Periodontology - Periodontal Disease
Periodontal disease is a condition that affects the periodontium, which is a set of specialized tissues that support and surround the teeth. The periodontium includes the gingiva, or gum tissues; the cementum, which is the mineral that coats the roots of the teeth; the alveolar bone in which the teeth are secured; and the periodontal ligaments, which are the fibers that attach the cementum to the alveolar bone. Periodontal disease is also called gum disease, and it is very common; the Centers for Disease Control estimates that nearly half of adults over 30 have some form of gum disease. Gingivitis is the earliest manifestation of gum disease, and it is characterized by swelling, redness, and possibly bleeding in the gum tissue. More advanced gum disease is called periodontitis and is largely characterized by the gums pulling away from the teeth; periodontitis may also lead to degradation of the bone that supports the teeth and to the teeth loosening or falling out. Periodontitis also usually causes bad breath.
The primary cause of periodontal disease is infection caused by bacteria in the mouth. In its earliest stages, periodontal disease has few symptoms, and those symptoms that do appear are largely painless, leading many people to assume that all is well with their gums. During a routine dental checkup, dentists will assess the condition of the gum tissue and the alveolar bone, and it is at these dental checkups that gum disease is often caught in these earliest stages. When diagnosed early enough, periodontal disease is often reversible. If it is not diagnosed and treated early, however, it can lead to permanent damage. Before permanent damage is incurred, periodontal disease can usually be treated and reversed with proper oral hygiene and periodic professional cleaning of the teeth. Once the periodontal ligament has begun detaching, a professional periodontal treatment is necessary to keep gum disease from further progressing, and the patient must routinely visit the dentist for maintenance treatments. At different stages, treatment may require topical or oral antibiotics or surgery if the teeth are to be retained.
Periodontitis is associated with many conditions and risk factors. The disease is linked to systemic inflammation and has been associated with hypertension, heart attacks, and Alzheimer’s disease. People with diabetes are more likely to have periodontitis. There are also possible connections between periodontitis and erectile dysfunction, inflammatory bowel disease, and pancreatic cancer, though no association with these conditions has been proven. Risk factors include cigarette smoking, certain connective-tissue disorders, overhanging or ill-fitting dental restorations, and genetic susceptibility.
When the oral microbiome is upset by the bacteria in dental plaque that accumulates near and below the gum line, the immune system attacks these destructive microbes, attacking the oral cavity’s bones and ligaments in the process. While the bacterial accumulation triggers this response, it is the body’s own systems that initiate destruction of the periodontal tissues. Daily oral hygiene habits are the primary line of defense against bacterial plaque, and professional dental cleanings are also instrumental in plaque and tartar management. Once significant amounts of tartar, which is hardened plaque, have accumulated, this can only be removed with professional instruments by a dental hygienist or dentist.