Gum Disease What is Periodontal Disease?

Stages of Periodontal Disease

The word "periodontal" means "around the tooth."  Periodontal Disease (also known as "gum disease", "pyorrhea" or "periodontal infection") is a chronic bacterial infection in the gums and bone around your teeth. This infection causes the gums to be inflamed, swollen and tender.  Bleeding when brushing, flossing or eating is common. If it isn't treated, the inflammation can destroy the bone that anchors the teeth resulting in tooth looseness and eventual tooth loss.  Periodontal infection is the cause of 75% of all adult tooth loss.

More importantly, scientific research has confirmed an association with periodontal infection to several serious medical conditions including heart disease, diabetes and stroke. It is the inflammation present in the gums that triggers a threatening chain reaction in the bloodstream that can contribute negatively to these other conditions. As ongoing research continues to define how periodontal disease is connected with these and other health problems, it is clear that good oral health is essential. Achieving and maintaining good periodontal health is a key component to achieving overall wellness and whole body health.

How Does An "Ongoing Infection" Work?

When you were a child, did you ever get a bad scrape that became red and swollen? That was caused by bacteria that got under your skin. The area became infected and inflamed. It may have lasted for days or weeks, but eventually the inflammation went away. The inflammation disappeared when your immune system conquered the bacteria and the infection healed.

With a chronic infection, the immune system never wins the battle; the infection is always present and the inflammation never subsides. Periodontal disease is a chronic infection in the pockets around your teeth caused by tartar build-up on the root surfaces under the gums that is covered with bacterial film and toxins. Tooth brushing and flossing does not remove these accumulations. When there is build-up under the gums, the immune reaction is always present and leads to further bone damage and loss of supporting structures.

What Can Cause a "Burst" of Infection Activity?

People with periodontal disease can have low resistance to periodontal bacteria. This causes an ongoing gum infection that grows in "bursts" of activity. Each time it grows, more support for your teeth is lost. Some factors that can cause a "burst" of activity and can contribute to escalations are:

• Poor oral hygiene
• Dental plaque
• Tartar accumulation
• Smoking
• Dry mouth
• Genetic factors
• Stress or tension
• Clenching or grinding
• Poor diet or nutrition
• Age
• Illness

Getting Periodontal Infection Treated Right Away

If you experience any of the signs or symptoms of periodontal disease of if you haven't had a professional cleaning or check-up for some time, it is important that you receive a comprehensive periodontal evaluation. In just a few minutes, Dr. Indech can determine whether gum disease is present, the severity of the gum disease and the treatment that is necessary to overcome the condition in order to establish optimal oral health. Delays in diagnosing and treating can only lead to more breakdown requiring more involved treatment.

Symptoms of Periodontal Infection

Periodontal infection is usually painless until it reaches an advanced stage. However, there are some symptoms that indicate the presence of periodontal infection.
These include:

• Red or swollen gums
• Bleeding when brushing (pink toothbrush), or at other times
• Aching, itchy, sore or tender gums
• Receding gums (teeth beginning to look longer)
• Pus between your teeth and gums when you press down on the gums
• Bad breath
• Any change in the way your teeth fit together when you bite
• Any change in the fit of partial dentures
• Loose, separating or protruding teeth
• Spaces between teeth

If you notice any of the above warning signs of periodontal infection, please seek a periodontal examination.

Inflammation and Periodontal Disease

It is becoming increasingly clear in the medical scientific community that chronic inflammation is the root cause of many serious illnesses including heart disease, stroke, many cancers, intestinal conditions and brain deterioration (Alzheimers and senility). We know that inflammation on the surface of the body or in the gums produces local redness, heat, swelling and pain. The immune system is the cornerstone of the body's healing response, bringing specific "fighter cells" and increased cellular activity to a site of injury or infection. However, when inflammation persists or serves no purpose, the toxic byproducts and fighter cells can migrate from the inflamed site and circulate in the blood to other parts of the body damaging tissue, vessels, organs and promoting disease and illness. Stress, lack of exercise, genetic predisposition, and exposure to toxins (tobacco smoke, alcohol, other chemicals) can all contribute to chronic inflammation. Poor dietary choices can also play a role as well. Avoiding or minimizing all sources of inflammation is the best strategy for reducing the risk for many diseases. 

