Genetic: Periodontal Disease

Definition
Description
Demographics
Causes and Symptoms
Diagnosis
Treatment
Prognosis
Prevention
The Future
For more information

Definition

Periodontal disease refers to inflammation of the gums and damage to the tissues beneath the gums caused by bacteria that live in the mouth. Gingivitis is the term that dentists use for inflammation that is limited to the gums. Disease that affects the tissues and bone beneath the gums is called periodontitis. In severe cases, periodontal disease can lead to the loss of teeth. There is also some possibility that it can also lead to an increased risk of heart disease and stroke, but researchers are still studying the issue.

Description

Periodontal disease is a disorder of the gums that can lead to sore, swollen gums that bleed easily or even to the eventual loss of teeth. It develops slowly over a period of years in most people and often has no early symptoms at all. The first stage of periodontal disease is called gingivitis or inflammation of the gums. The inflammation is caused by bacteria that live in the mouth in a sticky film called plaque. The bacteria can attack the teeth along the gum line if they get into the small space between a tooth and the gum known as a sulcus. If a person does not remove the plaque by regular brushing and flossing, the bacteria in or near the sulci

release toxins that damage the gums and cause them to pull away from the base of the teeth. The person may notice that his or her gums look red or swollen, or that the gums bleed after brushing or biting into a hard food like an apple. The person may also have a bad taste in the mouth.

The next stage in periodontal disease is called periodontitis. If the gingivitis is not treated, the bacteria in the plaque multiply inside the pockets that are formed as the sulcus at the base of each tooth is enlarged. The bacteria continue to secrete toxins, and the body's immune response to the infection combines with the toxins to break down the connective tissues underneath the gums and the underlying bone. If this process is not stopped by appropriate treatment, the teeth become loosened and may fall out or have to be pulled.

Demographics

Periodontal disease is a common health problem among adolescents and adults in developed countries. It is estimated that 50 percent of teenagers and 80 percent of adults in the United States have some form of gum disease. Periodontal disease—not aging—is the largest single cause of tooth loss.

There are a number of risk factors for periodontal disease:

• Smoking or chewing tobacco. Tobacco use is the largest single risk factor for gum disease because it lowers the immune system's response to the bacteria that live in the mouth. It also interferes with the effectiveness of treatments for periodontal disease.
• Diabetes. Poor control of blood sugar levels speeds up the loss of soft tissue and bone in the mouth.
• Medications. Birth control pills, anti-seizure drugs, steroid medications, and anticancer drugs can all increase the risk of gum disease.
• False teeth that don't fit properly.
• Crooked teeth.
• Poor nutrition.
• Pregnancy. The hormonal changes of pregnancy make a woman's gums more vulnerable to infection.
• Emotional stress. High stress levels weaken the body's immune system, including its ability to fight off bacteria in the mouth.
• Fillings that have cracked or become loose.
• Genetic factors. In the United States, African Americans have higher rates of periodontal disease than members of other ethnic or racial groups. In Europe, people from the countries closer to the Mediterranean Sea have higher rates of periodontal disease than people from northern Europe.

Causes and Symptoms

The basic cause of periodontal disease is infection of the gums by bacteria living in the plaque that forms on the teeth and the gums after a person eats. The intensity of the body's immune response to the inflammation— which varies from person to person—is an additional factor, as are diseases like diabetes or AIDS that affect the whole body.

The symptoms of periodontal disease include:

• Sore or swollen gums
• Bleeding from the gums after brushing or flossing
• Bad breath
• An unpleasant or metallic taste in the mouth
• Visible shrinking of the gums and exposure of the roots of the teeth
• Increased sensitivity of the teeth to temperature changes
• Teeth that feel loose in the mouth
• A change in the way the teeth fit together when the person bites

Diagnosis

The diagnosis of periodontal disease can often be made when the dentist simply looks inside the person's mouth. The dentist may also use a probe to measure the size of the pockets between the teeth and the gums, and will usually take x-ray films of the teeth to see whether the connective tissues and bone beneath the teeth have been damaged.

Treatment

Gingivitis can be treated during a routine dental checkup, although the treatment may take more than one appointment. A dental hygienist can assist the dentist in removing plaque and tartar from the area around the gum line by scaling and planing the teeth. Scaling involves the use of a scraper to remove plaque from above and below the gum line. Planing involves smoothing out the roots of the teeth to encourage the gums to reattach to the roots.

