What is periodontal disease?
If you have been told you have periodontal (gum) disease, you're
not alone. An estimated 80 percent of American adults currently have
some form of the disease.
Periodontal diseases range from simple gum inflammation to serious
disease that results in major damage to the soft tissue and bone that
support the teeth. In the worst cases, teeth are lost.
Gum disease is a threat to your oral health. Whether it is stopped, slowed, or
gets worse depends a great deal on how well you care for your teeth
and gums every day, from this point forward.
Our mouths are full of bacteria. These bacteria, along with mucus
and other particles, constantly form a sticky, colorless "plaque" on
teeth. Brushing and flossing help get rid of plaque. Plaque that is
not removed can harden and form bacteria-harboring "tartar" that
brushing doesn't clean. Only a professional cleaning by a dentist or
dental hygienist can remove tartar.
- Gingivitis: The longer plaque and tartar are on teeth,
the more harmful they become. The bacteria cause inflammation of the
gums that is called "gingivitis." In gingivitis, the gums become
red, swollen and can bleed easily. Gingivitis is a mild form of gum
disease that can usually be reversed with daily brushing and
flossing, and regular cleaning by a dentist or dental hygienist.
This form of gum disease does not include any loss of bone and
tissue that hold teeth in place.
- Periodontitis: When gingivitis is not treated, it can
advance to "periodontitis" (which means "inflammation around the
tooth.") In periodontitis, gums pull away from the teeth and form
"pockets" that are infected. The body's immune system fights the
bacteria as the plaque spreads and grows below the gum line.
Bacterial toxins and the body's enzymes fighting the infection
actually start to break down the bone and connective tissue that
hold teeth in place. If not treated, the bones, gums, and connective
tissue that support the teeth are destroyed. The teeth may
eventually become loose and have to be removed.
risk factors contribute to periodontal disease?
- Smoking: Need another reason to quit smoking? Smoking is
one of the most significant risk factors associated with the
development of periodontitis. Additionally, smoking can lower the
chances of success of some treatments.
- Hormonal changes in women: These changes can make
gums more sensitive and make it easier for gingivitis to develop.
- Diabetes: People with diabetes are at higher risk for
developing infections, including periodontal disease.
- Stress: Research shows that stress can make it more
difficult for our bodies to fight infection, including periodontal
- Medications: Some drugs, such as antidepressants and some
heart medicines, can affect oral health because they lessen the flow
of saliva. (Saliva has a protective effect on teeth and gums.)
- Illnesses: Diseases like cancer or AIDS and their
treatments can also affect the health of gums.
- Genetic susceptibility: Some people are more prone to
severe periodontal disease than others.
Who gets periodontal disease?
People usually don't show signs of gum disease until they are in
their 30s or 40s. Men are more likely to have periodontal disease than
women. Although teenagers rarely develop periodontitis, they can
develop gingivitis, the milder form of gum disease. Most commonly, gum
disease develops when plaque is allowed to build up along and under
the gum line.
What can I do to
prevent periodontal disease?
Here are some things you can do to prevent periodontal diseases:
- Brush your teeth twice a day (with a fluoride toothpaste)
- Floss every day
- Visit the dentist routinely for a check-up and professional
- Eat a well balanced diet
- Don't use tobacco products
How do I know if I have periodontal disease?
Symptoms are often not noticeable until the disease is advanced.
- Bad breath that won't go away
- Red or swollen gums
- Tender or bleeding gums
- Painful chewing
- Loose teeth
- Sensitive teeth
Any of these symptoms may signal a serious problem, which should be
checked by a dentist. At your dental visit:
- The dentist will ask about your medical history to identify
underlying conditions or risk factors (such as smoking) that may
contribute to periodontal disease.
- The dentist or hygienist will examine your gums and note any
signs of inflammation.
- The dentist or hygienist will use a tiny ruler called a 'probe'
to check for periodontal pockets and to measure any pockets. In a
healthy mouth, the depth of these pockets is usually between 1 and 3
- The dentist or hygienist may take an x-ray to see whether there
is any bone loss.
