The word “periodontitis” comes from peri (meaning “around”), odont (“tooth”) and -itis (“inflammation”). Periodontitis is a disease which affects the tissues that surround and support the teeth. Periodontitis involves progressive loss of the alveolar bone around the teeth, and if left untreated, can lead to the loosening and subsequent loss of teeth. Periodontitis is caused by microorganisms which stick to and grow on the tooth’s surfaces, along with an overly aggressive immune response against these microorganisms.
We diagnose periodontal disease by inspecting the soft gum tissues around the teeth with a special probe and by examining the patient’s x-ray(s); in diagnosing the disease, we want to determine the amount of bone loss around the teeth. Sometimes we will refer patients to a specialist dentist, known as a periodontist, for treatment of periodontitis.
The severity of disease refers to the amount of periodontal ligament fibres that have been lost, termed ‘Attachment Loss’.
The standard classification of severity is as follows:
- Mild: 1–2 mm of attachment loss.
- Moderate: 3–4 mm of attachment loss.
- Severe: ≥ 5 mm of attachment loss.
Signs and Symptoms:
In the early stages, periodontitis has very few symptoms and in many people the disease has progressed significantly before they actually seek treatment. Symptoms may include the following:
- Redness or bleeding of gums while brushing teeth, using dental floss or biting into hard food.
- Gum swelling that recurs.
- Halitosis, or bad breath, and a persistent metallic taste in the mouth.
- Gingival recession, resulting in apparent lengthening of teeth. (This may also be caused by heavy handed brushing or with a stiff tooth brush
- Deep pockets between the teeth and the gums (pockets are sites where the attachment has been gradually destroyed).
- Loose teeth, in the later stages (though this may occur for other reasons as well).
Patients should be aware that the gum inflammation and bone destruction are largely painless. Hence, people may wrongly assume that bleeding gums after tooth brushing is insignificant, although this may be a symptom of progressing periodontitis in that patient.
Periodontitis is an inflammation of the periodontium, the tissues that support the teeth. The periodontium consists of four tissues:
- Gingiva, or Gum Tissue.
- Cementum, or outer layer of the roots of teeth.
- Alveolar bone, or the bony sockets into which the teeth are anchored.
- Periodontal Ligaments (PDLs), which are the connective tissue fibres that run between the cementum and the alveolar bone.
In some people, gingivitis may progress to periodontitis with the destruction of the gingival fibres, the gum tissues separate from the tooth and form a deep crevice, called a periodontal pocket. Sub-gingival microorganisms (those that exist under the gum line) colonise the periodontal pockets and cause further inflammation in the gum tissues and progressive bone loss. Other examples of causes are those things that, by definition, cause microbic plaque accumulation, such as overhangs on fillings.
If left undisturbed, microbic plaque calcifies to form tartar. As dentists, we must completely remove this tartar above and below the gum line, in order to treat gingivitis and periodontitis. Although the main cause of both gingivitis and periodontitis is the microbic plaque that sticks to the tooth surface, there are many other modifying factors. A very strong risk factor is one’s genetic susceptibility. Several conditions and diseases, including Down syndrome, Diabetes, and other diseases that affect one’s resistance to infection also increase susceptibility to periodontitis.