The periodontits
What is periodontitis?
Periodontal disease is a disease that affects the periodontium, the system that supports the teeth.
There are many forms, but the most common are gingivitis and periodontitis.
Gingivitis: the first stage of periodontal diseases. Your gums become red and swollen, making them prone to bleeding when you brush your teeth. If gingivitis is not treated, periodontal disease may progress and lead to irreversible loss of the tooth’s supporting tissues: bone, periodontal ligament, and gingival tissue.
Periodontitis: Periodontitis is an inflammatory disease caused by a bacterial organization, which triggers increased inflammation and bone loss around the tooth in susceptible individuals. The gums separate from the teeth, forming periodontal pockets in which infection develops. As the disease advances, teeth may loosen and fall out.
How can you tell if you have periodontitis?
How does periodontitis begin?
Periodontitis typically begins with simple gum inflammation, which is called gingivitis.
It may be difficult to recognize in the early stages. However, one of the first signs you might notice is bleeding gums when brushing.
Often, your gums become red, swollen, and a layer of plaque appears on your teeth.
If you don’t treat gingivitis at this stage, it may progress to periodontitis. This progression often happens without visible signs, making the disease difficult to detect on your own.
What are the signs of periodontitis?
Over time, several changes may appear:
- Your gums bleed more, during brushing or even spontaneously.
- Persistent bad breath sets in.
- The position of the teeth changes, sometimes without pain.
- Teeth may appear longer because gums recede.
- Occasional pain may occur.
Warning: tobacco hides the signs
In smokers, tobacco decreases blood circulation in the gums. Thus, bleeding becomes less visible, which can mask early signs of the disease.
A disease often detected too late
Often, patients discover periodontitis only at ages 40 or 50, when damage is already advanced.
However, a trained periodontist can detect signs of the disease much earlier, simply through a clinical exam.
What causes periodontitis?
A healthy mouth hosts more than 700 different bacterial species, most of which are harmless and live in harmony with their host. However, when teeth are not properly cleaned, bacterial deposits can accumulate, forming dental plaque, which promotes the growth of more aggressive bacteria.
The body’s natural defenses also come into play. In all cases, periodontitis is caused by a buildup of bacteria.
How does periodontitis progress?
If you don’t brush your teeth to remove soft bacterial plaque, minerals accumulate over time and hard plaque called tartar forms on your teeth. The presence of tartar favors the growth of bacterial plaque toward the tooth roots. As inflammation progresses, it disrupts the union between the gum and the tooth root, creating a space: a periodontal pocket.This pocket is an ideal place for pathogenic bacteria to colonize and multiply, accelerating the disease’s progression. In this new environment, bacteria release toxins in the form of metabolic products, further stimulating the body’s defense mechanisms.
The severity and speed of progression of periodontitis depend on the balance of several factors:
- the quantity and type of bacteria
- the strength of the individual's defense mechanisms
- the presence of certain risk factors
Which factors favor the onset and progression of periodontitis?
Certain risk factors can further weaken the body’s defenses and accelerate disease progression. Likewise, some medications, such as antihypertensives, vasodilators, as well as immunotherapies, can also affect the inflammatory response, making patients more susceptible to gingivitis:
- Tobacco: Patients who smoke are much more likely to suffer from periodontal disease. Studies have shown that tobacco is one of the most important risk factors for the development and progression of periodontitis.
- Diabetes: Patients with diabetes often suffer from periodontal diseases.
- Other diseases can affect an individual’s inflammatory system and worsen gum health. For example, cardiovascular diseases and rheumatoid arthritis. Diseases that compromise the body's immune system, such as leukemia and AIDS, can greatly worsen gum condition.
- Genetics: Some patients are at higher risk of developing periodontitis even with very careful tooth brushing.
- Stress can also impact your ability to fight the disease. Research shows that stress makes individuals more vulnerable when combating infectious diseases.
- Bruxism, teeth grinding, can worsen destruction of periodontal tissues because it can apply excessive force to the tissues supporting the teeth.
- Diet: Nutrition can affect oral health. A diet poor in essential nutrients impairs the immune system. It becomes more difficult for the body to fight infections.
What are the consequences of periodontitis?
Periodontitis is the leading cause of tooth loss.
If periodontal inflammation persists without control, the destruction of the structures supporting the tooth, including the surrounding bone, occurs.
Teeth eventually move and fall out or must be extracted. Other problems patients may face include painful abscesses, dental movement interfering with eating, and unaesthetic lengthening of teeth with exposed roots.
Untreated periodontitis can affect your overall health:
- Increased risk of pregnancy complications (preeclampsia, premature birth, low birth weight)
- Worsening of diabetes
- Increased risk of heart disease
- Increased risk of stroke
- Increased risk of lung disease
- Increased risk of erectile dysfunction
How to treat periodontitis?
The main objective is to eliminate irritants and pathogenic bacteria that cause inflammation of the gums and supporting tissues of the teeth.
The periodontal disease treatment begins with etiological therapy: scaling and root planing and strengthening oral hygiene techniques.
After this treatment, combined with effective oral hygiene, one observes a significant improvement in the condition of the gums: reduced swelling, stronger attachment to teeth, and reduced depth of periodontal pockets.
Some advanced cases require corrective surgical phases.
The goals of these treatments are multiple:
- to allow access to the entire root when deep pockets are present
- complete removal of tartar
- elimination of deep inflammation
- reduction of pocket depth
- regeneration of the tooth’s supporting tissues
Other surgical treatments, notably gum grafts, may be performed to cover exposed roots and treat gingival recession.
Other methods may also complement periodontal treatment, such as orthodontics (to move teeth). Missing or teeth that must be removed may be replaced by various prostheses or by dental implants.
Once the disease is treated, supportive or maintenance treatment is essential to preserve periodontal health.
These sessions allow control and prevention of new pocket formation. They permit deep cleaning to improve hygiene techniques and reduce plaque and deposits hard to reach for patients. These maintenance sessions typically occur every three to four months.
Periodontal disease is treatable. The key to success is to follow the treatments recommended by your periodontist and remove the bacterial plaque that can trigger disease progression via good oral hygiene.