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Causes and disease development

Answering questions about periodontal Disease

The most common affection of the periodontum is Periodontal Disease

Periodontal Disease

Periodontal disease is a chronicle bacterial infection which destroys the gum and supporting bone that hold teeth; these bacteria can affect one tooth or many teeth.

Gingivitis is the earliest and mildest form of gum disease. It is caused by bacteria beneath the gums, which in turn get there because of an inadequate oral hygiene. Gingivitis can be reversed by getting rid of the bacteria, which is often achieved by simply improving oral hygiene. The symptoms include swollen, reddish and bleeding gums. Bad breath, or halitosis, is common too. At this stage, damage is limited to the gum tissue.

It is important to notice that periodontal disease is considered a “silent” disease. This means that in most cases the patient is unaware of having this problem because there is no pain or discomfort, especially in early stages.

The detection of this disease is made by the general dentist or by a periodontist, after measuring the space between the gum and teeth (periodontal probing) and making a radiographic evaluation to see if there is any bone loss, and how bad it is.

Causes and disease development

Periodontal disease is caused by specific bacteria. Some bacteria are normally present in the mouth. If they stay adhered onto teeth, they form a “dental plaque” in less than 24 hours; this plaque is a sticky, colorless, well organized bio-film which causes an inflammatory response if it remains there for several days; this plaque is mineralized in just a few more days and it becomes tartar or calculus which has a rough surface which in turn provokes further accumulation of bacteria and their products and also makes it even more difficult to remove these bacteria.

The presence of bacteria and their products (toxins) next to the gum tissue causes it to swell (edema), to become dark red, and to bleed. The next step is the loss of the seal between the gum and the teeth, provoking the formation of periodontal pockets (a space between gums and teeth colonized by bacteria). All this is associated with loss of the alveolar bone (bone surrounding the teeth) and dental mobility. The severity of periodontitis depends on the pocket depth, bone loss and dental mobility levels.
There are different risk factors involved in developing periodontitis, some of which can be reduced significantly by making changes in your lifestyle choices.

Considering Risk Factors

Inadequate oral hygiene is the most important risk factor for gum disease. Bacteria and calculus have a direct relation with periodontal disease
Smoking. A common habit that greatly increases your odds of developing gum disease is tobacco use. According to the American Academy of Periodontology, "...17.6 percent of current or former cigar or pipe smokers had moderate to severe periodontitis--nearly three times the rate of non-smokers. In addition, they averaged four missing teeth." The American Dental Association states that smokers are four times more likely to develop gum disease than non-smokers. Smoking increases the development of calculus, a hardened bacterial plaque that has to be removed by a professional cleaning procedure (performed by a hygienist, general dentist or periodontist). Smoking also causes loss of attachment between the teeth and gum, which increases bacterial growth below the gums.
Hormonal changes, during pregnancy, puberty and menopause can cause the gums to become red, tender and bleed easily
Inheritance. A family story of periodontal disease indicates a greater likelihood of developing this problem, you cannot change this, but the good news is that you can prevent periodontal disease anyway, by reducing other risk factors.
Stress and poor nutrition make it more difficult for the body to fight off infections
Medications. Some contraceptives, antidepressants and certain heart medications can affect oral health
Systemic diseases that interfere with the body’s immune system may increase the risk of having periodontal disease or may worsen the condition when it is present.

Related Systemic diseases

Diabetes. There is enough information which proves that people with diabetes are more likely to have periodontal disease than people without it. A study in the Journal of Periodontology found that “poorly controlled type 2 diabetic patients are more likely to develop periodontal disease than well-controlled diabetics are."
Patients with Rheumatoid Arthritis (RA) have a higher incidence of periodontal disease compared to healthy controls. Rheumatoid Arthritis is an autoimmune disease.
There is also some new evidence of greater prevalence and severity of periodontal disease among patients with renal disease.

