Welcome to the patient information page about periodontitis.
We are providing the information about periodontitis based on EFP website (http://www.efp.org/)
because their information is well accepted in the world and trustworthy.The EFP
(European Federation of Periodontology) is one of the largest dental organizations
in Europe currently with 28 National Periodontal member Societies.
Please see below if you need information about periodontitis.
What is Periodontology?
Periodontology is the study of the specialized system of hard and soft tissues
that supports your teeth and maintains their position in the jaw. This apparatus,
known as the periodontium, has some very important functions:
it securely attaches the teeth to the jaws; it acts as a shock absorber during
biting and chewing and therefore helps to prevent damage to the teeth from excessive
forces; and it maintains the teeth in a stable position within the jaws so that
that they work together efficiently and comfortably during chewing.
The periodontium is made up of several component structures that
work together. The tooth socket is the bony pouch in the upper
or lower jawbone in which the tooth is positioned. Below the gums,
the supporting root/roots of the teeth, which are not usually visible in a healthy
mouth, extend down into the tooth socket and are covered by a
layer of cementum. Extending between the root cementum and the bony socket is a complex arrangement of tiny fibres,
known as the periodontal ligament, which holds the tooth in place
almost like a sling. Because the different parts of the periodontium are made
from living tissues, they are able to adapt to changes in our mouths over time,
making the tiny changes in shape and thickness that keep the position of the teeth
stable.
What is Periodontitis?
Periodontitis is a very common condition in which the gums and deeper periodontal
structures become inflamed. This inflammation of the gums, which usually takes
the form of redness, swelling and a tendency to bleed during tooth brushing, is
the body’s response to certain bacteria that have been allowed to accumulate on
the teeth. Although part of the body’s defence system, this inflammatory response
can eventually cause serious damage. If left unchecked, the inflammation can spread
down below the gums and along the roots of the teeth, causing destruction of the
periodontal ligament and the supporting bone. This ultimately leads to the loosening
and potential loss of the teeth.
What is a Periodontist?
Periodontists are dental practitioners who specialize in the prevention and treatment
of diseases of the tooth-supporting tissues - the periodontium. Although all dentists
receive training in the diagnosis and treatment of mild to moderate periodontal
disease, it is usual practice to refer severe or complex cases to a periodontist,
who will have undertaken additional training and acquired special expertise in
the area.
Within the field of periodontology, there is also a range of different specialities
which focus on particular types of treatment; for example, some dentists may focus
their practice on providing implant therapy to replace missing teeth.
More on Periodontitis
What is periodontitis?
Periodontitis is inflammation of the gums and supporting structures of the teeth.
It is one of the most common human diseases.
Periodontitis is caused by certain bacteria (known as periodontal bacteria) and
by the local inflammation triggered by those bacteria. Although these periodontal
bacteria are naturally present in the mouth, they are only harmful when the conditions
are right for them to increase dramatically in numbers. This happens when a layer
of bacteria and food debris, known as plaque, builds up and is left undisturbed
on the teeth, commonly in hard-to-reach areas such as between the teeth. The more
dangerous bacteria are able to thrive and multiply, producing some harmful by-products
which stimulate the body’s defensive inflammatory response in the gums. As the
disease progresses, chronic inflammation causes the bone of the jaw to be destroyed
and the teeth to be lost. In many people, this is a gradual process that takes
place over many years and, if detected and treated, can be halted. However, some
young adults have a very active form of the disease which causes early loosening
and loss of the teeth.
How can I recognise periodontitis?
Periodontitis always begins with inflammation of the gums, known as gingivitis.
This is not always easy to recognize but one of the first signs that you may become
aware of is bleeding from the gums when you brush your teeth. The gums may look
red and swollen and you might notice a discoloured layer of bacterial plaque on
the teeth.
Left untreated, gingivitis may progress to periodontitis, often without any obvious
signs to alert you. However, some changes that you might experience over time
include: increased bleeding from the gums, which may be provoked by brushing or
eating, or even be spontaneous; bad breath; changes in the positioning of the
teeth in the jaws; lengthening of the teeth (gum recession); and possibly pain.
