Questions and Answers Regarding Periodontal Disease
What is periodontal disease?
It is a chronic inflammatory disease that affects the gum tissue, ligaments, and bone around the teeth. It causes weakening and ultimate destruction of these tissues which protect and support the teeth and hold them in place. Pyorrhea is an older, outdated term for this disease.
How does periodontal disease start?
It starts with gum inflammation. If the problem is not corrected the inflammation gradually extends below the gum line. Now the fibers connecting each tooth to its bony socket are affected. As time goes on, the bone will also become involved as the inflammation extends deeper into the fiber area.
What causes periodontal disease?
Bacterial plaque! Plaque, simply defined, is an organized colony of bacteria which causes inflammation and ultimately the breakdown of the gum tissue and bone. Of course, there are other causative factors which contribute to periodontal breakdown. Examples are missing teeth, food impactions, poor occlusion, etc. Bacterial plaque, however, is the primary cause of periodontal disease.
Can it be controlled?
Yes, except in the most advanced cases or where the patient refuses to accept responsibility for proper home care.
But, Doctor, I brush my teeth all the time!
We do not wish to imply that patients do not brush. But brushing cleans only the cheek, tongue, and biting surfaces of the teeth.
Periodontal disease starts and does its greatest damage between the teeth. How the patient cleans is most important particularly in the between the teeth areas where the toothbrush cannot reach.
What, exactly, is plaque?
Plaque is a sticky, transparent substance which clings to the teeth. Once removed, it reforms again in 24 hours. In this substance live an enormous number of micro-organisms. Because most of the bacteria live in protected areas which are inaccessible to conventional toothbrushing, they pose a constant threat to the teeth and gum tissue.
As the bacterial elements organize to form plaque (every 24 hours) they produce toxic acids which can ultimately destroy the holding fibers and the supporting bone.
What are the symptoms of periodontal disease?
1. Bleeding gums.
2. Excessive formation of calculus deposits.
3. Drifting or shifting of any teeth--including fanning of the front teeth.
4. Loosening of any teeth.
5. Swelling in the gingival (gum) area, possibly indicating the presence of an abscess.
Why do teeth become loose?
We could compare a tooth to a fence post. If two-thirds of the fence post is in the ground, it is solid. But if erosion occurs and a great deal of the support is lost, leaving only one-quarter of the post remaining in the ground, it is no longer solid. It becomes loose. When a tooth loses its support, it, too, becomes loose.
Is there a simple comparison to help me understand more about the nature of periodontal disease; more specifically, how the gum crevice deepens to form the periodontal pocket?
Yes. Visualize the neck of the tooth encircled with a tight turtleneck sweater which represents the gingival (gum) tissue. The threads in the sweater could be compared to the tough elastic fibers which lace through the tissue. Healthy tissue is so tight that bacterial action cannot affect it.
However, if bacterial plaque is allowed to accumulate in the crevice area (where the gum tissue meets the tooth), the bacterial toxins slowly destroy the elasticity of the fibers. Then the bacteria and toxins can slip into the deeper fiber areas. Here they find a favorable environment where they can multiply to form more colonies and more toxins. Now the deepest fibers and the supporting bone receive the brunt of the bacterial attack and the pocket continues to deepen. This is the nature of periodontal disease.
Can a dentist actually measure the amount of destruction of periodontal disease?
Yes, to a great degree. We use an instrument called a periodontal probe to measure the depth of the crevice; i.e., the space between the tooth and the gum tissue. With this instrument we can actually survey the amount of bone destruction. The probe is marked in millimeter increments.
Is periodontal disease inherited?
No. We feel, however, that there may be an inheritable weakness; i.e., the tendency toward heavier plaque formation, but the individual who maintains a totally clean mouth can control virtually all periodontal disease--regardless of inheritable weakness.
Is it contagious?
No.
At what age is it most prevalent?
Usually the onset of periodontal disease takes place at about 35 years of age, although it can occur earlier or later in life. Most dentists agree that 90% of the population over 35 is afflicted to some degree.
How is periodontal disease treated?
The treatment usually consists of three important phrases:
1. The learning phase. All periodontal patients must learn the facts regarding the destructive power of this disease process and its effect in the mouth.
2. The control phase. The problems of the existing disease must be controlled. Treatment may include the correction of gum and bone defects, as well as correction of malocclusion problems and the replacement of missing teeth.
3. The preventive phase Once the disease process is under control, with as many problems eliminated as possible, it is the responsibility of the patient to seek regular preventive treatment. Of course, effective personal oral hygiene must be maintained at all times.
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