
  • Hematological disorders
  • Rheumatoid arthritis
  • AIDS
  • Cancer
  • Osteoporosis
  • Pregnancy and menopause
  • Obesity
  • Vascular disease (stroke)
  • Hypertension

And the increased risk is associated with the following factors:

  • Smoking
  • Age
  • Sex
  • Socio-economic status
  • Education and ethnicity
  • Poor nutrition
  • Bruxism/teeth clenching or grinding
  • Stress
  • Use of certain medications
  • Hormonal changes

How is gingivitis or periodontitis diagnosed?

The process will begin with your dentists asking the following key questions:

  • Do your gums bleed when you brush them or during the night?
  • Do you have any loose teeth?
  • Do you have any difficulties with chewing?
  • Do you have an unpleasant taste in your mouth or a bad odor/breath?
  • Do you suffer from pain, swelling, boils or blisters in your mouth?
  • Do you smoke?

On the basis of your answers, your dentist will use the following methods to accurately diagnose the presence and severity of disease:

  1. Examination: In dental examinations, teeth and gums are examined for any signs that indicate a gum disease and your dentist may inquire about medical history to identify conditions or risk factors that may increase your risk.
  2. Measuring the depth of periodontal pockets: Periodontal pocket measurement is generally a painless investigation (unless the disease is severe) where a metal probe is inserted below the gum line to measure the depth of the space between the gum and tooth, which enlarge as plaque builds up and acid eats into the teeth and gums. Pockets of 1-3mm are considered optimal and anything over that as indicative of disease.
  3. X-rays: X-rays are used to identify deterioration of surrounding structures such as bone and again will clarify the severity of the disease.

Classification of gum disease 

Dentists classify disease using the following four categories.

Gingivitis

This is the mildest stage of the disease, indicative of inflamed gum tissues. Those with diabetes, pregnant women, and steroid users are at increased risk of developing gingivitis; if untreated the risk of serious periodontal problems in the future is increased.

Chronic Periodontal Disease

The next stage is known as chronic periodontal disease. This is where gingivitis has progressed leading to steady deterioration of the gum and bone tissues. This is generally age-related (over 40), hence why receding gums (and thus teeth appearing longer) typify chronic periodontal disease.

Aggressive periodontal disease

Aggressive periodontal disease is the next stage in severity which involves a considerable increase in symptoms: loss of bone and tissue attachment is rapid; and this form of gum disease is often associated with diabetics and smokers.

Necrotizing periodontal disease

Finally, those suffering from pre-existing conditions such as chronic stress, HIV, immunosuppression, and malnutrition are most at risk of developing the necrotizing periodontal disease which involves tissue death and rapid destruction of the structures surrounding the teeth.

The severity of the disease is dependent upon both modifiable and non-modifiable factors — factors you can influence, such as lifestyle, and your oral hygiene, and those you cannot or you can to a much lesser extent, such as genetic predisposition, medications for other conditions, and pre-existing health conditions. 

What are the treatment options for periodontitis?

The best way to prevent gingivitis and periodontitis is to remove the bacterial plaque from your teeth by brushing. Brush your teeth for two minutes at least twice a day (morning and night), alongside daily flossing. Flossing is recommended before brushing teeth as loosened food particles and bacteria can then be brushed away. This should be reinforced by regular dental check-ups and hygienist cleaning, usually every six to 12 months.

Management of gum disease is primarily achieved by removing the causative factors (dental plaque, bacteria, and tartar) by means of scaling and root planing alongside education to enable people to maintain good oral hygiene independently at home.

Where professional treatment is required, it may consist of the following approaches.

Non-surgical treatments

If periodontitis isn't severe, treatment may involve less aggressive procedures, including:

Surgical treatments

If you have advanced periodontitis, treatment may consist of surgical approaches, such as:

Complimentary approaches and lifestyle options

Nutrition

Poor nutrition is associated with a range of issues and awareness of the impact of the food that you eat on levels of inflammation in the body is increasing. It is now acknowledged that chronic inflammation is associated with a range of diseases such as heart disease, depression and diabetes, and even periodontitis.

For example, research indicates that a diet with an excess of refined carbohydrates can increase inflammation of the gums and periodontal tissue. Of course, it depends on the type of carbohydrate but high glycemic index foods, such as refined carbohydrates can cause spikes in blood sugar which stimulates the release of inflammatory-inducing markers in the body. Furthermore, sugar has long been recognized as the main contributory factor in the development of tooth decay.

The type of food we eat dictates our intake of vitamins, minerals, and antioxidants, which are necessary for good health and optimum functioning. This includes the periodontal system as good nutrition is essential in order to maintain the health of oral and periodontal tissues. For example, specific vitamin deficiencies such as C and D can lead to the oral indicators of diseases such as scurvy and rickets; two diseases believed to be a rarity in the 'first world' but which are sadly staging a comeback.

Conversely, certain groups may also be prone to nutritional deficiencies by virtue of periodontal issues (older people or those with dentures, for example) or the condition itself (pregnancy) so nutritional awareness and advice can be very helpful for the prevention and management of periodontal diseases.

Licorice root and other natural extracts

There is a growing body of research to suggest that there are various natural substances that contain a wide range of antimicrobial, antioxidant, and anti-inflammatory properties. Natural phytochemicals and antioxidants present in some herbal medicines may arrest alveolar bone loss (a feature of periodontitis) and reduce the increased oxidative stress caused by periodontitis. One such example is licorice root extract which research suggests can reduce the presence of specific bacteria and reduce inflammation involved in the disease, and even prevent the bone loss that might ultimately occur.

Ultimately how you respond to gum disease is your decision but it can be prevented and treatment is usually successful; arresting and treating this process will result in you having your own teeth for life, greater confidence and self-esteem and ultimately the better quality of life.

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