GUM (PERIODONTAL) DISEASES & THEIR TREATMENT
What is meant by the term periodontal disease?
Causes of periodontal diseases
Types of periodontal disease
Treatment of periodontal disease
Periodontal (gums) diseases
Periodontal (gum) diseases, including gingivitis and
periodontitis, are serious infections that, left untreated, can
lead to tooth loss. The word periodontal literally means
"around the tooth." Periodontal disease is a chronic bacterial
infection that affects the gums and bone supporting the teeth.
Periodontal disease can affect one tooth or many teeth. It
begins when the bacteria in plaque (the sticky, colorless film
that constantly forms on your teeth) causes the gums to become
the mildest form of the disease, gingivitis, the gums redden,
swell and bleed easily. There is usually little or no
discomfort. Gingivitis is often caused by inadequate oral
hygiene. Gingivitis is reversible with professional treatment
and good oral home care.
Untreated gingivitis can advance to periodontitis. With time,
plaque can spread and grow below the gum line. Toxins produced
by the bacteria in plaque irritate the gums. The toxins
stimulate a chronic inflammatory response in which the body in
essence turns on itself, and the tissues and bone that support
the teeth are broken down and destroyed. Gums separate from the
teeth, forming pockets (spaces between the teeth and gums) that
become infected. As the disease progresses, the pockets deepen
and more gum tissue and bone are destroyed. Often, this
destructive process has very mild symptoms. Eventually, teeth
can become loose and may have to be removed.
Causes of Periodontal Disease
main cause of periodontal disease is bacterial plaque, a sticky,
colorless film that constantly forms on your teeth. However,
factors like the following also affect the health of your gums.
Smoking/Tobacco Use -
tobacco use is linked with many serious illnesses such as
cancer, lung disease and heart disease, as well as numerous
other health problems. Tobacco users also are at increased risk
for periodontal disease. Recent studies have shown that tobacco
use may be one of the most significant risk factors in the
development and progression of periodontal disease.
Research proves that up to 30% of the population
may be genetically susceptible to gum disease. Despite
aggressive oral care habits, these people may be six times more
likely to develop periodontal disease. Identifying these people
with a genetic test before they even show signs of the disease
and getting them into early interceptive treatment may help them
keep their teeth for a lifetime.
Hormonal changes in women –
Pregnancy, Puberty, Menopause, Mensturation etc. - During these
phases, women’s bodies experience hormonal changes which can
affect many of the tissues in the body, including gums. Gums can
become sensitive, and at times react strongly to the hormonal
fluctuations. This makes gums more susceptible to diseases.
Additionally, recent studies suggest that pregnant women with
gum disease are seven times more likely to deliver preterm, low
birth weight babies.
is linked to many serious conditions such as hypertension,
cancer, and numerous other health problems. Stress also is a
risk factor for periodontal disease. Research demonstrates that
stress can make it more difficult for the body to fight off
infection, including periodontal diseases.
drugs, such as oral contraceptives, anti-depressants, and
certain heart medicines, can affect the oral health.
Clenching & grinding of teeth (Bruxism) -
put excess force on the supporting tissues of the teeth and
could speed up the rate at which these periodontal tissues are
is a disease that causes altered levels of sugar
in the blood. Diabetes develops from either a deficiency in
insulin production (a hormone that is the key component in the
body's ability to use blood sugars) or the body's inability to
use insulin correctly. Diabetic patients are at higher risk for
developing infections, including periodontal diseases. These
infections can impair the ability to process and/or utilize
insulin, which may cause the diabetic status to be more
difficult to control and the infection to be more severe than a
High LDL cholesterol levels
– apart from causing coronary artery disease, high cholesterol
levels have also been proven to cause periodontal disease.
Other systemic diseases -
Diseases that interfere with the body's
immune system (eg. HIV infection, Hepatitis B infection etc.)
may worsen the condition of the gums.
Poor nutrition -
a diet low in important nutrients can compromise
the body's immune system and make it harder for the body to
fight off infection. Because periodontal disease is a serious
infection, poor nutrition can worsen the condition of the gums.