Bleeding from the gums may be less noticeable in smokers, because of the effect
of nicotine on blood vessels, and so the disease process may be masked.
It often happens that the presence of periodontitis is not recognized by an individual
until they are 40 or 50 years of age, by which time a great deal of damage may
have occurred. However, a dentist is able to detect signs of the disease at a
much earlier stage during a routine examination and can monitor your periodontal
status using a special assessment known as the Periodontal Screening Index.
What are the causes of periodontitis?
A healthy mouth is colonized by more than 700 different species of bacteria, most
of which are completely harmless and live in harmony with their host. However,
when tooth cleaning is not thorough enough, the bacterial deposits build up next
to the gums, forming a plaque, and the conditions become suitable for more dangerous
bacteria to flourish. The natural defences of the body are also compromised.
In all cases, periodontitis is caused by the build-up of bacteria
in the form of dental plaque.
If the soft bacterial plaque is not removed by brushing, minerals are deposited
within it over time and it becomes a hard deposit on the tooth called tartar.
The presence of tartar encourages the growth of the bacterial plaque towards the
tooth roots. As the inflammation progresses deeper, the attachment of the gum
to the root is disrupted and a gap or periodontalpocket is formed
between them. This pocket is an ideal place for harmful bacteria to colonize and
in which to multiply, therefore driving the disease process forward. In their
new habitat, the bacteria release toxins as products of their metabolism, which
further trigger the body’s defence mechanisms.
The severity and speed of progression of periodontitis depends upon the balance
of a number of factors: the number and type of bacteria present,
how strong the individual’s defence mechanisms are, and the presence
or absence of certain risk factors. For example, the more aggressive
the bacteria and the weaker the immune response of the patient, the more active
will be the disease. Added to that, some risk factors, such as smoking or diabetes,
can further weaken the body’s defences and speed up the disease process. In the
same way, certain drugs, such as antihypertensive or vasodilating agents and immunotherapy,
affect the inflammatory response to plaque and make patients more susceptible
to gingivitis. However, it is important to recognize that, without the accumulation
of bacterial plaque, periodontitis will not occur.
What can I do to prevent periodontal disease?
Periodontal inflammation is not inevitable. The development of gingivitis and
periodontitis can be prevented by adopting thorough oral hygiene habits, alongside
regular professional examinations and support.
The basic elements of a good oral hygiene regime are:
Cleaning the chewing surfaces and sides of the teeth twice daily, with a
toothbrush (of an appropriate size and in good condition) and toothpaste.
Cleaning the spaces between the teeth where the toothbrush bristles cannot
reach, using either dental floss or an interdental brush, depending on the size
of the space. This should be done once daily.
Dental floss should be used where the teeth are close together, with little or
no space between them, while interdental brushes are suitable for larger gaps.
Special care should be taken to clean thoroughly around crooked or crowded teeth,
or around fillings, crowns and dentures, as plaque accumulates readily in these
places and access might be limited.
Antibacterial mouthwashes are a useful supplement to brushing, as they inhibit
bacterial growth and dampen inflammatory changes. They should be used after tooth
brushing.
If, as a result of an inadequate cleaning technique, plaque deposits are left
on the teeth, these will become mineralised and turn into hard, fixed deposits
(calculus, commonly known as tartar) that cannot be removed with a toothbrush.
Your dentist or periodontist will identify these tartar deposits during your regular
dental inspection and remove them as part of a professional clean. After the deposits
are removed, the teeth are polished with special pastes and cups to create a smooth
surface that is less likely to accumulate plaque.
What are the consequences of periodontal disease?
Periodontitis is the leading cause of tooth
loss.
If the progress of periodontal inflammation is not halted, the supporting structures
of the teeth, including the surrounding bone, are destroyed. The teeth eventually
loosen and are lost, or require extraction. Other problems patients may experience
include painful abscesses, drifting of the teeth which may interfere with eating,
and unsightly lengthening of the teeth with exposure of the roots, as a result
of gum recession.
