Periodontal disease: Periodontal disease,  its association with systemic diseases, caring for your mouth, and oral pathology

About Periodontal Diseases

Periodontal (gum) diseases are chronic inflammatory conditions caused by oral bacteria.   Periodontal diseases are among the most common infections in the United States. One out of every two American adults aged 30 and over has periodontal disease according to recent findings from the Centers for Disease Control and Prevention (CDC).  A study published in August 2012 in the Journal of Dental Research estimates that 47 percent, or 65 million American adults, have mild, moderate or severe periodontitis, the more advanced form of periodontal disease. In adults 65 and older, prevalence rates increase to over 70 percent.

Bacteria which are growing on the teeth constantly build a colorless film called a ‘plaque’.  If this bacterial plaque is not removed from the teeth with proper brushing and flossing, it can lead to destruction of the gum’s fiber attachment to the teeth as well as the bone that supports the teeth.   Good oral hygiene and regular professional dental cleanings can help to prevent the progression of periodontal disease.

Signs of Periodontal Disease

Periodontal diseases are generally painless until they reach their advanced stages.  If left untreated, periodontal diseases can result in red, swollen, and bleeding gums, periodontal pocketing, bad breath and tooth mobility, which results in eventual tooth loss.

Most Common Forms of Periodontal Disease

Gingivitis: The mildest form of the disease which manifests as inflammation of the gum tissue only.  It is reversible with professional treatment followed by good home care.  Gingivitis causes the gums to become red and swollen and to bleed easily, though little or no discomfort is present at this stage.

Periodontitis: If gingivitis is left untreated, it can advance to periodontitis, which involves inflammation of the gums as well as breakdown of the bone and tissues surrounding the teeth. This leads to periodontal pocket formation populated with pathogenic periodontal bacteria.  Depending on the stage of the disease – mild, moderate, or advanced – the degree of periodontal tissue destruction is different, therefore the treatment options vary.  There are chronic slowly progressing as well as aggressive rapidly progressing forms of periodontitis.

Gingival (gum) recession: Gingival recession (receding gums) refers to exposure of the roots of the teeth caused by a loss of gum tissue and underlying bone with the subsequent gingival margin being positioned further down the root of the tooth. Tooth sensitivity and an unaesthetic longer appearance of the teeth may be consequences of gum recession.   Gingival recession can be corrected using soft tissue grafts.

Factors Contributing to Periodontal Disease

Smoking/Tobacco use:  Tobacco users are more likely to get periodontal disease and develop more severe forms.  In addition, healing processes may be delayed and unpredictable.

Genetics: Some particular groups of people are more prone to developing periodontal disease depending on their genotype and if certain conditions are met.

Diabetes:  The relationship between periodontal disease and diabetes goes both ways – poorly controlled diabetic patients are more likely to develop periodontal disease, which in turn can increase blood sugar and diabetic complications.  In fact, periodontal disease is considered the sixth complication of diabetes besides micro- and macro-vascular complications.

Clenching and grinding of the teeth: The excessive force generated by these habits can accelerate the breakdown of periodontal tissues resulting in loosening of the teeth.

Systemic diseases: Diseases that affect the body’s immune system can negatively impact the condition of the gums as well as recovery during treatment.

Stress: Stress can make it more challenging for the body to fight off infection, including infection associated with periodontal diseases.

Pregnancy and Puberty:  Hormonal changes can influence the gums to become more swollen and tender and to bleed more easily.

Medications: Some drugs, such as antidepressants, certain heart medications, and oral contraceptives can affect oral health and, specifically, gum tissues.  You should always inform your dental care provider of the medicines you are taking and any changes in your health history.

Poor nutrition: A diet low in important nutrients can contribute to worsening of the periodontal condition and slower recovery after periodontal treatment.

Treatment for Periodontal Disease

Once your periodontal condition has been evaluated, we will help you determine the treatment options that are best to stop the progression of your disease and bring you back to health.  Depending on the stage of your periodontal disease, simple to more involved periodontal procedures may be necessary with the primary objective to return you to good oral health, then help you to maintain it.  Once the disease progression has been controlled, regular periodontal maintenance is recommended for all periodontal patients, similar in concept to any other chronic disease.  Periodontal disease can and often does recur, and early intervention can prevent further breakdown allowing simple treatment in the early stages.

Association of Systemic Diseases with Periodontal Disease

Diabetes – Periodontal Disease
The relationship between periodontal disease and diabetes goes both ways – poorly controlled diabetic patients are more likely to develop periodontal disease, which in turn can increase blood sugar and diabetic complications.  In fact, periodontal disease is often considered the sixth complication of diabetes besides micro- and macro-vascular complications.

In order to control the combined problems of periodontal disease and diabetes, we work closely with your physician to provide you with optimal care.

Heart Disease and Stroke – Periodontal Disease
Scientific studies have established an association between gum disease (periodontitis) and cardiovascular disease, including heart attack, atherosclerosis and stroke.  Chronic inflammation is a common underlying result of both periodontitis and cardiovascular disease and can independently link periodontal disease to the development or progression of cardiovascular disease in some patients.  By maintaining good periodontal health under the continuous supervision of a periodontist, you can improve your oral health status, reduce systemic inflammation, and benefit your heart as well.

Women and Periodontal Disease
Women have unique health needs. Hormonal fluctuations throughout a woman’s life can affect many tissues, including gum tissue, during:

  • Puberty – There is a higher tendency for swollen gums during puberty.
  • Menstruation – Menstruation gingivitis can occur right before menstruation and manifests as bleeding gums, bright red and swollen gums, and sores on the inside of the cheek
  • Pregnancy – Pregnancy gingivitis or pregnancy tumors can occur anytime during pregnancy. Also, there is a possible relationship between periodontal disease and pre-term, low-birth-weight babies,
  • Menopause – Menopausal gingivostomatitis, dry mouth, burning sensations in the gum tissue, and altered taste are commonly associated with the depletion of estrogen during menopause.

Research indicates that women have generally better knowledge of periodontal health and are more committed to maintaining healthy teeth and gums. According to a recent study published in April 2011, women are almost twice as likely to have received a regular dental check-up in the past year. In addition, women were more likely to schedule the recommended treatment following the dental check-up.

Tobacco and Periodontal Disease
Smoking is undoubtedly one of the most influential, and most prevalent, behavioral risk factors in the development of chronic periodontitis.  Tobacco smokers are 2.5 to 6 times more likely to develop periodontitis as well as  more severe periodontitis than nonsmokers. Smokeless tobacco users are 2 times more likely to develop periodontitis than nonusers. As many as 41.9% of all current periodontitis cases and more than 90% of refractory periodontitis cases can be attributed to tobacco smoking.  Research studies strongly suggest that quitting the habit can have a significant beneficial impact on the outcome of periodontal treatment.

Respiratory disease – Periodontal disease
Research shows that periodontal health may be related to respiratory health. Many respiratory infections may be caused by bacteria from the upper throat being inhaled into the lower respiratory tract.  Respiratory diseases such as COPD (chronic obstructive pulmonary disease), pneumonia, acute bronchitis and other problems may be prevented or their progression diminished by working with a periodontist to improve oral health.