Periodontitis responsible for systemic diseases
On the other hand Periodontitis can be responsible for some systemic diseases,

Now we have evidence that suggests that people with periodontal disease have twice the risk of suffering a heart attack. Blood clots related to the inflammation process or by bacteria normally present in periodontal infection could be responsible for increasing the risk of heart attack.
It is suspected that periodontal infection may complicate the severity of diabetes and the degree of metabolic control, resulting in a 2-way relationship between diabetes mellitus and periodontal disease/infection. This proposed dual pathway of tissue destruction suggests that control of chronic periodontal infection is essential for achieving long-term control of diabetes mellitus.
New research confirms findings that periodontal disease may increase a person's risk for the respiratory disorder Chronic Obstructive Pulmonary Disease (COPD)

Answering questions about periodontal Disease

Is it common?

Gingivitis is very common; the average of this problem varies depending on geographic region and types of population. In general we can say that the prevalence (percentage of cases in a moment) can reflect more than 80% in children and 40% in adults. Regarding Periodontitis is hard to say because it depends on many factors, but there are several studies that reflect that Periodontitis can be present in more than 50% in adults more than 40 years old; advanced severe-destructive periodontitis is present in about 1 to 4% of the population.

Is it contagious?

No. Neither chronic gingivitis nor periodontitis are contagious. Although there are reports of bacterial transmission from one person to another, other factors would be necessary to produce gingivitis. No hygiene and presence of bacteria for several days is the main requirement to produce gingivitis and patient’s susceptibility is necessary for the onset of periodontitis.

Is it reversible?

We can say that Gingivitis is reversible. A good oral hygiene technique that eliminates the presence of bacterial plaque will produce immediate improvement of the inflamed gums; it will change to normal features (pink, firm and no bleeding) in just a few days. Three times a day (or at least twice) of brushing and flossing is enough to have successful results. Professional cleaning is very important because that is the only way to remove calculus and get a smooth surface by means of scaling and dental polishing. This smooth dental surface is easy to clean and promotes gum health.

lPeriodontitis can be cured, but it is not reversible. Although there are many successful regenerative procedures, you cannot have again the same conditions that exist in health.

How is the treatment?

The treatment consists of three stages: the first is the same treatment as for gingivitis, the second stage consists in corrective procedures in order to eliminate periodontal pockets and obtain new attachment between gum and teeth; there are also several kinds of regenerative procedures (bone grafts) that can be done in order to regenerate some of the bone that has been lost. The third stage includes some monitoring appointments in order to maintain periodontal health, very commonly dental hypersensitivity can be present and is treated on this stage. We consider a patient healthy when he has no gum inflammation, when he has no discomfort and when we find a space with a depth less than 3 mm between gum and teeth.

How long is the treatment?

It takes two to four weeks to control gingivitis completely. The treatment of periodontitis takes between two to four months depending on the case severity.

Which are the consequences of not treating periodontal disease?

Gingivitis is just the beginning of periodontal disease, we can say that it is just the mildest form of this problem; many people that do not treat gingivitis are going to progress into having periodontitis. The consequences of not treating periodontitis are bone loss, dental mobility and eventually tooth loss.

At what age could periodontal disease be already present?

Gingivitis can start at a very early age, with temporary dentition from six to seven years of age, but is more common to observe it in puberty and adolescence. It is just necessary to have dental plaque constantly for several days. Gingivitis could be present all lifelong. Periodontitis normally appears in people between 30 to 40 years old.

Is there any relation between periodontal disease and socioeconomic level?

There are several studies that show that the poorest populations have more Gingivitis and Periodontitis, and this fact is definitively related to levels of dental care education. The more information that children, adolescents and adults have, the less common periodontal disease is. More education makes this problem easier to prevent.

What kind of specialist treats periodontal disease?

Any dentist has to be prepared to diagnose, treat and prevent gingivitis.
Periodontists treat periodontitis; they diagnose the kind of periodontal disease for each case, and apply the correct treatment.

How can I prevent periodontal disease?

You need to brush at least twice a day, but preferably more often, including after each meal, using an adequate technique recommended by the hygienist, dentist or periodontist. Flossing daily is a good way to get rid of bacteria along and just beneath the gum line, as well as between teeth. Professional cleanings are very important and it is strongly recommended to do these cleanings twice a year because they are very effective for reducing plaque and detecting gum disease early. They consist in tartar scaling and polishing of the teeth creating smooth surfaces that are easier to clean.