It is now understood that untreated periodontal disease can have effects
on general health; for example, it poses an increased risk for complications
during pregnancy (pre-eclampsia, premature birth and low birth weight) and also
an increased risk for heart disease and diabetes.
What are the risk factors for periodontitis?
There are a number of factors that increase your chance of developing periodontitis
and make it more likely to progress. Well-known risk factors include stress, some
systemic diseases such as diabetes, and - most importantly - smoking.
Smoking and periodontitis
Smokers are significantly more likely to develop periodontitis than non-smokers.
Periodontal treatments (such as gum/ bone grafts and implants) are less successful
in smokers than non-smokers due to poorer healing.
Periodontitis progresses much faster, with more rapid tooth loss, in smokers.
Of cases of periodontitis which does not respond to treatment, about 90%
are in smokers.
How is periodontitis treated?
With careful assessment and treatment, it is usually possible to completely halt
the progress of periodontitis. The key to success is to eliminate the bacterial
plaque which is triggering the disease process and to establish excellent oral
hygiene practices.
Oral hygiene instruction and advice
The aim of the oral hygiene phase of treatment is to reduce the number of bacteria
in the mouth and therefore reduce the level of inflammation. Your dental practitioner
will first explain the causes of your periodontitis and explain exactly how to
keep your teeth and gums clean. You will be given individual advice on how to
use the various cleaning aids most effectively; for example, the most appropriate
tooth brushing technique and the correct use of dental floss and interdental brushes.
Professional cleaning
All soft deposits will be removed from accessible areas of the teeth and the teeth
polished and treated with fluoride. Depending on the improvement seen in plaque
control and gum health, further instruction and cleaning may be carried out in
subsequent visits. The next step would be for your practitioner to remove all
bacterial deposits and tartar from the root surfaces and gingival pockets.
Antibiotic therapy
In some cases, with or without microbiological evaluation, antibiotics are prescribed
to deal with active or persistent gum infections, which have not responded to
oral hygiene measures.
Reassessment
After several weeks, your dentist or periodontist will make a full assessment
of your gums to check the progress of your treatment. A special instrument called
a periodontal probe is used to record the depth of any periodontal pockets and
check for bleeding from the gums. If periodontal pockets are still present, further
treatment options may be suggested, including surgical corrective therapy.
Corrective (surgical) treatment
Sometimes, a surgical procedure is carried out to clean away plaque bacteria and
deposits that are under the gum within periodontal pockets and on the root surfaces
at the furcations (where the roots diverge). These areas are inaccessible to brushes
and floss and inflammation will persist in these sites as long as bacteria are
allowed to colonize them. Under local anaesthesia, the gum is lifted away and
the root surfaces are cleaned under direct vision to ensure that all bacteria
are removed. Sometimes, it is possible to treat bone loss at the same time using
a special regenerative treatment. At the end of the procedure, the gums are sutured
back into place around the teeth.
Aftercare-supportive periodontal therapy
The long-term success of periodontal treatment depends both on your own efforts
with oral hygiene and those of the practice team who provide your regular care
and ongoing assessment. After the first phase of treatment has been completed,
your dentist will need to review the condition of your gums at regular intervals
to check that the inflammation has been halted. The frequency of your follow-up
appointments will depend on the severity of disease and your individual risk of
disease progression. Usually, follow-up visits are scheduled for every three to
six months.
Regular follow-up appointments are vitally important to ensure that the disease
process does not recur, causing further destruction of the gums and supporting
bone. If there are signs of continuing disease, your dentist will be able to identify
new or recurring sites of inflammation and treat them at an early stage. You will
also be given advice on how to modify your oral hygiene practices to tackle the
inflammation.
Successful periodontal treatment requires your full co-operation in regard
to daily oral hygiene practices and attendance at regular follow-up appointments.
How healthy are your gums?
