Periodontal disease affects millions of Americans, leading to bad breath, unstable teeth, and missing teeth. Also called gum disease and periodontitis, periodontal disease is an inflammatory disease caused by bacterial toxins in dental plaque and tartar. Like many other diseases, it progresses through various stages, and it is easiest to treat when you catch it early.
Gingivitis is the precursor to full-blown periodontal disease. This is the earliest stage of gum disease, and when you intervene at this stage, it is reversible. Bacteria that live in dental plaque produce toxins that penetrate the surrounding gum tissue. The human body responds to these toxins with inflammation. The term “gingivitis” literally means inflammation of the gum tissues.
Because the inflammatory response increases the blood flow to the site of “injury”, gingivitis typically causes redness, swelling, tenderness and a tendency of the gums to bleed. Healthy gums are pink and flat against the bone and teeth, and they do not hurt when you brush or floss. In gingivitis, there is no loss of the attachment of supporting structures surrounding the teeth.
As the bacteria producing toxins are present in both soft plaque and hard tartar buildup, a professional teeth cleaning is necessary to remove all of the bacteria from the teeth and allow the gums to heal from gingivitis. Maintaining a great oral hygiene routine at home will keep the plaque off between your teeth cleanings with the dental hygienist.
Gingivitis vs. Periodontitis
We mark the transition from gingivitis to periodontitis when there is a loss of attachment. Teeth are surrounded by jawbone, a ligament connecting the bone to the teeth, and gum tissues covering the jawbone. In order for adequate support of chewing, these structures must remain attached to one another. When gingivitis goes untreated, and the bacteria continue to produce toxins, the inflammatory response begins destroying the surrounding structures.
Your dentist and dental hygienist measure these attachments using a tiny “ruler” called a periodontal probe. By measuring between the teeth and gums at six separate locations around every tooth, we gather information about the attachment of these important structures around each tooth.
These measurements, assessed in conjunction with close-up dental x-rays, provide the foundation for the diagnosis of periodontal disease.
Mild Periodontal Disease
In the earliest stages of periodontal disease, the measurement between the teeth and gums must be four millimeters or deeper, and there must be three millimeters of attachment loss. (The reason for this distinction is that it is possible to have “pseudo-pockets” when the gums are swollen, but the attaching structures remain at a healthy position.)
Mild Periodontal Disease has a good prognosis with dental intervention. The most common treatment involves a procedure known as Scaling and Root Planing, commonly referred to as a “deep cleaning”. During this procedure, your dentist or dental hygienist uses specialized instruments to remove all bacterial buildup from these pockets. Follow-up care is necessary to ensure the disease doesn’t relapse.
Moderate Periodontal Disease
As periodontal disease worsens, we see greater depths of the measurements and more attachment loss. We define moderate periodontal disease by the presence of at least two sites between the teeth of attachment loss measuring a minimum of four millimeters or two sites between the teeth with five millimeter measurements or deeper. The emphasis on “between the teeth” is important as these areas are the most difficult for patients to clean.
Treatment varies with moderate periodontal disease, and the first step is removal of the bacterial buildup. In many cases, your dentist will begin with the same “deep cleaning” procedure to see how the tissues respond. The further the periodontal disease progresses, the more difficult it is to successfully treat. Follow-up care becomes more important as the disease worsens.
Severe Periodontal Disease
Severe periodontal disease is defined by the presence of at least two sites between the teeth of attachment loss measuring a minimum of six millimeters and at least one site between the teeth with a five millimeter measurement or deeper. Severe periodontitis may also include teeth that are loose, shifting, or painful.
The treatment of severe periodontal disease may include several procedures aimed at first stopping the progression of the disease, and then rebuilding new attachment between the teeth and supporting structures. The goal of treating severe periodontal disease is to save as many teeth as possible in order to maintain normal chewing function.
More Questions about Periodontal Disease?
Call Rockland Dental Specialists to ask our experts. We have been successfully treating periodontal disease for years. We can answer any question you have and help you stop periodontal disease in its tracks.