What Is Periodontal Disease?

Periodontal (gum) disease, such as gingivitis and periodontitis, are usually painless but serious infections that if 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 inflamed.

Some of the signs of periodontal disease include:
- Bleeding gums during brushing
- Red, swollen or tender gums
- Gums that have pulled away from the teeth
- Persistent bad breath
- Pus between the teeth and gums
- Loose or separating teeth
- A change in the way your teeth fit together when you bite
- A change in the fit of partial dentures

Although plaque is the primary cause of periodontal diseases, other factors such as smoking and tobacco use, pregnancy and puberty, stress, medications, clenching or grinding your teeth, and diabetes and other systemic diseases can play significant and contributing roles in the development, extent and/or severity of the disease. There can be many forms of periodontal disease with the most common forms described below.

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 often caused by inadequate oral hygiene (brushing and flossing). Gingivitis is reversible with professional treatment and good oral home care.

PERIODONTITIS
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, but eventually, teeth can progress from mild to moderate to severe periodontal disease in which so much bone has been destroyed that the teeth need to be removed. Periodontitis is not a "curable" disease but it can be treated and stopped from progressing.

Studies have also shown that a link exists between periodontal disease and such conditions as diabetes, heart disease, and pre-term birth and low birth-weight babies. For more information on these subjects please ask one of the doctors.

There are several forms or ways of classifying periodontal disease. The most common ones include the following.

Chronic Periodontitis results in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss. This is the most frequently occurring form of periodontitis and is characterized by pocket formation and/or recession of the gingiva. 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.

Aggressive Periodontitis occurs in patients who are otherwise clinically healthy. Common features include rapid attachment loss and bone destruction and familial aggregation.

Periodontitis as a manifestation of systemic diseases often begins at a young age. Systemic conditions such as heart disease, respiratory disease, and diabetes are associated with this form of periodontitis.

Necrotizing Periodontal Disease is an infection characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions such as HIV infection, malnutrition and immunosuppression.

Perio/Endo Lesions are a type of periodontitis that occurs in conjunction with a dead or dieing tooth. It can begin with deep pockets and bone loss that work its way into the nerve of the tooth killing it. It can also work in reverse with the infection from a dead nerve leading to bone loss and deep pocketing around a tooth.