Check the health of your gums by asking yourself the following questions:
Are your gums swollen? (Compare the appearance of your gums with those in
the picture of healthy gums in the right)
Do your gums bleed when you are brushing, or when you use a toothpick or
other cleaning device?
Have your gums shrunk back or receded, so that your teeth appear lengthened?
Are you aware of any loosening of your teeth?
Do you see any yellowish, pus-like fluid at the gum line when you massage
your gums?
Have your teeth drifted or changed position, and have any gaps appeared between
them?
Have your parents or siblings lost teeth prematurely due to tooth loosening?
If you have answered one or more of these questions with ‘yes’, you should
contact your dental practice for a periodontal assessment.
Don’t forget that regular check-up appointments with your dentist (at least twice
yearly) will enable your dentist to check your periodontal health.
Why is periodontology important?
In many ways, the mouth can be seen as a mirror of the general condition of your
body. In particular, our periodontal status can often tell us more than simply
what is happening locally in our gums. Although periodontitis is always triggered
by plaque accumulation on the teeth, diseases affecting the rest of the body,
known as systemic diseases, can weaken the supporting structures of the teeth.
Also, some serious disorders are known to show themselves in the mouth before
they are evident in any other part of the body. Therefore, it is sometimes the
case that a trained periodontist is the first person to detect the signs of a
general disease, such as diabetes or blood disorders, when examining a patient’s
mouth. Because of this association with general health and overlap with other
medical disciplines, periodontology can rightly be regarded as a ‘holistic’ form
of dentistry.
Other conditions that affect periodontal health
There are a number of general conditions which can affect your chances of developing
periodontitis and potentially put you into a high-risk category. Sometimes, the
effects of the disease itself increase your risk of gum problems - for example,
in diabetes; in other cases, the medications prescribed may have a damaging effect
- for example, phenytoin taken for epilepsy or nifedipine for high blood pressure.
High blood pressure
If you suffer high blood pressure, you should be aware of the possible effects
of your prescribed medication on the health of your gums. This knowledge allows
you to take steps to protect yourself against gum problems and tooth loss.
High blood pressure medications and thickening of the gums
If you have been diagnosed with high blood pressure, it is likely that you will
have to take antihypertensive medications over a long period. One group of antihypertensive
medications, known as calcium antagonists - for example, nifedipine, amlodipine
and felodipine - can cause a troublesome overgrowth of the gums in some susceptible
individuals. This is not only unsightly but can cause difficulty in chewing if
it is allowed to advance. Furthermore, the enlarged and misshapen gums make effective
tooth cleaning impossible and enable plaque to accumulate. This results in inflammation
of the gums (gingivitis), which may progress to the destruction
of the tooth-supporting tissues (periodontitis) and possible
tooth loss.
What can you do to tackle the problem?
Although the blood pressure medication may be responsible for causing changes
in the size and shape of the gums, the presence of dental plaque around the teeth
remains the most important factor in causing periodontitis, because the inflammatory
changes are triggered by periodontal bacteria. Furthermore, gum overgrowth tends
to be worse in sites where bacteria accumulate readily and usually begins between
the teeth. This sets up a vicious cycle, because the overgrown areas then become
even more difficult to clean because of the extra gum tissue. Efficient plaque
removal is therefore the key to limiting the gum overgrowth and preventing inflammation,
tissue destruction and tooth loss.
Daily care at home
If you are taking antihypertensive medications, it is essential that you maintain
a regular and thorough oral hygiene routine at home, including careful tooth brushing
and interdental cleaning, with small brushes or floss. Your dentist will demonstrate
the correct techniques for your mouth. Fluoride toothpastes, mouthwashes and gels
will help provide protection against tooth decay.
Professional care
Your dentist will be able to provide personalised preventive care to care for
your gums, including professional tooth cleaning, medical treatments and advice.
It is advisable to have your teeth professionally cleaned at least twice a year;
at these visits, all soft and hard deposits are removed by a specially trained
professional (a dentist or hygienist) and your oral hygiene practices are reviewed
and adjusted if necessary. These measures are often successful in reducing mild
overgrowth of the gums and will help prevent further enlargement.
