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Periodontal
Definitions
FAQ's
Periodontal
Definitions
- Calculus:
Plaque
bacteria that were never removed completely with
brushing and flossing. The
hard deposit of mineralized plaque that forms on
the crown and/or root of the tooth. Also
referred to as tartar.
- Gingiva:
The soft tissue
that covers the jawbone. Also referred to as the
gums.
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healthy
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- Gingivectomy:
The surgical
removal of gingiva (gum).
- Gingivitis:
An inflammation or
infection of the gingiva (gum tissue); the
initial stage of periodontal disease.
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gingivitis |
- Gingivoplasty:
A surgical
procedure to reshape or repair the gingiva
(gum).
- Graft:
A piece of gum
tissue or synthetic material placed in contact
with tissue to repair a defect or supplement a
deficiency.
- Gum:
See gingiva.
- Periodontal:
Relating to the
tissue and bone that supports the tooth (from
peri, meaning "around," and odont,
"tooth").
- Periodontal
disease: The
inflammation and infection of gums, ligaments,
bone, and other tissues surrounding the teeth.
Gingivitis (gums) and periodontitis (gums and
bone) are the two main forms of periodontal
disease. Also called gum disease or pyorrhea.
- Periodontal
pocket: An
abnormal deepening of the gum crevice. It is
caused when disease and infection destroy the
ligament that attaches the gum to the tooth and
the underlying bone.
- Periodontal
surgery: A
surgical procedure involving the gums and
jawbone.
- Periodontics:
The dental
specialty that deals with and treats the gum
tissue and bone that supports the teeth.
- Periodontist:
Dental specialist with
expertise in surgically treating the effects of
periodontal disease.
- Periodontitis:
Inflammation of
the supporting structures of the tooth,
including the gum, the periodontal ligament, and
the jawbone.
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periodontitis |
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advanced
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- Plaque:
A film of sticky
material containing saliva, food particles, and
bacteria that attaches to the tooth surface both
above and below the gum line. When left on the
tooth it can promote gum disease and tooth
decay.
- Tartar:
See calculus.
Frequently Asked
Questions
What
is periodontal disease?
Periodontal disease, also called gum disease,
periodontitis, or pyorrhea, is a complex disease
which can be acute or chronic with flare-ups and
quiet periods, like any chronic disease.
Periodontal disease involves the inflammation of the
gum tissue, and the resulting destruction of the
bone that holds the teeth in the jaw by the
inflammatory process. It is the number one
cause of tooth loss in adults. Periodontal
disease also has implications for increased risk for
other health problems.
What
causes periodontal disease?
In its most basic form, the answer to this
question is bacteria. There are over 450 different
species of bacteria that can live in our mouths,
some of which cause periodontal disease. The
current understanding of periodontal disease
attributes 50% of the destruction directly to the
bacterial toxins and 50% to the inflammatory process
that they trigger in our own immune systems.
Are
there contributing factors in periodontal disease?
Yes: how effectively you clean your teeth, the
type(s) of bacteria present, tooth position and
alignment, your general health and resistance,
saliva (amount, pH, viscosity), medications you may
be taking, cigarettes and tobacco products are some
of the most significant factors.
The
importance of gum tissue.
The gum tissue around the teeth overlies the
bone that holds our teeth in place. The top of the
gum that is visible is approximately 2-3 millimeters
(one millimeter is about the thickness of a dime)
higher than the actual attachment of the gum to the
tooth in health, making a space similar to a
turtleneck collar. Within this space, bacteria live
and multiply. These bacteria produce toxins that
cause our bodies to respond in a localized reaction
called inflammation. In periodontal disease, the
fibers that attach the gum to the tooth are
destroyed by the process of inflammation. Once
these fibers are damaged, the bacterial infiltration
can continue to deeper levels of the gum and bone
typifying the advancing nature of periodontal
disease.
What
is gingivitis?
Gingivitis is inflammation of the gums and is
apparent with red gums that can bleed upon touching
(brushing and/or flossing). Because
inflammation of the gums must occur before the bone
is destroyed, gingivitis, or inflammation of the
gums is the precursor to periodontal disease.
Gingivitis may persist for years before the
inflammatory process allows destruction of the bone
to occur. The important thing to note about
gingivitis is that it cannot be
distinguished from periodontal disease simply by
observation. To determine if someone has gingivitis
or periodontal disease, a periodontal examination
must be performed.
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gingivitis
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What
is a periodontal examination?
A number of components contribute to a thorough
periodontal examination:
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periodontal
probe
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- visual
evaluation of the teeth and gums, including
measuring the crevice depth around each tooth
(periodontal probing)
- x-ray
evaluation of supporting bone,
- review
and evaluation of health and dental history
(habits, medications)
- evaluation
of bite and tooth position (including models of
teeth)
- microscopic
examination of plaque,
- other
appropriate diagnostic aids as indicated
How
do I know if I have periodontal disease?
