Periodontitis

What is Periodontitis?

Periodontitis is disease affecting the gums, ligaments and bones supporting the teeth. It is a complication of untreated gingivitis, an inflammation of the gums caused by bacterial plaque deposits on the teeth. As the condition persists, the gums recede and small ulcerous pockets form between the tooth and gumline, where the plaque deposits continue to accumulate and, in turn, cause further recession of the gumline and deepening of the pockets. Ultimately, these pockets penetrate to the roots of the teeth, and the teeth may loosen or fall out.

The cause for periodontitis is usually poor care of the mouth and teeth and, in some cases, poor diet. Smoking, diabetes and thyroid conditions increase risks for developing periodontitis, which also strikes during pregnancy or the teenage years. In very rare cases, the problem may arise because of defective fillings or structural defects in the mouth.

The American Dental Association estimates that nearly 45% of working age adults have gingival bleeding, over 50% have gingival recession, and almost 25% have severe destruction due to periodontal disease.

How is it diagnosed?

History: Because there is little pain associated with periodontitis unless there is an accompanying abscess, the usual symptoms of the problem are a pink toothbrush (caused by the gums bleeding during toothbrushing) and bad breath (caused by food particles being trapped in the pockets). The individual may also notice a gradual receding of the gumline.

Physical exam: The gums will probably be swollen and bleed easily on irritation. They may also be discolored. If the condition is severe, the individual's bite may have changed. Periodontal pocket measurements will provide information about the extent of the disease.

Tests: No test is necessary to diagnose periodontitis, although x-rays are needed to determine the extent of any periodontal destruction.

How is Periodontitis treated?

• In its early stages, the typical treatment for periodontitis is a thorough professional cleaning to remove plaque from the tooth surfaces and subgingival curettage (a procedure to cut away diseased tissue from the pockets around the teeth).
• More serious cases may require a gingivectomy (also known as a gum resection) or gingivoplasty, both of which are performed under local anesthetic.
• Advanced forms of periodontitis may require flap surgery, which involves lifting away the gums from the teeth, to remove diseased tissue, repair the damaged bone, and replace the gum in its proper position.
• In cases where periodontitis is believed to be due to structural problems of the mouth, or has progressed to the point where it has significantly damaged the underlying structure, extensive bone surgery may be required.
• Where the problem is due to uneven tooth surfaces, occlusal adjustment may be recommended to reshape the chewing and biting surfaces of the teeth.

Following treatment, individuals who smoke are usually urged to quit. All individuals are encouraged to practice good dental hygiene by brushing and flossing regularly and having teeth cleaned professionally for plaque removal. Some individuals may be advised to use special dental cleaning tools as well.

Medications

Information	Brand	Generic	Label	Rating
	Minocin	Minocycline
	Flagyl	Metronidazole
	Augmentin	Amoxicillin/Clavulanate
	Motrin	Ibuprofen

Cleocin (Clindamycin), Doryx (Doxycycline), Ilosone (Erythromycin), Naprosyn (Naproxen)

What might complicate it?

Certain medications for high blood pressure and epilepsy can cause gums to swell. If periodontal disease has progressed to the point where it damages the underlying support structure of the teeth, this may call for extensive reconstructive surgery.

Predicted outcome

Generally, the earlier periodontitis develops or the more advanced it is when it is diagnosed, the more chronic a problem it is likely to be. Gingivitis is usually reversible after cleaning the teeth and removing diseased tissue, and, provided the individual practices good oral hygiene thereafter, the problem may not recur. More serious cases of periodontitis are liable to recur, and the individual may require extensive care for the remainder of his or her life.

Alternatives

Gingivitis or gingival abscess may present with similar signs.

Appropriate specialists

Dentist, periodontist and oral surgeon.

Last updated 18 December 2015