The most common type of periodontal disease are Gingivitis and Periodontitis.

Gingivitis: Infection of the gingiva (gum tissue), and is the initial stage of the disease process. Gums become red, swollen and may bleed easily. Underlying bone levels are unaffected.

Periodontitis: is classified as being Mild, Moderate or Severe, depending upon the amount of destruction to the gums, ligaments and bone that surround teeth. As the disease progresses, gums separate from the teeth and form gum pockets. These pockets get deeper as more underlying bone is destroyed. Gum pockets will collect increasing amounts of bacterial plaque and calculus (tartar) as the disease process worsens. Teeth will loosen as more bone is lost.

The response of the gums and bone to dental plaque may be modified by one or more of the following factors.

• Poorly fitting dental restorations

• Smoking

• Crowded teeth, improper bite alignment

• Clenching or grinding of teeth

• Hormonal changes, including pregnancy, menstruation and menopause

• Diet

• Systemic diseases, including blood disorders and diabetes

• Medications, including calcium channel blockers and anti-convulsants

• Bleeding gums

• Tenderness, swelling, red color

• Abscess

• Persistent bad breath

• Loose teeth, separating teeth

• Pain

Periodontal disease can be easily detected by a general dentist or periodontist during regular examinations. A periodontal charting should be performed for all teeth. A periodontal probe, with ruled millimeter markings, is used to measure the depth of the space between the teeth and gums. Ideally, normal measurements range between 1 and 3 millimeters. Depths greater than this may signify the presence of periodontal pockets and associated gum disease. Dental radiographs should be taken to evaluate any evidence of bone damage has occurred as a result of the disease process.

This movie shows how we can determine pocket depths around teeth. The amount of bone loss around teeth can also be evaluated from these pocket readings. The dentist checks 6 areas around every tooth to get accurate recordings. Pocket depths and bone loss readings are important in determining the type of treatment that may be needed.

The main goal of periodontal treatment is elimination of the disease process from the gums, ligaments and bone that surround the teeth, and restoration of dental health.

1. Non-Surgical Phase

Initial treatment involves educating patients in the proper methods of effective, daily plaque removal and oral hygiene. This is a critical component of successful therapy.

Scaling and root planing are performed by the clinician under local anesthesia to debride the tooth structure and remove bacterial plaque and calculus deposits (the source of the infection) from the gum pockets. In mild cases of gingivitis and periodontitis, antibiotic or irrigation with anti-microbials (chemical agents) may be suggested in conjunction with scaling and root planing to control and target periodontal pathogens. The purpose of this phase of treatment is to improve the overall tissue quality especially prior to surgical phase.

2. Surgical Phase

In cases which demonstrate deeper gum pockets and underlying bone loss, it becomes necessary to surgically eliminate the diseased gum pockets and bony destruction with osseous (bone) surgery. The gum is reflected and retracted away from the teeth to expose the underlying roots and bone deformities. The bone is contoured to approximate a normal physiologic profile, and the gum is sutured back to place. When the gum heals, normal probing depth is re-established between the gum and tooth. The reduced probing depth facilitates easy removal of plaque by patients at home and by hygienists during professional cleaning.

Additional treatment modalities may be necessary to treat periodontal disease and restore health. These may include:

• Bone grafts for bone regeneration

• Gum grafts to treat gum recession and pathological root exposure

• Cosmetic plastic surgery of the gums to improve appearance

• Fabrication of night guards for bruxism (tooth grinding)

• Removal of diseased roots on some types of molars

• Use of medications such as antibiotics, fluoride and antimicrobial rinses

3. Maintenance

Once the active phase of treatment is complete and health has been restored, it is extremely important that patients be seen by a hygienist for routine dental and periodontal cleaning on a regular basis. This regimen, along with diligent home care and oral hygiene, will give the best chance for preventing recurrence of disease and maintaining long term periodontal health.

The oral cavity is a portal to various parts of your body. Recent studies have shown that periodontal disease is linked to various types of systemic conditions and diseases. Periodontal pathogens consists of strains of bacteria that can invade the gingival tissue and enter the bloodstream, circulating throughout the body. The bacteria can secrete harmful toxins and virulence factors. These factors activate the body's immune systme to respond much in the same way as the body responds to infected cuts or illnesses like pneumonia; with inflammation, pain and destruction of the tissues. The connection between oral and systemic disease means individuals with periodontal disease can be at high risk for cardiovascular disease, diabetes, stroke, premature and low birth weight babies, respiratory diseases, pancreatic cancer and osteoporosis.

There is a correlation between periodontal disease and hormonal changes among women. Women are susceptible to periodontal disease at certain stages of life. Hormonal fluctuations can affect the blood supply to the gingiva as well as react to irritants from bacterial plaque.

Successful periodontal treatment can significantly reduce the risks of bacterial infection, reduce inflammation, lower blood pressure and blood sugar levels. It is important to have a complete and recent physical examination by your physician before you proceed with your periodontal therapy. Be sure to provide Dr. Ekelman with a list of specific drugs you are currently taking for certain medical conditions. Some commonly prescribed medications can cause dry mouth which contributes to rapid plaque formation and bleeding.

To learn more about the systemic links, see www.perio.org.