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Periodontal Disease


Periodontal disease is a bacterial infection that damages your gums and the fibers that connect your gums to your teeth and tooth-supporting bone. It is also known as "gum disease." Without proper oral hygiene and treatment, it can cause your teeth to loosen and lead to missing teeth. In severe cases, it can also destroy the bone that supports your teeth.

Periodontal disease is caused by bacteria, and hundreds of different species may be involved. These bacteria release acids and enzymes that can directly break down tooth-supporting tissue and bone. They also trigger an immune response that produces tissue-destroying acids and enzymes, resulting in infection and inflammation characterized by redness, swelling, and tenderness.

While gum disease becomes more common as you get older, the disease can begin at any time. Periodontal disease can be localized or generalized. Localized disease is defined as less than 30% of your teeth are affected, while generalized disease means more than 30% of your teeth are affected.

Types of periodontal disease

According to the American Academy of Periodontology, there are many types of periodontal disease. The four most common are:

  • Chronic periodontitis: which results in inflammation within the supporting tissues of the teeth, along with relatively slow loss of periodontal attachment fibers and bone. This is the most common type of periodontitis in adults.
  • Aggressive periodontitis: which occurs in otherwise healthy people. This type of periodontal disease may include rapid loss of bone and periodontal attachment fibers.
  • Periodontitis as a manifestation of systemic diseases: which often begins at younger ages and may be associated with conditions such as heart disease, respiratory disease, and diabetes.
  • Necrotizing periodontal disease: which is an infection characterized by necrosis of supporting tissues, periodontal attachment fibers, and bone. This type of periodontal disease is most commonly found in individuals with conditions such as HIV, malnutrition, and immunosuppression.

Stages and grades of periodontal disease

If your dentist diagnoses you with periodontal disease, they will assign and continuously reevaluate a "stage" and "grade" based on various factors.

  • The stage classifies the severity of the disease based on the extent of the damage. It also considers how challenging it will be to manage the disease over time. Stages range from 1 (least complex) to 4 (most complex).
  • The grade classifies how quickly the disease is likely to progress and how responsive it may be to traditional treatments. The grade also considers the likelihood that the disease may impact your overall health. Grades range from A (slow) to C (rapid).

Not everyone is equally susceptible to periodontal disease. In addition, periodontal disease progresses differently in different people. Your dentist will help you understand what treatment and maintenance strategy is right for you.

Periodontal disease and your overall health

Research has revealed that periodontal disease may impact conditions such as respiratory disease, cardiovascular disease, arthritis, stroke, diabetes, pregnancy, and others. Research continues to emerge about the mouth-body connection.

In addition, research also shows that conditions like diabetes, HIV/AIDs, arthritis, cancer, and leukemia may increase a person's risk for developing periodontal disease. The conditions may also present challenges in the management of periodontal disease.

While the connections are not fully understood, these connections appear to exist because the bacterial infection from your mouth enters your bloodstream and produces an effect. That effect may be from inflammation caused by the infection or from the impact of or by-products from the bacteria itself. For example, the body produces a compound called C-Reactive Protein. Its levels can be monitored, and if it exceeds a certain level, the risk of inflammatory harm to the body is increased.

If you or a family member are diagnosed with periodontal disease, it is important to have it treated as soon as possible to reduce the effects of bacteria in the mouth. Early treatment, the use of antimicrobial agents, and ongoing maintenance can help avoid more expensive dental procedures. It can also help mitigate the effects on other conditions in your body.

Periodontal disease is typically caused by poor oral hygiene, which leads to the accumulation of plaque and bacteria on your teeth and gums. If you do not continually remove the plaque, gingivitis may develop. Gingivitis is reversible if treated properly. If untreated, gingivitis can progress into periodontal disease, as the gingival fibers attaching the gums to the teeth and tooth-supporting bone begin to break down.

