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Periodontitis

Definition

Periodontitis is an advanced form of gum disease. It can cause destruction of the supportive structures around your teeth and lead to permanent tooth loss.
Untreated periodontitis can be serious and lead to complications such as:

Causes

Bacteria grow on your teeth and create a filmy coating called plaque. A build up of this plaque causes an inflammation of the gum tissue, known as gingivitis. If gingivitis is left untreated, the plaque can extend under the gum line can create pockets around the teeth. Bacteria can collect in these pockets and cause regular inflammation and destruction known as periodontitis. Over time, this chronic inflammation and bacteria cause destruction of gum tissue, ligaments, and bones that hold your teeth in place.
nucleus fact sheet image
Untreated gingivitis leading to periodontitis
Copyright © Nucleus Medical Media, Inc.

Risk Factors

Poor oral hygiene including untreated gingivitis increases the risk of periodontitis.
Other factors that can increase bacteria or plaque in your mouth include:
  • Genetics
  • Untreated gingivitis
  • Poor dietary habits
  • Advancing age
  • Uncontrolled diabetes
  • Metabolic syndrome—A condition marked by elevated blood pressure, cholesterol, blood glucose, and body weight. Excess weight centered around the midsection is of particular concern.
  • Suppressed immune system
  • Pregnancy
  • Smoking or chew tobacco

Symptoms

Periodontitis normally occurs without symptoms. In those that have symptoms, periodontitis may cause:
  • Red, swollen, tender, or bleeding gums
  • Receding gums that may expose the root of your teeth
  • Loose teeth or teeth that fall out
  • Persistent bad breath
  • Presence of pus between your teeth
  • Change in the way your teeth fit together when you bite down
  • Swelling of face and jaw
  • Weight loss in elderly

Diagnosis

Your dentist will ask about your symptoms and medical history. A complete oral exam will be done. Periodontal disease can be diagnosed during an oral exam. Your dentist may do x-rays to determine how much damage has been done.

Treatment

The goal of treatment is to stop the bacterial invasion. Further course of treatment depends on the severity and progression of the periodontitis.
Talk to your dentist about the best treatment plan for you. Options include:

Deep Cleaning

A cleaning procedure called scaling and root planing is done first. These will remove excess build-up above and below the gum line, and along the tooth root where bacteria thrive. In some cases, lasers can be used to remove plaque.

Medications

Your dentist may recommend antibiotics to treat any bacterial infection. Antibiotics may be given as:
  • Oral tablets
  • Topical mouthwash
  • Beads that are placed into the infected gum pockets

Surgery

You may need surgery if your periodontitis doesn’t improve with deep cleaning or antibiotic treatment. Surgery may be also necessary to repair damaged gum tissues and bones. Surgical procedures include:
  • Flap surgery—Sections of gum tissue are opened to access the root of the tooth for deep cleaning. The gum tissue is reshaped and put back into position.
  • Bone and tissue graft—Tissue from another part of your body is used as a base to promote regrowth of healthy gum, bone, or connective tissue.
  • Enamel matrix application—A special gel is applied to the tooth root to stimulate growth of healthy bone and tissue.
  • Dental implants—An artificial tooth is placed in the jaw to hold a replacement tooth or bridge.

Prevention

To help reduce your chance of developing periodontitis, take these steps:
  • Brush your teeth and tongue with fluoride toothpaste at least two times per day
  • Use a soft-bristled toothbrush or a powered toothbrush if advised by your dentist
  • Floss your teeth once per day
  • Use a mouthwash after brushing and flossing your teeth
  • If you smoke or chew tobacco, talk to your doctor or dentist about how you can quit successfully
  • See your dentist as recommended for regular cleanings and check-ups

RESOURCES

American Academy of Periodontology http://www.perio.org

American Dental Association http://www.mouthhealthy.org

CANADIAN RESOURCES

Canadian Dental Association http://www.cda-adc.ca

Public Health Agency of Canada http://www.phac-aspc.gc.ca

References

Periodontal (gum) disease: Cause, symptoms, and treatment. National Institute of Dental and Craniofacial Research website. Available at: http://www.nidcr.nih.gov/OralHealth/Topics/GumDiseases/PeriodontalGumDisease.htm. Updated August 2012. Accessed November 6, 2013.

Periodontal treatments and procedures. American Academy of Periodontology website. Available at: http://www.perio.org/consumer/treatments%5Fprocedures. Accessed November 6, 2013.

Periodontitis. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated August 22, 2013. Accessed November 6, 2013.

What is gum disease? Academy of General Dentistry Know Your Teeth website. Available at: http://www.knowyourteeth.com/infobites/abc/article/?abc=G&iid=324&aid=1251. Updated January 2012. Accessed November 6, 2013.

What is periodontal disease? American Academy of Periodontology website. Available at: http://www.perio.org/patient-resources. Accessed November 6, 2013.

5/28/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Nibali L, Tatarakis N, et al. Clinical review: Association between metabolic syndrome and periodontitis: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2013;98(3):913-920.

7/13/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed. Yaacob M, Worthington HV, et al. Powered versus manual toothbrushing for oral health. Cochrane Database Syst Rev. 2014 Jun 17;6.

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