Periodontal disease is the most prevalent infection of the oral cavity next to caries. It is the infection of tooth-supporting structures, i.e., the Gingiva, periodontal ligament, cementum, and the tooth-supporting bone. Though it can lead to tooth loss, it can be prevented if proper measures are taken under a dentist’s guidance.
Etiology of gum disease
The primary cause for gingival diseases is plaque, which is nothing but the protein coat that forms teeth. It can be easily removed by efficient brushing. Plaque contains millions of bacteria that attach to the teeth and release noxious chemical by-products that irritate the Gingiva and lead to gums’ inflammation.
Other factors that influence the progression of gingivitis include:
- Overall immune status of the person
- Hormonal changes occurring during puberty, monthly menstrual cycle, pregnancy, menopause make gums more sensitive and increase the inflammatory response.
- Medications that alter the tissues’ response: use of anticonvulsant Dilantin sodium, immunosuppressants like Cyclosporine after kidney transplant, calcium channel blockers like Nifedipine used to treat hypertension. The use of contraceptives alters the response of gums to plaque.
- Poor oral hygiene practices, like not brushing or improper brushing.
- Inability to perform proper brushing due to improper alignment of teeth.
- Bad habits like smoking, use of pan, gutkha, tambaku, etc.
- Systemic diseases may show their manifestations on the gums. For example, diabetes, HIV infection, cancers, viral and bacterial infections, autoimmune conditions, etc.
- Vitamin deficiencies
- Inability to perform proper oral hygiene like physically disabled persons and those who are mentally retarded.
Initiation of gum disease
Due to improper or inadequate brushing, plaque accumulates on teeth. The plaque at the gum margins and between the teeth plays a vital role in starting the inflammation.
Long-standing plaque undergoes calcification to form calculus, which is nothing but tartar. This tartar always has a surface matrix of bacteria that irritates the gums leading to gingivitis. Bacterial by-products irritate the gums and lead to the destruction of underlying structures if untreated, known as periodontitis.
Difference between gingivitis and periodontitis
Gingivitis is the inflammation of gums, which is reversible if the etiological factors are eliminated.
Periodontitis is the inflammation of the tooth-supporting structures. There is the destruction of the periodontal ligament, tooth-supporting bone, and infection of tooth root cementum. All periodontitis cases are previous cases of gingivitis, but not all cases of gingivitis progress to periodontitis.
The progression of gingivitis to periodontitis is dependent on many factors. Periodontitis is associated with periodontal pocket formation and damage of the epithelial attachment to the tooth.
It is nothing but the deepening of the gingival sulcus, i.e., the space between the gum and tooth, which is usually 1 to 3 mm. with the formation of the periodontal pocket, there is food accumulation and stagnation, which further worsens the situation.
Symptoms of gum disease
Gum disease is a silent killer. By the time there are clinical manifestations of periodontal disease, it reaches an advanced stage. Early detection and diagnosis reduce the morbidity and loss of teeth.
After accumulating plaque, there is redness of gums, slight swelling, bleeding on eating hard foods like biting an apple.
Clinical features of gum disease include:
- Red, swollen sensitive gums
- Lousy breath most common patient complaint
- Bleeding on brushing
- Dull pain in the gums
- An urge to dig between the teeth with a toothpick
- Pus exudation from gums
- The appearance of spaces between teeth
- Mobility and shifting of teeth
- Gum recession with exposure of root
- Hypersensitivity
- Pain on chewing
Periodontal disease may involve a single tooth, multiple teeth, or the whole dentition. Therefore, timely Periodontal Treatment is highly important.
Diagnosis of periodontal disease and Periodontal Treatment
A thorough clinical examination by a dentist or periodontist is necessary to determine periodontal disease’s occurrence and extent.
Visual examination for redness, bleeding, swelling, pus exudation, and gums’ firmness is followed by careful probing around and between teeth with a calibrated periodontal probe. The practitioner will check for
- Sulcus depth-more than 3mm indicates periodontal disease
- Mobility of teeth
- Recession of gums
- Bleeding on probing
- Level of attachment
- Extrusion, intrusion, or migration of teeth.
- Wasting diseases of teeth
IOPA X-rays of few teeth, an orthopantomography, or a CBCT may form an adjunct to the right clinical diagnosis. A correlation between clinical and radiological findings helps the dentist in arriving at a final diagnosis. General health condition and attitude of the patient towards treatment, underlying systemic diseases should be taken into consideration while formulating a personalized treatment plan
Treatment of periodontal disease
Simple, uncomplicated gingivitis can be treated with
- Thorough scaling and root planing
- Oral hygiene instructions
- Regular follow up
Periodontitis treatment may include
- Scaling and root planing
- Curettage
- Flap surgery with or without the usage of
- Graft materials
- GTR GBR procedures
- Splinting of teeth to promote healing.
- Oral hygiene instructions
- Follow up
- Prescription of medicines wherever required
- Local drug delivery if needed
Follow-up treatment is necessary as the treatment plan to maintain the gums in health and prevent periodontal disease recurrence. A meticulous maintenance program must be planned so that the periodontium can be maintained in a healthy state.
Prevention of Periodontal disease
As prevention is better than cure, all steps should be taken for early diagnosis and arrest of disease in the early stages. Patients should be educated regarding the proper use of brushing, flossing, irrigation, mouthwashes, other interdental cleaning aids. Every person should go for a dental checkup at least every six months.
They should be motivated to abstain from harmful and deleterious habits. Appreciation during follow-up boosts the patient towards good maintenance.
Wrapping up
Gum diseases affect us both physically as well as mentally. They affect our lives drastically and reduce the health and life of our teeth. So, always prefer to get in touch with the best dentist to check up your gums to avoid gum diseases regularly. You can also contact TruCare for gum disease treatment and Periodontal treatment from experts at an affordable price.