In some cases, when the gum overgrowth is advanced despite thorough cleaning,
it may be necessary to consider minor surgery to remove some of the overgrown
gum tissue and give better access for cleaning. This option would be discussed
fully with you, after careful consideration by the professional team responsible
for your care, including your medical specialist, dentist and/or periodontist.
Changing medication or dosage
It is sometimes possible to reduce the dosage of blood pressure-lowering medication
or to consider switching to an alternative medication. This is something which
should never be undertaken independently, but requires a full consultation with
the medical practitioner who is responsible for your prescription, so that you
can be sure that your blood pressure continues to be adequately controlled.
The long-term success of treatment depends on the combined efforts of
you and your dental professional.
Are you diabetic and more than 40 years old?
If the answer is yes, please read the important information below, which
relates to your dental health.
Diabetes mellitus - a condition in which the body is unable to control its sugar
levels properly - is an increasingly common disease in Western countries, affecting
at least 5% of the population. In fact, it is thought likely that only about half
of people affected with diabetes have actually been diagnosed. Overall, 80% of
known diabetics are more than 40 years of age, with just 0.05% below the age of
15 years.
Dentists now know that, in patients with diabetes, untreated periodontal disease
progresses very rapidly, often leading to early tooth loss. In addition, wound
healing following dental extractions is often very slow and inefficient in these
individuals. Other problems that might be encountered are abscesses (painful infections),
gingivitis with ulcers or sores, and fissures or cracks at the corners of the
mouth. Anti-diabetic medications may also cause a patient to suffer from a very
dry mouth, which makes dental decay more likely.
Diabetes and periodontal disease
Patients with Type 1 (primary, insulin-dependent) diabetes and the more common
Type 2 (non-insulin dependent) diabetes each have a three times greater risk of
periodontitis, compared with non-diabetic individuals. There is also a higher
chance that they will suffer bone loss and experience an active and rapid form
of the disease. In turn, the presence of unrecognized or untreated periodontitis
makes it more likely that their diabetes will be poorly controlled. Therefore,
treatment of periodontal disease in diabetic patients is crucial, not only to
preserve the teeth, but to help prevent possible complications of uncontrolled
diabetes.
It is important - and heartening - to realise that a patient with well-controlled
diabetes has no greater risk of periodontal disease than a non-diabetic person.
This is why it is very important to make sure that blood sugar levels are under
good control when combating periodontal disease - the better the diabetic control,
the more successful periodontal treatment will be.
Kidney disease and dialysis
One potential complication of diabetes mellitus, especially when it is poorly
controlled, is irreversible damage to the kidneys. This damage may progress over
time until kidney function is severely impaired and either dialysis or a kidney
transplant is necessary.
It is very important for the overall health of patients with kidney disease that
their mouth should be free from inflammation and bacterial build-up. However,
oral hygiene can be a low priority for dialysis patients, because of the demands
of their treatment for kidney disease, with the result that periodontal disease
and tooth decay are commonly seen. This is an added disease burden for the body
and is likely to weaken its ability to cope with the systemic disease. Excellent
oral hygiene and treatment of all decayed teeth is essential.
What measures can you take to help yourself?
Personal care at home
Your cooperation with the oral hygiene recommendations of your dentists is vital
to the success of preventive treatment. It is essential that you maintain a regular
and thorough cleaning routine at home, including careful tooth brushing twice
daily and interdental cleansing once daily. Fluoride toothpastes, mouthwashes
and gels will help provide protection against tooth decay.
Professional care
Your dentist will be able to provide personalised preventive care to care for
your gums, including professional tooth cleaning, medical treatments and advice.
It is advisable to have your teeth professionally cleaned at least twice a year;
at these visits, all soft and hard deposits are removed by a specially trained
professional (a dentist or hygienist) and your oral hygiene practices are reviewed
and adjusted if necessary. It is very important to attend regular follow-up appointments,
so that your condition can be closely monitored.
For the best treatment result, it is crucial that your diabetes is under
excellent control.
