Gingivitis is the mildest form of periodontal disease. It causes the gums to become red, swollen, and bleed easily. There is usually little or no discomfort at this stage. Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with professional treatment and good oral home care.
Factors that may contribute to gingivitis include, diabetes, smoking, aging, genetic predisposition, systemic diseases and conditions, stress, inadequate nutrition, puberty, hormonal fluctuations, pregnancy, substance abuse, HIV infection, and certain medication use.
Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.
One of the first things your dentist will recommend as a part of treatment for periodontal disease is a behavior change on your part. Since dental plaque is the main cause of periodontal disease, its removal on a daily basis is essential. For many patients this involves forming new oral hygiene habits, along with cessation of smoking and other lifestyle changes. Consistent behavior change is the most important element in maintaining long term periodontal health, since daily plaque removal in large part will set the stage for sustained, successful treatment.
Cleaning however, isn't all on your shoulders — your dentist will also see that your teeth receive a thorough cleaning in his or her office to quickly remove the deposits of calcified plaque called calculus or tartar and other bacterial toxins which become ingrained into the root surfaces. This process of mechanical cleaning is generally known as scaling and root planing using ultrasonic and hand scaling instruments. It may be carried out by a hygienist, a dentist or a periodontist, and sometimes requires local anesthesia. Scaling usually results in little or no pain, although in rare instances a patient may need mild pain medication for a day or two.
After three or four weeks your dentist will evaluate the response of your gingival tissues to the initial therapy. In early or mild cases the healing response may be good enough to return an individual to periodontal health. Your dentist will probably recommend a regular schedule of office checkups and cleanings to maintain this healthy state.
Generally, attention to the bite or bite disorders are treated during or after initial therapy once an inflammation free environment has been established. This phase of treatment addresses such issues as loose teeth, clenching or grinding habits, may include localized grinding of some tooth surfaces or even orthodontic (tooth movement) treatment.
Surgical treatment may be needed in more severe cases of periodontal disease that do not respond adequately to non-surgical initial therapy. Periodontal surgical treatment today encompasses a variety of sophisticated plastic surgical procedures. These include techniques to repair and regenerate soft (gingival) and hard (bony) tissues and replace missing teeth with dental implants. They are usually performed by a periodontal specialist trained in these techniques. Most procedures are performed with local anesthesia (numbing of the gum/periodontal tissues), and sometimes with the use of intravenous or conscious sedation. The objective of surgery is generally to eliminate pockets, regenerate attachment and return the patient to more normal function and esthetics, while generally providing an environment more conducive to oral hygiene and maintenance care.
If you have periodontal disease all is not lost. Remember, your teeth were meant to last a life time. Early diagnosis and treatment of periodontal disease are also essential in keeping your teeth for life. While periodontal disease is treatable, vigilance is necessary to prevent recurrence: institute daily plaque removal through brushing and flossing as a part of your oral hygiene; seek treatment to quit smoking; and establish a regular schedule of clinical cleanings and checkups.
In a nutshell, a familiar adage aptly describes your best defense against periodontal disease, “if you look after your teeth, they will look after you.”