- The dentist may refer you to a periodontist, a specialist who
treats gum diseases.
How is periodontal disease treated?
The main goal of treatment is to control the infection. The number
and types of treatment will vary, depending on the extent of the gum
disease. Any type of treatment requires that the patient keep up good
daily care at home. Additionally, modifying certain behaviors, such as
quitting tobacco use, might also be suggested as a way to improve
- Deep Cleaning (Scaling and Root Planing): The dentist,
periodontist, or dental hygienist removes the plaque through a
deep-cleaning method called scaling and root planing. Scaling means
scraping off the tartar from above and below the gum line. Root
planing gets rid of rough spots on the tooth root where the germs
gather, and helps remove bacteria that contribute to the disease.
- Medications: Medications may be used with treatment that
includes scaling and root planing, but they cannot always take the
place of surgery. Depending on the severity of gum disease, the
dentist or periodontist may still suggest surgical treatment.
Long-term studies will be needed to determine whether using
medications reduces the need for surgery and whether they are
effective over a long period of time. Here are some medications that
are currently used:
- Prescription antimicrobial mouthrinse- A
prescription mouthrinse containing an antimicrobial called chlorhexidine
to control bacteria when treating gingivitis and after gum surgery.
It is used like a regular mouthwash.
- Antiseptic "chip"- A tiny piece of
gelatin filled with the medicine chlorhexidine to control bacteria
and reduce the size of periodontal pockets. It is used after root
planing and placed in the pockets where the medicine is slowly
released over time.
- Antibiotic gel- A gel that contains the antibiotic doxycycline
used to control bacteria and reduce the size of periodontal pockets. The periodontist puts it in the pockets
after scaling and root planing. The antibiotic is released slowly
over a period of about seven days.
- Antibiotic micro-spheres- Tiny, round particles that contain the
antibiotic minocycline to control bacteria and reduce the size
of periodontal pockets. The periodontist puts the micro-spheres
into the pockets after scaling and root planing. The particles
release minocycline slowly over time.
- Enzyme suppressant- A low dose of the medication doxycycline that
keeps destructive enzymes in check. If not controlled, certain enzymes can break down gum tissue.
It is used to hold back the body's enzyme response. This medication is in pill form
and used in combination with scaling and root planing.
- Flap Surgery- Surgery might be necessary if inflammation
and deep pockets remain following treatment with deep cleaning and
medications. A periodontist may perform flap surgery to remove
tartar deposits in deep pockets or to reduce the periodontal pocket
and make it easier for the patient, dentist, and hygienist to keep
the area clean. This common surgery involves lifting back the gums
and removing the tartar. The gums are then sutured back in place so
that the tissue fits snugly around the tooth again.
- Bone and Tissue Grafts- In addition to flap surgery, your
periodontist may suggest bone or tissue grafts. Grafting is a way to
replace or encourage new growth of bone or gum tissue destroyed by
periodontitis. A technique that can be used with bone grafting is
called guided tissue regeneration, in which a small piece of
mesh-like fabric is inserted between the bone and gum tissue. This
keeps the gum tissue from growing into the area where the bone
should be, allowing the bone and connective tissue to regrow.
Since each case is different, it is not possible to predict with
certainty which grafts will be successful over the long-term.
Treatment results depend on many things, including severity of the
disease, ability to maintain oral hygiene at home, and certain risk
factors, such as smoking, which may lower the chances of success.
Ask your periodontist what the level of success might be in your
- Getting a Second Opinion About Treatment: When
considering any extensive dental or medical treatment options, you
should think about getting a second opinion. To find a dentist or
periodontist for a second opinion, call your local dental society.
They can provide you with names of practitioners in your area.
Additionally, dental schools may sometimes be able to offer a second
opinion. Call the dental school in your area to find out whether it
offers this service.
Information for this
article provided by:
NIDCR (National Institute of Dental and Craniofacial Research)
NIH Publication No. 02-1142
Last Reviewed November 2004