Factors that increase your risk of developing periodontal disease include:

  • Poor oral health habits.
  • Gingivitis
  • Advancing age
  • Smoking or chewing tobacco
  • Medications that cause dry mouth or affect the gums.
  • Grinding or clenching your teeth
  • Stress
  • Diseases or conditions such as diabetes, arthritis, eating disorders, respiratory diseases, and others.
  • Diseases or conditions that suppress your body's immunity, such as HIV/AIDS, leukemia, and certain other cancers.
  • Hormonal changes in women such as puberty, changes in menstrual cycle, use of birth control, or pregnancy.
  • Crooked or crowded teeth or dental work that are more difficult to keep clean.
  • Poor nutrition, such as a diet high in sugars
  • Vitamin C deficiency
  • Genetics. If you have a family history of periodontal disease, tell your dentist as you may be at greater risk for developing it yourself.

If you notice any of these symptoms, schedule an appointment with your dentist.

  • Sore, swollen, or bleeding gums (especially when you brush and floss).
  • Bad breath
  • Pain when chewing
  • Receding gums
  • Shifting teeth
  • Misaligned teeth
  • Loose or missing teeth

If you are diagnosed with periodontal disease, you have a better chance of preventing its progression if you begin treatment and management as soon as possible. At your initial visit, your dentist or hygienist will:

  • Ask about your medical history to discuss any medical conditions you have, medications you take, or habits that may be related to periodontal disease.
  • Check your gums for signs of inflammation, infection, bleeding, and discoloration.
  • Examine your mouth to look for plaque and tartar.
  • Measure the gum pockets around your teeth and make a record of them to monitor over time.
    • Gum pockets that measure between one and three millimeters are generally considered healthy, as they can be cleaned with a toothbrush and floss. Pockets around three to four millimeters deep with signs of inflammation may indicate gingivitis. Pockets deeper than four millimeters may indicate periodontal disease.
    • Take X-rays to check for any bone loss. Early periodontal disease may or may not be visible on X-rays, even though the disease has already begun to soften the bone. Moderate to severe periodontal disease is visible on X-rays as darkened areas of altered bone.
    • Determine the type, grade, and stage of your disease and how many teeth it is affecting.
    • Talk to you about changes to your home oral hygiene.
    • Recommend non-surgical or surgical periodontal procedures if active periodontal disease is diagnosed.

    At this point, your dentist may begin treatment. One or more follow-up appointments may be required to treat your disease. Depending on the severity of your disease, your general dentist may refer you to a periodontist.

    At the follow-up appointments, your dentist will:

    • Re-evaluate your teeth and gums to determine if the inflammation has been reduced or eliminated.
    • Measure the depths of your gum pockets to determine if the disease is stable or progressing.
    • Take additional X-ray images to see if the disease is stabilizing.

Your best defense against periodontal disease is a lifetime of proper and consistent good oral hygiene at home, regular dental exams, and professional tooth cleanings. This reduces the chance of getting the disease and improves your ability to treat it effectively if it occurs.

The goal of periodontal disease treatment is controlling the infection in your mouth to slow the disease's progression and prevent additional damage that may negatively impact your overall health. Your dentist and hygienist can help you play an essential role in managing your periodontal disease through periodontal maintenance treatment, but the ultimate responsibility for preventing its progression in the vast majority of cases lies with you. There are several types of periodontal treatments. The types you need depend on the specific state of your disease. The types of treatments, and when you need them, also change as the disease improves, stabilizes, or progresses over time.

The most important factors in ensuring long-term success with periodontal disease are:

  • An understanding of the significance of the illness.
  • Your motivation to control the disease and prevent its progression.
  • Following your dentist's recommended oral hygiene guidelines.
  • Reducing or eliminating the contributing factors that you can control.
  • Making sure you attend all follow-up exams and procedures that are needed to manage the disease.

If your periodontal disease isn't severe, your treatment options are typically non-surgical and include:

After your periodontal disease is under control, other treatments or surgeries may be needed to help correct the damage it has caused. These may include:

Some of these treatments may result in receding gums, which may require additional treatment.

Tooth removal may be another option to consider. Periodontal disease will go away if the affected teeth are removed, although risk factors for future disease may remain. The infection does not remain in the bone once the affected teeth are gone. However, missing teeth can have significant consequences if they are not replaced.

  • Author: Symbyos staff, Fluent staff
  • Medical review: Thomas J. Greany DDS, 1/18/2021
  • Last updated: 12/20/2021