Periodontitis or Gum Disease
Periodontitis is an inflammatory disease that affects the tissue surrounding and supporting the teeth. These tissues called the periodontium are the primary layer of support for the alveolar bone around the teeth, that holds the teeth in place in the oral arch. This inflammation or damage to the tissue, if left untreated, will result in progressive loss of the alveolar bone around the teeth. This will in turn loosen the teeth and eventually lead of loss of teeth. Periodontitis or gum disease is caused or aggravated by bacterial microorganisms on the teeth.
There are various categories or stages in periodontal disease. The initial stage of periodontal disease is called Gingivitis. Gingivitis is often treatable and also preventable from recurring.
The other categories of periodontal diseases are destructive in nature, meaning the adverse effects of the disease cannot be reversed. It can often lead to bone loss, loss of tooth and other health issues related to the gum disease. Some of them are called chronic periodontitis, Aggressive Periodontitis, Periodontitis as a manifestation of systemic disease, necrotizing ulcerative periodontitis etc… Your dentist will be able to identify the nature of periodontitis affecting you if you are diagnosed with gum disease. Periodontitis is known to increase risk of stroke, myocardial infarction, atherosclerosis and other diseases.
Managing Periodontitis or Gum Disease
There are several stages in managing periodontitis or gum disease. By following the oral hygiene instruction from your dentist you could arrest the progression of the disease and reduce risk in further damages to bone and gum tissues.
The cornerstone of successful periodontal treatment starts with establishing excellent oral hygiene. This includes twice-daily brushing with daily flossing. Also, the use of an interdental brush is helpful if space between the teeth allows. For smaller spaces, products such as narrow picks with soft rubber bristles provide excellent manual cleaning. Persons with dexterity problems, such as arthritis, may find oral hygiene to be difficult and may require more frequent professional care and/or the use of a powered tooth brush. Persons with periodontitis must realize it is a chronic inflammatory disease and a lifelong regimen of excellent hygiene and professional maintenance care with a dentist/hygienist or periodontist is required to maintain affected teeth. The following are the various ways the periodontal disease can be managed.
Initial therapy involves removing all sub gingival tarter and plaque by scaling and root planing. This noninvasive treatment is effective if the pocket depth is shallower than 4 to 5 mm. The pocket depth is measured by dentist using a periodontal probe. To Evaluate the periodontal conditions, dentist may do an initial debridement before performing a scaling and root planing.
Multiple clinical studies have shown nonsurgical scaling and root planing are usually successful if the periodontal pockets are shallower than 4–5 mm (0.16–0.20 in). The dentist or hygienist must perform a re-evaluation four to six weeks after the initial scaling and root planning, to determine if the patient’s oral hygiene has improved and inflammation has regressed. Probing should be avoided then, and an analysis by gingival index should determine the presence or absence of inflammation. The monthly reevaluation of periodontal therapy should involve periodontal charting as a better indication of the success of treatment, and to see if other courses of treatment can be identified. Pocket depths of greater than 5–6 mm (0.20–0.24 in) which remain after initial therapy, with bleeding upon probing, indicate continued active disease and will very likely lead to further bone loss over time. This is especially true in molar tooth sites where furcation (areas between the roots) has been exposed.
If nonsurgical therapy is found to have been unsuccessful in managing signs of disease activity, periodontal surgery may be needed to stop progressive bone loss and regenerate lost bone where possible. Many surgical approaches are used in treatment of advanced periodontitis, including open flap debridement and osseous surgery, as well as guided tissue regeneration and bone grafting. The goal of periodontal surgery is access for definitive calculus removal and surgical management of bony irregularities which have resulted from the disease process to reduce pockets as much as possible. Long-term studies have shown, in moderate to advanced periodontitis, surgically treated cases often have less further breakdown over time and, when coupled with a regular post-treatment maintenance regimen, are successful in nearly halting tooth loss in nearly 85% of patients.
Once successful periodontal treatment has been completed, with or without surgery, an ongoing regimen of “periodontal maintenance” is required. This involves regular checkups and detailed cleanings every three months to prevent repopulation of periodontitis-causing microorganism, and to closely monitor affected teeth so early treatment can be rendered if disease recurs. Usually, periodontal disease exists due to poor plaque control, therefore if the brushing techniques are not modified, a periodontal recurrence is probable.
Periodontitis has an inescapable relationship with sub gingival calculus (tartar). The first step in any procedure is to eliminate calculus under the gum line, as it houses destructive anaerobic microorganisms that consume bone, gum and cementum (connective tissue) for food.
Most alternative “at-home” gum disease treatments involve injecting antimicrobial solutions, such as hydrogen peroxide, into periodontal pockets via slender applicators or oral irrigators. This process disrupts anaerobic micro-organism colonies and is effective at reducing infections and inflammation when used daily. A number of other products, functionally equivalent to hydrogen peroxide, are commercially available, but at substantially higher cost. However, such treatments do not address calculus formations, and so are short-lived, as anaerobic microbial colonies quickly regenerate in and around calculus.