PERIODONTITIS (or pyorrhea) is a fairly common condition in which inflamation of the gums progresses to dissolve away the bone supporting the teeth. It also occurs due to plaque.
People with periodontitis often have particularly active forms of bacteria in their mouth and/or have difficulty fighting off this form of infection. The inflammation from the bacteria causes the bone surrounding the teeth to be dissolved away which can cause loosening and drifting of teeth and may even lead to loss of teeth because of lack of support. The gums usually show signs of problems (e.g., gingivitis, including swelling, redness and, in addition to bleeding, there may also be pus present). This condition can be made worse by smoking and by other medical conditions such as diabetes, leukemia, and other ailments resulting in poor immune function.
Most gum and tooth problems are due to poor oral hygiene. It is essential to regularly remove the bacteria (plaque) that naturally forms on teeth to prevent gingivitis and periodontitis. Bleeding gums are not normal. The bleeding is a sign of irritation caused by bacteria. Bleeding gums need more (or better) brushing and flossing, never less. The following are warning signs that you may have periodontal disease:
- gums that bleed easily
- red, swollen, tender gums
- gums that pull away from the teeth
- persistent bad breath or bad taste
- permanent teeth that are loose or separating
- changes in the way your teeth fit together
- changes in the fit of partial denture
Progress of Periodontal Disease
Healthy gingiva, periodontal ligament and bone anchor teeth firmly in place. Gingivitis develops as toxins, enzymes, and other plaque byproducts irritate the gums, making them tender and swollen and likely to bleed easily.
Periodontitis occurs when plaque byproducts destroy the tissue that anchors the teeth and bone. As the disease progresses, pockets form, which allow more plaque to collect below the gum line. Tooth roots are easily exposed and become susceptible and sensitive to cold and touch.
In advanced periodontitis, the teeth lose more support as the disease continues to destroy the periodontal ligament and bone. Unless treated, the affected tooth frequently becomes loose and may fall out and removal by a dentist may be required.
A toothbrush with a small head and soft bristles will more than adequately clean your teeth without causing damage to teeth and gums. Always make sure you brush all your teeth both inside and outside to ensure thorough cleaning.
Hold the brush with the bristles about 45 degrees to the tooth and gum and move the brush in a small circular action (concentrating on one tooth at a time). When a circular action is too difficult to manage, try using a small horizontal scrubbing action. Use firm pressure but never press too hard to not wear away the enamel. It is important to clean both teeth and the gum next to the teeth.
Brushes can only clean some surfaces of the teeth. To clean between teeth, it is important to use floss. Flossing can be a little difficult in the beginning, but after a few weeks practice it becomes very easy. Most floss comes with instructions on the pack. It is important that the floss passes lightly below the gum line to clean out the small crevice between the tooth and the gum. Brushing and flossing will not remove good fillings. Only fillings that are in poor condition may be removed by flossing and are best replaced before any further decay has the chance to form.
Health Care
As with all dental conditions, your dentist should be consulted. Patients with periodontitis need special attention and will sometimes be referred for special treatment from a periodontist. Your dentist will diagnose and treat your particular problem. Periodontitis can usually be controlled, but once the bone loss has occurred, it is very difficult to ever restore it. Ask your dentist about how to brush and floss your teeth. Your dentist may recommend other oral hygiene aids such as special toothbrushes and interdental cleaning sticks (toothpicks) which are available from your pharmacist. Ask your dentist to show you how to use these.
Diet Tips
- Having a wholesome, balanced diet helps to promote healthy teeth and gums. It is a good idea to eat plenty of fruits and vegetables which are good sources of vitamins, minerals, and soluble fiber.
- Food should be as fresh as possible, and it is best to eat vegetables raw or lightly steamed, if possible, to help retain the nutrient content.
- Try not to snack between meals. Eating between meals without brushing afterwards allows plaque to build up which can result in periodontitis and gingivitis. Eating between meals becomes a habit.
- After eating, it is important to clean your teeth to reduce the formation of bacteria which can cause periodontitis and gingivitis.
- Make sure that you clean your teeth before going to sleep. Going to bed without brushing allows plaque to grow on teeth and gums all night.
The importance of good oral hygiene cannot be overemphasized. Having an adequate diet alone will not prevent gingivitis and periodontitis. There is no substitute for regular manual cleaning with a toothbrush, toothpaste, and floss.
Calculus (tartar) is a hard and calcified plaque deposit on the surface of the teeth which cannot be brushed or flossed away and needs to be removed by your dentist. Calculus is always coated with a microscopic layer of plaque which may cause periodontitis. It can form underneath the gum line and needs to be carefully removed by your dentist. Due to the serious nature of this condition, your mouth should be thoroughly checked by your dentist on a regular basis.
Current research suggests that there may be a link between periodontitis and other diseases that affect the entire body (systemic diseases). Periodontitis has been linked to cardiovascular problems, stroke, bacterial pneumonia, diabetes, and problems related to pregnancy. More research is needed to determine the direct correlation between periodontitis and systemic problems.
There are other factors that may increase the risk of developing periodontal disease. They include:
- smoking or chewing tobacco.
- medication such as steriods, some anti-epilepsy drugs, cancer therapy drugs, and some calcium channel blockers.
- bridges that no longer fit properly, crooked teeth or worn, loose or cracked fillings that may hold plaque in place.
- pregnancy or use of oral contraceptives.
Follow these recommendations to keep your teeth healthy:
- brush your teeth thoroughly twice a day.
- clean between your teeth with floss or other interdental cleaner every day.
- eat a balanced diet and limit snacks.
- visit your dentist regularly for an exam and professional cleaning.
- avoid tobacco.
- smile with confidence.