What Is Periodontitis?
When the topic is about oral health, we can’t compromise as our gums are one of the most critical elements in a healthy mouth. Periodontitis, also referred to as gum disease, is an ordinary condition in which the gums, as well as deeper periodontal structures, become aroused. This dental condition is considered as a serious infection of the gums. It is basically an inflammation of the gums and assisting structures of the teeth and also considered as one of the most common human diseases.
The inflammation of gums generally takes the form of swelling, redness and a tendency to bleed at the time of brushing. It is the response of a person’s body to release bacteria which have been allowed to accumulate on the teeth. However in parts of the body’s defense system, this inflammatory response can be responsible for causing deliberate damage. If left unchecked, the inflammation might spread down along the roots of the teeth and below the gums, causing the demolition of the periodontal ligaments and the supporting bone.
It is caused by periodontal bacteria that have been allowed to accumulate on both teeth and gums and the local inflammation triggered by those bacteria. Though periodontal bacteria are familiar to our mouth as they inherits natural presence. They will strike with a harmful effect when the conditions are right for them to uplift dramatically in numbers. It will occur when a layer of food debris and bacteria, called plaque, gets intensified and is left undisturbed on the teeth, mainly in hard-to-reach parts like between the teeth.
The more dangerous bacteria get a chance to thrive and multiply, originating some dangerous by-products that stimulate the defensive inflammatory response of the body in the gums. As the disease advances, chronic inflammation causes the jaw bone to be destroyed and the teeth to be lost. This is a gradual process in many people and takes place over many years and, if detected and treated on time, can be halted. Though we see some adults have a very alive form of a disease that is responsible for early loosening and loss of the teeth.
Symptoms of periodontitis depends upon the stage of disease, but some general symptoms include pain at the time of chewing, inflammatory response throughout the body, tooth loss, receding gums, changes in the position of teeth or loose teeth, gums that bleed at the time of brushing or flossing, formation of plaque in teeth, foul taste in the mouth, red, tender, or swollen gums, bad breath, etc. In the early stages, symptoms aren’t as noticeable. At such cases, a dentist will be the best person to point those signs.
The major and all-time famous cause of periodontitis is the formation of bacteria in the form of dental plaque. A healthy mouth shares near about 700 different types of bacteria, out of which most of them are considered as harmless and live with harmony with their host. By the time when tooth cleaning are not thorough enough, the bacterial deposit formation next to the gums, forming a plaque. Thus the condition becomes suitable for more harmful bacteria to prosper.
If the soft bacterial is not ejected by brushing, minerals are located within it over time and develop as a hard deposit known as plaque. The existence of plaque promotes the advancement of the bacterial plaque towards the teeth roots. A gap or periodontal pocket is formed between them and an attachment of the gum to the root is disrupted as the inflammation progresses.
The periodontal pocket is an ideal location for dangerous bacteria to take place and grow. The bacteria exert toxins as products of their metabolism in their new habitat, that further trigger the body’s defence mechanisms. The speed and severity of periodontitis’s progression depend on the balance of a number of factors, like the type and number of bacteria present, presence, and absence of different risk factors, and how strong the individual’s defence mechanisms are.
For example, more aggression of the bacteria is responsible for weakening the immune response of the patient, and the disease will be more active. Even different types of drugs like vasodilating agents or antihypertensive and immunotherapy affect the inflammatory response to plaque and make patients more susceptible towards gingivitis. Though, it is crucial to recognize that without the accumulation of bacterial plaque, periodontitis will not happen. There are some risk factors mentioned below regarding periodontitis.
Risk Factors of Periodontitis
Well-known risk factors include some systematic diseases like diabetes, stress and most importantly smoking. Smokers are more likely to encourage periodontitis in themselves as compared to the non-smokers. This dental disease progresses much faster, with more rapid tooth loss in smokers. Even the treatments of this dental problem like gum/bone graft and implant prove to be less successful in smokers due to poorer healing.
Consequences Of Periodontitis
It is claimed to be the leading cause of tooth loss. If the progress of inflammation of periodontitis is not halted, the supporting structures of the teeth, including the surrounding bone gets destroyed. With this process, the teeth eventually get loosen and may be lost, or need extraction. Some other problems that a patient may experience contain drifting of the teeth that may interface with eating, unsightly lengthening of the teeth with exposure of the roots, and painful abscess, as a result of gum recession.
With the help of these things, we can understand that untreated periodontal diseases can lead to creating effects on general health. Like it pose an increased risk for complications at the time of pregnancy (low-birth-weight, premature birth or pre-eclampsia). In addition, there might be an increased risk of heart diseases and diabetes.
Periodontal Disease Stages
This disease has been distributed in different types of stages like early, moderate and advanced periodontal disease. We will try to discuss all of them separately.