While there are a number of signs and even some
symptoms of periodontal disease, the only true way
to determine if periodontal disease is present is by
having a periodontal exam. Even x-rays do not
show many areas where the bone may have been
destroyed. However, here are some signs to look for:
- Gums
that bleed when you brush your teeth. (This may
appear as a "pink toothbrush".)
- Gums
that are red, swollen or tender.
- Gums
that have pulled away from the teeth.
- Pus
between the teeth and gums when pressed.
- Permanent
teeth that are loose or separating.
- Any
change in the way your teeth fit together when
you bite.
- Any
changes in the fit of your partial denture.
- Bad
breath or bad taste.
Are
there different types of periodontal disease?
By far the most prevalent form of periodontal
disease is adult periodontitis. This is classified
into mild, moderate and severe types, depending on
the amount of bone loss. Mild periodontitis
occurs when the probing depths of the gum crevice
range from 4-5 millimeters. Moderate
periodontitis is designated for probing depths
between 6-7 millimeters, while severe periodontitis
occurs when depths of 8 millimeters or above are
observed. Since tooth roots average between
10-12 millimeters long, the deeper the pocket
(higher the measurement) the more severe the disease
and the greater chance for tooth loss.
Different readings can occur around different sides
on the same tooth.
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severe
periodontitis
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Is
periodontal disease transmissible?
Yes. See more about a microscopic
examination of plaque,
What
are the treatments for periodontal disease?
Treatment for periodontal disease depends on the
severity of the problem. What all types of
treatment do is to reestablish healthy gums that can
be maintained and act as a barrier to future
disease. Bacteria must be effectively and
thoroughly removed on a daily basis for permanent
success to occur.
The
first type of treatment involves what is called deep
scaling or root planing. It is the most
conservative treatment available and is commonly
called the Non-Surgical approach. This
is almost always done with local anesthetic and
rarely causes residual discomfort. In many
cases it is best to do each pocket more than once as
it is impossible to remove all deposits and debris
in the deeper pockets on the first treatment.
When successful, the gum will reattach at a higher
level than before thus reestablishing a better
barrier to the bacteria and the disease process will
be eliminated. There are many ways to enhance
these results, including first among these improved
homecare techniques. Other treatment options
include antibiotics and advanced therapy such as
Periostat
(collagenase inhibitor).
The
second major treatment is surgery.
Surgery is not a cure for the disease. Surgery
helps create a more maintainable periodontal
situation. The simplest type of surgery is
called a gingivectomy. A gingivectomy is the
surgical removal of the diseased gum tissue with the
healing of the gum at a lower level. Depending on
the pocket depth, this may involve massive tissue
loss. More common are "flap" procedures.
While there are different types of "flaps"
and different techniques, the goal is to temporarily
move the gum back during the surgery, remove the
underlying disease process and if necessary, change
the contour of the bone. The gum tissue is
then sutured back in place. With successful
healing, the gum will reattach at a higher level
than it was when the disease process was present,
although never back to where it was originally.
Other surgical techniques include the implantation
of new bone and the use of a synthetic bone matrix
that stimulates bone growth. The last
treatment is the use of extractions, or removal of
the teeth. Certainly, the goal of any
treatment is to save the teeth, however there are
times when the bone destruction is so great around
one or more teeth that it threatens to infect the
tooth next to it. If the adjacent tooth has a
level of bone that can successfully be treated by
one of the methods mentioned above, yet its next
door neighbor cannot, then removal of the hopeless
tooth can only help the long term prognosis.
It
is not uncommon to find periodontally involved teeth
often respond positively to root canal treatment.
Many studies have shown periodontal disease causing
bacteria within the tooth. Even with
antibiotic treatment these bacteria are not
eliminated.
Some
upper molars, which usually have three roots, often
respond positively to the removal of one of the
smaller roots - this is referred to as a root
amputation.
Tooth
position and bite are very significant factors.
When the forces on teeth are more than the
supporting bone and gum can withstand the underlying
periodontal disease can be aggravated. The
ultimate successful treatment of periodontal disease
usually involves some sort bite
adjustment and/or orthodontic treatment
(braces).
It
cannot be emphasized enough that while treatment may
re-establish a healthy gum condition, if the
bacteria are not regularly and effectively removed,
the disease will reappear.
What
is gum recession?
Gum recession occurs when the gum and
supporting bone are destroyed so that the top of the
gum recedes away from the biting edge or chewing
surface. This is the origin of the expression
"long in the tooth". Gum recession is most
often caused by too much force on teeth; however, it
can be also be caused by periodontal disease (NOTE:
it is not caused by toothbrushing). Gum recession caused by periodontal
disease most commonly occurs where the inflammation
caused by the disease process destroys the
attachment of the gum progressively down the root.
What
can be done about gum recession?
Treatment
options depend on the nature of the problem and the
cause. If root surface sensitivity occurs,
early treatment may simply involve desensitizing the
root surface. Sometimes a bonded filling can
serve as a barrier to temperature. Grafting of
gum tissue is very common and successful for
noticeable cases of recession. If the bite is
the significant underlying cause, then a bite
adjustment and/or orthodontic treatment (braces)
is indicated.
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