Stages of Periodontal Disease

On the basis of its severity, area involved and associated complications, gum disease can be divided into the following stages or types:

First Stage - Gingivitis

Clinically known as gingivitis (gingival = gums, itis = inflammation), the first stage of gum disease simply refers to the inflammation of your gums. In the early or first stage of gum disease, bacteria-laden plaque builds up gradually, eventually irritating the gums. It has been suggested that this irritation is caused due to the toxins released by the accumulated bacteria. As a result, gum becomes inflamed, may swell, redden and bleed quickly and easily while brushing the teeth.

characteristics of the first stage of gum disease - gingivitis

• pocket depth of 2-3mm with bleeding on gentle probing
• calculus along your sensitive gum line is changed into a rough surface on which plaque accumulates
• tender, red, inflamed and bleeding gums
• bad breath may be present
• spaces between the gum and tooth (periodontal pockets) may exist due to slight detachment of the periodontal fibers that hold the gums tightly against the teeth
• no underlying bone is involved or damaged
• this is relatively a mild form of gum disease and is easily reversible if treated early and properly

Second Stage - Early To Moderate Periodontitis

If the first stage is left untreated, it will progress to the second stage. Plaque turns into hard tartar which cannot be removed by brushing alone. This stage of gum disease requires more aggressive treatment to control.

characteristics of the second stage of gum disease - early to moderate periodontitis

• probing depth of 4-6mm with bleeding on gentle probing
• unlike the first stage, plaque and calculus (tartar) is not found “along” but “below” the gum line
• bad breath can be present
• tender, red, sore and bleeding gums may also be present
• periodontal pockets are formed as the dental tissues (gums and supportive ligaments) begin to pull away from the teeth
• these pockets act as a trap for infection
• bone starts to show damage, often leading to loose permanent teeth
• while relatively hard to treat, this stage can be reversed if addressed early and properly

Third Stage - Advanced Periodontitis

Also known as severe periodontitis, this stage represents the irreversible and complicated form of gum disease which is characterized by bone involvement, bone loss, tooth looseness, migration, discomfort and tooth loss.

characteristics of the third stage of gum disease - advanced periodontitis 

• probing depth of 7-12mm with bleeding on gentle probing
• pockets deepen and create more space for increased bacterial activity which leads to more bone and attachment fiber loss
• the deeper pockets may fill with pus
• this pus exists between the teeth and gums and is more visible when the gums are pressed together
• there may be swelling around the root which leads to even greater bone loss
• the bite can be affected
• teeth may lose so much support that either they fall out or need to be removed
• this third and the final stage of gum disease is irreversible

Stages of Periodontal Disease - In Summary
Periodontal disease is a common and serious dental disorder that needs to be addressed early and treated properly. Depending on the severity and rate of progression, this disease can be divided into the early (first stage), moderate (second stage) and advanced (third stage) forms. The damage caused by periodontal disease is for the most part irreversible and if left to progress, will result in tooth loss. The earlier the disease is diagnosed and treated, the simper and easier it is to manage, overcome, control and prevent from reoccurring. The signs and symptoms can be quite subtle and the condition is not associated with pain or discomfort in most cases until it has progress to the more advanced stages. Even if you don’t notice any signs or clinical manifestations, you may still have some “silent or underlying” gum disease. Additionally, there are other conditions affecting the mouth, gums and teeth that can go unnoticed including gum recession, tooth decay, developing root canal conditions and oral pathology to name a few. Regular dental and oral examination by your hygienist, dentist or periodontist along with the appropriate dental x-rays is the key for diagnosing dental and periodontal conditions early so that they can be dealt with in a simple manner. 

Who is a Periodontist?

A periodontist is a dentist with advanced training specializing in the prevention, diagnosis and treatment of periodontal disease, dental disease and oral pathology. Many periodontists have also received advanced training in the placement of dental implants and are experienced with many oral surgery procedures including extraction of teeth, wisdom teeth, bone grafting, biopsy and management of skin conditions affecting the mouth. Periodontists receive extensive training in these areas, including three additional years of education beyond dental school. Periodontics is one of the eight specialties recognized by the American Dental Association.