The long-term success of periodontal treatment depends on the joint efforts of
you and your dental practitioner.
Organ transplant recipients and the risk of periodontitis
Before organ transplantation is carried out, the mouth should be free of periodontal
disease and dental decay. Therefore, it is important to arrange to be examined
by your dentist in advance of the operation, so that decisions can be made about
any necessary treatment, in conjunction with your transplant specialist.
After the transplant procedure, you will need to take long-term immunosuppressivetherapy in order to prevent organ rejection and this will place you at increased risk
of periodontal disease. One of the most commonly used immunosuppressive drugs
is called cyclosporine A. Medications to lower blood pressure, such as calcium
antagonists, are also often prescribed to transplant recipients. In many people,
these medications cause a thickening of the gums, known as gingival hyperplasia,
after a few months of treatment and this outcome is known to be more likely if
inflammation is already present in the gums. The gum enlargement develops mainly
between the teeth, appearing as small swellings, but it may develop into more
generalised bulging of the gums. The overgrown gums partially cover the teeth
and make plaque removal very difficult, leading to the onset of inflammation.
What measures can you take to help yourself?
Personal care at home
Your cooperation with the oral hygiene recommendations of your dentists is vital
to the success of preventive treatment. It is essential that you maintain a regular
and thorough cleaning routine at home, including careful tooth brushing twice
daily and interdental cleansing once daily. Fluoride toothpastes, mouthwashes
and gels will help provide protection against tooth decay.
Professional care
Your dentist will be able to provide personalised preventive care to care for
your gums, including professional tooth cleaning, medical treatments and advice.
It is advisable to have your teeth professionally cleaned at least twice a year;
at these visits, all soft and hard deposits are removed by a specially trained
professional (a dentist or hygienist) and your oral hygiene practices are reviewed
and adjusted if necessary. It is very important to attend regular follow-up appointments,
so that your condition can be closely monitored.
If a combination of oral hygiene measures and professional cleaning is not enough
to reduce or limit the gum overgrowth to a manageable level, your dental practitioner
might suggest that you have surgery to trim and reshape the gum, to improve the
appearance, function and access for home care. Your dentist will liaise with your
physician to make sure that you have the correct antibiotic and steroid cover
for this procedure.
Phenytoin use in epilepsy
If you need to take phenytoin to control your epilepsy, read on to find
out how your medication could put you at risk of periodontal disease and what
you can do about it.
Phenytoin is an anticonvulsant drug, which is sometimes used in the treatment
of epilepsy. In some people, it causes an overgrowth of the gums which makes cleaning
of the teeth very difficult. As a result, bacterial plaque accumulates and triggers
inflammatory changes in the gums, leading to gingivitis and, potentially, periodontitis.
The enlargement of the gums is more likely to happen if the patient’s oral hygiene
is poor or if there are already inflammatory changes present in the gums when
treatment is started.
What measures can you take to help yourself?
Personal care at home
Your cooperation with the oral hygiene recommendations of your dentists is vital
to the success of preventive treatment. It is essential that you maintain a regular
and thorough cleaning routine at home, including careful tooth brushing twice
daily and interdental cleansing once daily. Fluoride toothpastes, mouthwashes
and gels will help provide protection against tooth decay.
Professional care
Your dentist will be able to provide personalised preventive care to care for
your gums, including professional tooth cleaning, medical treatments and advice.
It is advisable to have your teeth professionally cleaned at least twice a year;
at these visits, all soft and hard deposits are removed by a specially trained
professional (a dentist or hygienist) and your oral hygiene practices are reviewed
and adjusted if necessary. It is very important to attend regular follow-up appointments,
so that your condition can be closely monitored.
If a combination of oral hygiene measures and professional cleaning is not enough
to reduce or limit the gum overgrowth to a manageable level, your dental practitioner
might suggest that you have surgery to trim and reshape the gum, to improve the
appearance, function and access for home care. Your dentist will liaise with your
physician to make sure that you have the correct antibiotic and steroid cover
for this procedure.