- Early Periodontal Disease
In the initial stages of this dental problem, the gums will recede or will pull away from the teeth and small pockets develop between gums and teeth. The pockets dock injurious bacteria. The immune system of the body attempts to fight the infection, and the gum tissue begins to recede. The person may likely experience bleeding the time of brushing the teeth or flossing, and possibly some boneless.
- Moderate Periodontal Disease
This stage lies between early and advanced periodontal disease where a person might face bleeding and pain around the teeth and gum recession. The teeth will begin to lose bone support and the infection also lead to an inflammatory response throughout the body.
- Advanced Periodontal Disease
In this stage, the connective tissue which grips the teeth in place starts deteriorating. The gums, other tissues that support the teeth as well as bones are destroyed. If someone is facing this stage of periodontitis, they might experience severe pain at the time of chewing, a foul taste in their mouth, or severe bad breath.
Periodontitis vs Gingivitis
Periodontitis starts up with inflammation in the gums, called gingivitis. At the time of brush or floss, if your gums are bleeding, just be prepared because it is one of the initial signs of gingivitis. However, there is a difference between periodontitis and gingivitis. Gingivitis happens when the bacteria of mouth promote plaque, a sticky layer that can make possibilities in increasing the risk to both tooth decay and gum disease. This promotion causes the gums to bleed and become inflamed at the time of floss or brush. If left untreated, gingivitis may lead to gum disease.
On the other hand, periodontitis is a type of infection which causes the gum to pull away and exposing the teeth to germs, leaving them vulnerable. A person who has periodontitis, the inner layer of the gum and bone pull away from the teeth and develop pockets. These tiny spaces between gums and teeth amass debris and can become infected. The immune system of the body fights the bacteria as the plaque grows below the gum line and spreads. “When gingivitis is left untreated, it can lead towards periodontitis”.
Poisons or toxins, developed by the bacteria in plaque and body’s good enzymes incorporate in fighting the infections, proceed to break down the connective tissue as well as bone that hold teeth in place. As the disease advances, the pockets deepen and give rise to destroying more gum tissue and bone. When it happens, teeth get no longer anchored in place and become loose, and thus, tooth loss occurs.
In order to restore periodontal health, it is crucial to remove both plaque and calculus. Your healthcare professional may carry out scaling and debridement for cleaning the area below gum-line. This process may take place with the help of hand tools or ultrasonic device which breaks the calculus and plaque.
Numerous medicated mouthwashes and other treatments are available in dentistry department like antimicrobial mouth rinse, for example, chlorhexidine. It is implemented to control the bacteria at the time of treating gum disease and after surgery. A small piece of gelatine known as an antiseptic chip is also there that is filled with chlorhexidine.
An antibiotic gel can be another option as it controls bacteria and shrinks periodontal pockets. It contains doxycycline, that is an antibiotic. This gel is kept in the pockets after root planning and scaling. Enzyme suppressants are also helpful in keeping destructive enzymes in check with a low-close of doxycycline. Its specialty lies in a fact that some enzymes can break down gum tissue, but this suppressant can delay the response of body’s enzymes. Some oral antibiotics are also available in tablet or capsule form, and they can be taken orally.
If good oral hygiene and non-surgical treatments are not proving to be effective, there are some surgical intervention that may be needed in some cases. The first option is flap surgery. It is done to remove calculus in deep pockets. It is also essential to reduce the pocket so that keeping it cleaned gets easier. The plaque gets removed and gums are lifted back. After that, the gums are sutured back into their place in order to fit closely to the tooth. The gums will heal and fit tightly around the tooth after the surgery.
Another advanced treatment is bone and tissue grafts. This process is helpful in regenerating the bone or gum tissue which has been destroyed. New bone, natural or synthetic, will be placed where the bone was missed in order to promote bone growth. There is a surgical procedure called guided tissue regeneration (GTR) that opts barrier membrane to direct growth of gum tissue and new bone at sites where any of them or both are lacking. This aims to repair defects and regenerate tissues which have resulted from periodontitis.
A tiny piece of mesh-like material is kept between bone and gum tissue in this procedure. After doing this, a barrier gets created for the gum to grow into bone space,that eventually gives a chance for connective tissue as well as a bone to re-develop. The success of this procedure depends upon how advanced the disease is, and how well the patient adheres to a good oral hygiene program.
One can lower the risk of developing periodontitis, or any other health-related complications by keeping up with good oral habits like brushing and flossing daily in order to remove plaque from both teeth and gums. Try to opt for a suitable toothbrush as well as toothpaste twice in every twenty-four hours. It is very important to clean between the teeth or in the spaces where the brush cannot reach as it encourages bacteria to colonize. Dental floss might clean small gaps, but a dental brush is more ideal for cleaning larger space.
Try to take extra care at the time of cleaning around uneven surfaces like crooked teeth, dentures, closely-packed teeth, crowns, fillings, etc. Also, replace your toothbrush in between 3 to 4 months. Do not share your brush with anyone, as bacteria get a chance to pass from person to person.