Types of Periodontal Disease
There are many forms of periodontal disease. The most common
ones include the following.
a) Gingivitis -
Gingivitis is the mildest form of periodontal disease. It causes
the gums to become red, swollen, and bleed easily. There is
usually little or no discomfort at this stage. Gingivitis is
reversible with professional treatment and good at home oral
b) Aggressive Periodontitis -
form of periodontitis that occurs in patients who are otherwise
clinically healthy. Common features include rapid attachment
loss and bone destruction and familial aggregation.
c) Chronic Periodontitis -
form of periodontal disease resulting in inflammation within the
supporting tissues of the teeth, progressive attachment and bone
loss and is characterized by pocket formation and/or recession
of the gingiva. It is recognized as the most frequently
occurring form of periodontitis. It is prevalent in adults, but
can occur at any age. Progression of attachment loss usually
occurs slowly, but periods of rapid progression can occur.
d) Periodontitis as a Manifestation of Systemic Diseases -
Periodontititis, often with onset at a young age, associated with
one of several systemic diseases, such as diabetes.
e) Necrotizing Periodontal Diseases -
infection characterized by necrosis of gingival tissues,
periodontal ligament and alveolar bone. These lesions are most
commonly observed in individuals with systemic conditions
including, but not limited to, HIV infection, malnutrition and
Treatment of Periodontal Disease
some of the procedures that are employed to treat patients
diagnosed with a periodontal (gum) disease. The treatment is
aimed at eliminating / controlling the main cause of periodontal
disease - the bacteria in the form of a sticky, colorless
plaque that constantly forms on the teeth. However, treatment
can be complete only when all factors causing / promoting
periodontal (gum) diseases are brought under control
A) Non-Surgical Treatments
Scaling and root
planing are the non-surgical treatment methods adopted to
control periodontal disease. Scaling is the procedure
that meticulously removes plaque and tartar (the adherent,
sticky substance on teeth containing toxins and
micro-organisms). This is done in order to obtain a healing
response. Root planing is a careful cleaning of the root
surfaces to remove plaque and calculus [tartar] from deep
periodontal pockets and to smooth the tooth root to remove
bacterial toxins. These procedures are followed by adjunctive
therapy such as local delivery antimicrobials. Many patients do
not require any further active treatment, including surgical
therapy. However, the majority of patients will require ongoing
maintenance therapy to sustain health. Non-surgical therapy does
have its limitations, however, and when it does not achieve
periodontal health, surgery may be indicated to restore
periodontal anatomy damaged by periodontal diseases and to
facilitate oral hygiene practices.
surgery turns necessary when the tissue around the teeth is
unhealthy and cannot be repaired with non-surgical treatment.
Following are the four types of surgical treatments most
– Periodontal pockets are formed when gums recede from the
tooth surface as a result of gum disease, forming clefts
between the tooth and the gums. These clefts or pockets
facilitate accumulation of food debris and plaque. Reduction /
elimination of these pockets by surgical means is essential to
maintain periodontal health.
- Eliminating existing bacteria and regenerating bone and
tissue helps to reduce pocket depth and repair damage caused
by the progression of periodontal disease. Membranes
(filters), bone grafts or tissue- stimulating proteins are
used to encourage the body's natural ability to regenerate
bone and tissue in these procedures. GTR (Guided Tissue
Generation) methods come under this category of procedures.
Substitute Grafting to fill bone defects
seen around the diseased tooth after pulpo-periodontal therapy
excess gum and
bone tissue is reshaped to expose more of the natural tooth.
This can be done to one tooth, to the entire gum line, or to
several teeth to expose a natural, broad smile.
- Soft tissue
grafts can be used to cover roots or develop gum tissue where
absent due to excessive gingival recession. During this
procedure, gum tissue from the palate or another donor source
is taken to cover the exposed root. This can be done for one
tooth or several teeth to even to the gum line. This procedure
also helps in reducing dental sensitivity to a large extent.
– when one or more teeth are lost, an
indention may develop in the gums and jawbone where the tooth
used to be. This happens because the jawbone recedes when it no
longer is holding a tooth in place. Not only is this indentation
unnatural looking, it also causes the replacement tooth to look
too long compared to the adjacent teeth. This “defect” can be
filled by a procedure called ridge augmentation, recapturing the
natural contour of the gums and jaw. A new tooth can then be
created that is natural looking, easy-to-clean and beautiful.
AUGMENTATION DONE TO ELIMINATE INDENTATION
C) The Use of Lasers in
research suggests that the use of lasers as an adjunct to
scaling and root planing (SRP) may improve the effectiveness
of this procedure. In addition, when the lasers are used
properly during periodontal therapy there can be less
bleeding, swelling and discomfort to the patient during
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