What is periodontal disease?
Periodontal diseases and pathological conditions are diseases affecting the supportive tissue of the teeth, namely the bone that supports the teeth and the gingiva (gums).
The principal periodontal diseases are gingivitis and periodontitis. Gingivitis is an inflammation of the gums around the teeth. It is a reversible condition when treated. In contrast, periodontal disease is a serious condition that causes deterioration of the gums and the bone supporting the teeth.
Periodontal diseases are infections caused by the accumulation of pathogenic (disease-causing) bacteria and their toxins in the gingival crevice, the narrow 1 to 3 mm furrow between the teeth and the gums. These diseases can be worsened by various factors, principal among them the accumulation of tartar, smoking, genetic influences, stress and certain medical conditions such as diabetes, as well as the use of certain medications.
The most effective ways of preventing these diseases are meticulous oral hygiene including the use of dental floss, not smoking and regular visits to the dentist for frequent cleanings.
Periodontitis is characterized by the loss of bony support for the tooth and by detachment of the gums around the tooth, leading to the formation of “periodontal pockets” (Fig. 1). While periodontitis is often asymptomatic, the main signs patients notice are bleeding, swelling and receding of the gums, tooth migration and, occasionally, bad breath (Fig. 2). As the disease progresses, the teeth become loose. If periodontitis is untreated, teeth may fall out.
Periodontal diseases are diagnosed during dental checkups using a test called “PSR,” short for Periodontal Screening and Recording. This simple and rapid procedure allows the dentist to identify patients affected by periodontal disease. Based on the results, your dentist will make the appropriate recommendations to you. When periodontal disease is confirmed, the dentist will do a more complete examination of your periodontal tissues in order to evaluate the gingival characteristics: shape, color, texture, as well as the quantity and quality of the gum tissue. The depth of the pockets between the teeth and the gums and the amount of migration is measured. Radiological examinations are required to complete the evaluation of the periodontal bone. This comprehensive evaluation allows a diagnosis to be made, to identify causative factors and, finally, to establish an appropriate treatment plan for the condition of your gums leading to the improvement of your dental health.
What steps are involved in periodontal treatment?
Generally, treatments begin with a phase that addresses the causes of periodontal disease. This consists of eliminating the irritating factors – bacterial plaque and tartar – and correcting the factors contributing to their accumulation. Habits that can aggravate the disease should be modified. A treatment called scaling and root planning is utilized to clean the periodontal pockets. This treatment is normally conducted with local anesthesia using manual and ultrasonic instruments. In some situations, supportive antibiotic therapy may be recommended. In the days following this treatment, the patient may feel more sensitivity when chewing or brushing, as well as to temperature changes. After the gingival inflammation has been resolved, the gums will contract and become firmer, which may lead to an increased exposure of the roots thereby giving the appearance that the teeth are longer. Particular care must be given to the quality of daily oral hygiene in order to prevent root cavities because the roots are less resistant to cavities than the enamel on the tooth itself. To treat the increased sensitivity of the teeth to hot and cold, your dentist may prescribe a toothpaste formulated to reduce sensitivity and apply a desensitizing agent if needed.
This phase of treatment generally stops the progression of the disease and reduces inflammation of the gums, as well as reducing the depth of the periodontal pockets. In the following weeks, your dentist will re-evaluate your periodontal condition to measure how much improvement has been achieved.
After this phase of treating the causes of periodontal disease, some teeth may need periodontal surgery. This surgery allows the dentist to have access to the roots that have deep periodontal pockets and undertake a complete debridement. This procedure gives the gums and the bone a more natural shape, helping to further decrease the depth of the periodontal pockets and, in so doing, facilitates the patient’s dental hygiene. There are regenerative techniques that may also be attempted, depending on the situation. These procedures use various materials that promote new bone formation in order to partially replace the loss caused by periodontal disease. These techniques require specific conditions for clinical application; your dentist may recommend them if they are indicated for your periodontal condition.
Surgical procedures have notable treatment benefits, but they do involve a healing period.
It should be noted that there is a risk of recurrence or aggravation of your periodontal condition in spite of all the treatments provided.