Other treatments that may be needed to treat periodontal disease include:

• Antibiotic mouthwash to kill the bacteria that live in plaque. The dentist may prescribe a mouthwash containing a drug called chlorhexidine. The mouthwash is used at home like a regular mouthwash.
• Antibiotic chips or gels. These are placed in the gum pockets after scaling and planing. The antibiotic is slowly released over a period of about a week.
• Enzyme suppressant. This is a low-dose oral medication to be taken at home after scaling and planing. It is given to lower the body's immune response to the bacteria in the mouth.
• Surgery. If the gum disease has progressed to the point where tissue has been lost, the dentist may refer the patient to a specialized dentist called a periodontist. The periodontist may pull back the gums to remove plaque and tartar that cannot be removed by planing and scaling, and then suture (sew) the gums back in place around the base of the teeth. Another type of surgery that is sometimes used involves bone and tissue grafting to prevent the loss of teeth.

Prognosis

The prognosis of periodontal disease depends on the stage at which it is diagnosed and treated. Gingivitis can almost always be treated without

loss of teeth. The prognosis of periodontitis depends on the individual's overall health and the extent to which the infection has damaged the tissues and bone underneath the teeth. Diabetics, patients with AIDS, and heavy smokers generally have a poorer prognosis.

WORDS TO KNOW

Gingivitis: The medical term for inflammation of the gums.

Periodontitis: The medical term for gum disease that involves the connective tissue and bone beneath the gums.

Plaque: A film that forms on the surface of the teeth and gums containing bacteria, saliva, and dead cells.

Scaling: Scraping tartar away from the teeth around the gum line.

Sulcus (plural, sulci): The space or crevice between a tooth and the surrounding gum tissue.

Tartar: Hardened plaque.

Prevention

Periodontal disease is preventable with proper care of the mouth. The American Dental Association (ADA) recommends the following preventive steps:

• Get regular dental checkups that include professional gum cleaning if needed.
• Brush and floss after eating, and at least twice a day for a period of about three minutes.
• Get a fresh toothbrush every three months.
• Use a brush with soft rather than hard bristles; hard bristles can irritate the gums and make it easier for the bacteria to invade the injured tissues.
• Use a toothpaste that contains fluoride. The dentist may also recommend a mouthwash that contains fluoride.
• Avoid eating too many sweets and other foods that encourage plaque to form on the teeth and gums.
• Quit smoking (or do not start).

The Future

Some recent studies have suggested that periodontal disease increases a person's risk of stroke or heart disease in later life or a woman's risk of delivering a baby prematurely. Other researchers think there may be a connection between periodontal disease and increased difficulty in controlling blood sugar levels in people with diabetes. Although researchers have not proved a cause-and-effect relationship between gum disease and these other disorders, they have provided a reminder that proper care of the mouth and teeth is as important to good health as care of other body systems.

SEE ALSO Diabetes; Smoking; Stress; Tooth decay

For more information

BOOKS

Ferguson, Beth. Teeth. New York: Benchmark Books, 2004.

Mestman, Sadie S., and Ariella D. Herman. What to Do for Healthy Teeth: Easy to Read, Easy to Use. La Habra, CA: Institute for Healthcare Advancement, 2004.

Sutton, Amy L., ed. Dental Care and Oral Health Sourcebook. Detroit, MI: Omnigraphics, 2003.

PERIODICALS

Bakalar, Nicholas. “Mouth: Dental Calamities That Can Truly Hurt.” New York Times, May 13, 2008. Available online at http://query.nytimes.com/gst/fullpage.html?res=950DEEDA103CF930A25756C0A96E9C8B63 (accessed September 19, 2008).

WEB SITES

American Dental Association (ADA). Periodontal (Gum) Diseases. Available online at http://www.ada.org/public/topics/periodontal_diseases.asp (accessed September 19, 2008).

eMedicine Health. Periodontal (Gum) Disease. Available online at http://www.emedicinehealth.com/periodontal_gum_disease/article_em.htm (accessed September 19, 2008).

National Institute of Dental and Craniofacial Research (NIDCR). Periodontal (Gum) Disease: Causes, Symptoms, and Treatments. Available online at http://www.nidcr.nih.gov/OralHealth/Topics/GumDiseases/PeriodontalGumDisease.htm (updated July 23, 2008; accessed September 19, 2008).

TeensHealth. Gum Disease. Available online at http://kidshealth.org/teen/diseases_conditions/mouth/gum_disease.html (updated July 2005; accessed September 19, 2008).