Periodontitis. When gum disease becomes destructive.

In an earlier article I wrote about gum inflammation aka gingivitis which can be caused by dry mouth as well as many other factors. I touched upon what can happen if gingivitis is not managed and or treated and how it can progress into a condition where there is a loss of the tissue and bone support of the teeth (1) which can actually lead to tooth loss.  This article will go further into depth of advanced gum disease called periodontitis.

Read article about gingivitis here.

How many people have periodonitiis?

In the United States 50% of people over 30 years old and 70% of those over the age of 65 (1).

How do you know you have periodontitis?

Your dentist (either general or gum specialist – periodontist) will be the one to ultimately examine and diagnose periodontitis.  However, some common signs include:

  • Just like in gingivitis (where there is no tissue and bone loss however) the gums may appear red, inflamed, there can be bleeding on brushing, flossing, eating.
  • Bad breath or metallic taste in the mouth.
  • Teeth might be lose.
  • Teeth may appear to be longer (this is due to the shrinkage of the tissues and bone which are around teeth).

What are the consequences of untreated periodontal disease?

The biggest complication of periodontitis is the loss of tooth-supporting structures such as bone and gums. This leads to tooth loosening and even tooth loss.

Also, if there is a problem with the bone in our jaws we might not be able to replace the teeth so easily. There might not be enough healthy bone for implants (implants can also be negatively affected by periodontitis), or dentures may not have enough support to remain stable and comfortable.

Periodontitis beyond teeth. Can it affect our body?

No direct cause and effect has been proven. However, there is an association between periodontitis and increased inflammation in the body (2) and an increased risk for myocardial infarction (3), stroke (4), atherosclerosis (5) and high blood pressure (6).

Who is at risk?

  • Those with poor oral hygiene and untreated gingivitis (which can be caused by dry mouth).
  • Smokers (7)
  • Diabetics (8)
  • Those with a genetic predisposition
  • Those taking certain medications
  • HIV/AIDS patients (1)

What is the treatment of periodontitis?

It is important to be under the care of a dentist/periodontist who will manage and treat the condition.

During the initial visit the dentist will perform a detailed clinical and radiographic exam to determine the type and advancement of periodontitis (there are many types and classifications . Treatment is usually catered to the patient’s specific needs but often includes

  • Establishment of an oral hygiene routine, brushing 2x per day, proper flossing 1 x per day, using interproximal brush, mouth rinse (the dentist may prescribe you chlorhexidine gluconate rinse for a limited period of time).
  • First round of therapy may include different forms of deep cleanings which serve to remove calculus from underneath the gums. These procedures are called Root Surface Instrumentation and Scaling and Root Planing. (9)
  • The patient is followed after 6 weeks to monitor for oral hygiene improvement and decreased inflammation in the gums.
  • If the first round of treatment is not successful (usually this happens in more advanced cases) surgery may be considered by the dentist. Some procedures include retracting of gums to have access to the roots from which calculus is removed (debridement), possible grafting of bone and tissues. (10) 
  • Application of medications such as antibiotics and steroids locally (11).
  • Maintenance where patient is monitored for healing. Cleanings are usually recommended every 3 months to prevent re-colonization of bacteria and calculus.

What are the outcomes? 

Treatment of periodontitis focuses primarily on controlling the progression of the disease. In many cases it is difficult to restore the tissue and bone that was lost. Therefore, it is important to identify and treat the condition as soon as possible.

Read more: 7 Best Dry Mouth Remedies

Dr. Anna Glinianska

 

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References: 

1) "Periodontal Disease"CDC. 10 March 2015. Retrieved 13 March 2018.

2) D'Aiuto F, Ready D, Tonetti MS (August 2004). "Periodontal disease and C-reactive protein-associated cardiovascular risk". Journal of Periodontal Research39(4): 236–41

3) Pussinen PJ, Alfthan G, Tuomilehto J, Asikainen S, Jousilahti P (October 2004). "High serum antibody levels to Porphyromonas gingivalis predict myocardial infarction". European Journal of Cardiovascular Prevention and Rehabilitation11(5): 408–11.

4) Ford PJ, Gemmell E, Timms P, Chan A, Preston FM, Seymour GJ (January 2007). "Anti-P. gingivalis response correlates with atherosclerosis". Journal of Dental Research86(1): 35–40

5) Beck JD, Eke P, Heiss G, Madianos P, Couper D, Lin D, Moss K, Elter J, Offenbacher S (July 2005). "Periodontal disease and coronary heart disease: a reappraisal of the exposure". Circulation112(1): 19–24

6) Martin-Cabezas R, Seelam N, Petit C, Agossa K, Gaertner S, Tenenbaum H, Davideau JL, Huck O (October 2016). "Association between periodontitis and arterial hypertension: A systematic review and meta-analysis". American Heart Journal180: 98–112.

7) Obeid P, Bercy P (2000). "Effects of smoking on periodontal health: a review". Advances in Therapy17(5): 230–7

8) Lalla E, Cheng B, Lal S, Kaplan S, Softness B, Greenberg E, Goland RS, Lamster IB (April 2007). "Diabetes mellitus promotes periodontal destruction in children". Journal of Clinical Periodontology34(4): 294–8.

9) "Current Concepts in Periodontal Pathogenesis"DentalUpdate31(10): 570–578. December 2004.

10) Hirschfeld L, Wasserman B (May 1978). "A long-term survey of tooth loss in 600 treated periodontal patients". Journal of Periodontology49(5): 225–37.

11) Nadig PS, Shah MA (2016). "Tetracycline as local drug delivery in treatment of chronic periodontitis: A systematic review and meta-analysis"Journal of Indian Society of Periodontology20(6): 576–58

 

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