Periodontal Disease and Treatment


Periodontal disease affects the tooth supporting structures of bone and gums, in the mouth. It often goes undiagnosed because it doesn’t hurt, but as the disease progresses, the infection can result in bone loss and loss of teeth. Treatment of the infected tissue surrounding the teeth and recommended re-care can help to stabilize the condition and reduce tooth loss.

Treatment recommendations can vary depending on the severity of the condition.

What are some common causes of periodontal disease?

There are genetic and environmental factors involved in the onset of gum disease. By evaluating the factors you may have, you can eliminate some and reduce your risks of gum disease.

Here are some of the most common causes of gum disease:

  • Poor Oral Hygiene - Preventing gum disease starts right at home with oral hygiene and diet. Although it is important for patients to do their part at home, it takes a combination of thorough home care and professional care to maintain healthy gums. When bacteria and calculus (tartar) remain on the teeth for long periods of time, the gums and bone around the teeth become affected by bacteria toxins and can cause gingivitis or periodontitis, which can lead to tooth loss.
  • Diet- Bacteria that causes periodontal disease thrives in an acidic environment. Food and drinks such as wine, black tea, coffee, fruits and fruit juice, soft drinks, white bread and several others are categorically acidic and need to be considered as a risk factor.
  • Tobacco Use– Smoking and tobacco use of any form is one of the most significant factors in the development and progression of gum disease. Smokers are at a disadvantage because it suppresses the immune system and slows the rate of recovery and healing, making the odds of success following treatment low. Smoking especially increases inflammation by reducing oxygen in gum tissue. In addition, smokers are far more likely to suffer from calculus (tartar) build up on teeth, deep pockets in the gingival tissue and significant bone loss. The risk increases with the number of cigarettes smoked each day.
  • Genetic Predisposition – Despite patient efforts to comply with proper home care and diet, research has shown as much as 30% of the population may have a strong genetic predisposition to gum disease. Individuals with this type of genetic make up are six times more likely to develop periodontal disease than individuals with no genetic predisposition. Tests can be utilized in order to determine your susceptibility and make you aware if you’re part of the 30%. Remember: early intervention is key in order to keep the oral cavity healthy.
  • Female Hormones

1.) Menstruation: Before menstruation progesterone levels are high (progesterone dilates blood vessels causing inflammation and blocks the repair of collagen and structural proteins that support the gums)

2.) Pregnancy: Pregnancy can aggravate existing gingivitis, however there is such a thing as pregnancy induced gingivitis. Pregnancy gingivitis typically worsens around the 2nd month and reaches its peak in the 8th month. Pregnancy gingivitis increases the risk for preterm low-weight infants. It usually takes a few months after delivery to subside if gingivitis wasn’t present prior to pregnancy.

3.) Oral Contraceptives: Birth control may contain synthetic progesterone, causing inflammation and blocking the repair of structural components of the gum tissue.

4.) Menopause: Estrogen deficiency reduces bone mineral dentistry which can lead to bone loss.

  • Chronic Stress– Stress has as much of a physical component as it does a mental component. Stress plays a huge role in the state of the gums for several reasons. Patients who experience stress may use coping mechanisms that increase their risk for periodontal disease such as nicotine, alcohol or drugs. When under periods of stress the immune system feels threatened and in defensive produces a hormone called cortisone. Scientist believe that the increase in cortisone may lead to destruction of gum tissues and the supportive bone around the the teeth. In addition, stress also lowers the immune systems ability of the to fight off disease, which means bacterial infections within the oral cavity may flourish and the body won’t have the ability to heal.
  • Diabetes and Underlying Medical Issues – Many medical conditions can intensify or accelerate the onset and progression of gum disease including respiratory disease, heart disease, arthritis and osteoporosis. Diabetes, both type I & II causes changes in blood vessels and elevate levels of inflammatory chemicals. In addition diabetes compromises the ability to heal.
  • Heart Disease- Heart health and gum health are directly related. If plaque builds up within the tissue the vascular component of that tissue is pumping that bacteria systemically. When this bacteria passes through the arteries and heart it causes a cycle inflammation and arterial narrowing which can lead to heart attacks. Oral bacterial also increases the risk of clotting which may lead to a stroke.
  • Grinding Teeth – The clenching or grinding of the teeth can significantly damage the supporting tissue surrounding the teeth. Most patients are unaware that they clench or grind their teeth because it commonly occurs during sleep. Grinding and clenching alone destroys the supporting bone of the teeth, and the destruction of those tissues can become accelerated when an individual has periodontal disease.
  • Medication – Many drugs including oral contraceptive pills, heart medicines, anti-depressants and steroids alter the environment of the oral cavity; making patients more susceptible to gum disease. For example, several medications have the side effect of dry mouth. Saliva naturally flushes the mouth of bacteria and helps inhibit the growth of plaque and calculus which are causative factors of gum disease.
  • Wisdom Teeth- Wisdom teeth can be impacted, meaning the tooth is tightly wedged against an adjacent tooth. This poses as an issue because the constant pressure and force of the impacted tooth can eventually compromise the second molars. The second molars roots may reabsorb or cause periodontal pocketing. They may also be partially erupted and in that case hard to maintain due to the difficulty accessing them in order to properly floss and brush them.
  • Poorly Contoured Fillings/Crowns- When fillings and crowns aren’t flush to the tooth surface or if they go below the gum line they tend to trap debris and become a breeding ground for bacteria.
  • Tooth Abnormalities- Crowding or malocclusion encourages the build up of plaque and tartar, which are factories that initiate gum disease.
  • Mouth Breathing- When tissues dry out they become irritated and inflamed.
  • Alcohol Abuse- Alcohol can dry out the gum tissue and make it irritated and inflamed. We’d suggest you also stay away from oral rinses that contain alcohol. In addition studies have revealed that patients whom abuse alcohol are at higher risk for periodontal disease, tooth decay and precancerous lesions.
  • Vitamin C Deficiency- Vitamin C helps the body repair and maintain connective tissue, this vitamin is especially depleted in smokers.
  • Orthodontics- Brackets commonly harbor debris and are difficult and time consuming to floss around, this is more of a matter of patient compliance.

What are some treatment options?

Treatment depends entirely upon the type and severity of the disease. Your dentist and dental hygienist will evaluate for periodontal disease and recommend appropriate treatment.

Periodontal disease progresses as the pocket or space between the tooth and gums gets filled with bacteria, plaque, and tartar, causing irritation to the surrounding tissues. When these irritants remain in the pocket space, they can cause damage and begin to break down and destroy gum tissue and eventually, the bone that supports the teeth!If the disease is caught in the early stages of gingivitis, and no damage has been done, intervention will be key to prevent it from progressing. Intervention may be instructions to alter or eliminate any of the factors from the list above.

If the disease has progressed to more advanced stages, a special periodontal cleaning called scaling and root planing or root debridement therapy(deep cleaning) will be recommended. It is usually done one quadrant of the mouth at a time while the area is numb. In this procedure, tartar, plaque, and toxins are removed from above and below the gum line (scaling) and rough spots on root surfaces are made smooth (planing). This procedure helps gum tissue to heal and pockets to shrink. Special medicated mouth rinses, gels and an electric tooth brush may be recommended to help control infection and healing.

If the pockets do not heal after scaling and root planing, the dentist may recommend that you see a Periodontist (specialist of the gums and supporting bone) so they can further evaluate your condition and help guide you in other treatment options.