Periodontal literally means “around the tooth.” Periodontal or gum diseases are serious infections affecting the tissues surrounding the teeth. These tissues include the gums and bone supporting the teeth. Gone unchecked, periodontal disease can result in tooth loss.

Periodontal disease is usually a slow, painless and progressive disease. Most adults with periodontal disease are unaware they have it.

Periodontal diseases can take a number of years for enough bone loss to occur for the teeth to become loose. However, the severity of the disease can vary from one person to another. Periodontal diseases are classified according to the severity of the disease. The two major stages are gingivitis and periodontitis. Gingivitis is a milder and reversible form of periodontal disease that only affects the gums. Gingivitis may lead to more serious, destructive forms of periodontal disease called periodontitis.

If diagnosed and treated early, however, the teeth can be saved. Treatment becomes more difficult as it progresses but it can be very successfully treated in the earlier stages.

The main cause of gum disease is bacterial plaque, a sticky film that forms on your teeth. Plaque is an often colourless mass of bacteria that sticks to teeth, crowns and bridges, and other tissues in the oral cavity. Plaque is constantly forming on the teeth. Plaque irritates the gums, causing them to become red, tender, and swollen (see picture).

If not removed daily, plaque becomes the hard material known as tartar or calculus. Calculus cannot be removed by brushing and flossing alone. A dentist, periodontist, or hygienist must remove it manually to stop the disease process.

If calculus develops below the gums on the tooth root, it makes plaque removal more difficult, increasing your risk for developing periodontal disease. Toxins (poisons) produced by the bacteria in plaque irritate the gums, causing infection. These toxins also can destroy the tissues supporting the teeth, including the bone. When this happens, gums separate from the teeth, forming “pockets” that fill with even more plaque and more infection. As the diseases progress, these pockets deepen, more gum tissue and bone are destroyed, and the teeth eventually become loose. If periodontal diseases are not treated, the teeth may need to be removed.

The best way to find out if you have periodontal disease is to have your dentist or a periodontist examine your mouth. Many times the common signs, such as bleeding gums and tooth looseness, are not present and the disease goes undiagnosed until the gum disease is very advanced.The clinical diagnosis of periodontitis requires evaluation by a trained examiner and evidence of gingival inflammation, loss of connective tissue surrounding the teeth measured by clinical examination and bone loss detected by radiography.

Advanced bone loss around teeth by periodontal disease

loss of supporting tissue surrounding the teeth measured by clinical examination

Use the following questions to see if you may have some of the signs and symptoms indicative of progressive periodontal disease:

• Does your gum bleed when you floss or brush your teeth?
• Are your gums red, tender or swollen?
• Is pus visible when you press on your gums?
• Do your teeth appear to be getting LONGER?
• Is your gum line Uneven when you smile?
• Are the roots of your teeth exposed and sensitive to hot or cold?
• Can you move or wiggle one or more of your teeth with your tongue or fingers?
• Is there S P A C E S between your teeth where there were none before?
• Has there been a change in how you bite?
• Has there been a change in how your partial denture(s) fit(s)?
• Do you have bad breath or a bad taste in your mouth?

The best way to prevent periodontal disease is through effective daily brushing and flossing, as well as regular dental visits that include a periodontal exam and thorough cleaning. If plaque is not removed, it can turn into a hard substance called calculus in less than two days. Calculus, or tartar as this substance is often called, is so hard, it can only be removed during a professional cleaning. Daily cleaning will help keep calculus formation to a minimum, but it won't completely prevent it. A professional cleaning, by a dentist or hygienist, at least twice a year is necessary to remove calculus from places your toothbrush and floss may have missed.

There are many factors other than plaque that contribute to periodontal disease. This means that there is not just one cause of periodontal diseases but rather multiple factors that can affect the health of your gums.

TOBACCO use significantly increases the risk of developing periodontal diseases and can negatively affect treatment.

HORMONAL CHANGES during pregnancy, puberty and menopause can cause the gums to become red, tender and bleed easily.

GENETICS and family history of periodontal diseases indicate a greater likelihood of developing these diseases.

STRESS can make it more difficult for the body to fight off infection, including periodontal diseases.

Some MEDICATIONS such as oral contraceptives, antidepressants and certain heart medicine, can affect oral health.

DESTRUCTIVE HABITS such as improper oral hygiene technique, oral piercing, drug or alcohol abuse can affect periodontal health.

POOR NUTRITION can make it harder for the body to fight off infection.

SYSTEMIC DISEASES that interfere with the body's immune system may worsen the condition of the gums and supporting bone.

Research suggests that the germs that cause gum disease may be transferred in saliva.

Periodontal disease is not cured; in most people, most of the time, it is controlled. Failure to practice good oral hygiene and get the prescribed regular dental cleanings can lead to relapse. Changes in your health may also lead to increased disease susceptibility

Research has shown that periodontal bacteria are associated with cardiovascular disease. Treating your periodontal disease can decrease these bacteria and may decrease the risk of developing cardiovascular disease and other systemic health conditions (such as diabetes and premature low birth weight babies).

Not usually. There may be minor discomfort, which is usually well controlled with local anaesthesia and pain medications. Most patients go back to work and normal activities the day after surgical therapy.

Yes, we can evaluate and treat your periodontal condition without a referral. And if you do not have a general dentist we can refer you to one.

Gingival flap surgery is a type of gum procedure. The gums are separated from the teeth and folded back temporarily. This allows a dentist to reach the root of the tooth and the bone. Gingival flap surgery is used to treat gum disease (periodontitis). It may be recommended for people with advanced periodontitis. Usually, a treatment that doesn't involve surgery is done first. This is called scaling and root planing. If this treatment does not eliminate the gum infection, gingival flap surgery may be used. It also may be done along with another procedure known as osseous (bone) surgery.

There are many types of periodontal diseases. The following is an overview of the most common:
Gingivitis: As the mildest form of the periodontal diseases, gingivitis causes the gums to become red, swollen, and bleed easily. There is usually no discomfort at this stage.

Chronic Periodontitis: Chronic periodontitis is a condition resulting in inflammation within the soft tissues surrounding the teeth causing progressive attachment and bone loss (see below pictures). It is diagnosed by bone loss on a dental X-ray, the formation of gum pockets and/or receding gums. It is most common in adults, but can occur at any age.

Aggressive Periodontitis: This form occurs in patients who are otherwise in good health. Common features include rapid attachment loss and bone destruction. There are two forms of aggressive periodontitis:

LOCALIZED AGGRESSIVE PERIODONTITIS – Most often occurs near puberty and usually involves attachment loss around first molars and/or front teeth but may involve one or two additional teeth.

GENERALIZED AGGRESSIVE PERIODONTITIS – Usually, but not always affects people under 30 years of age. It involves attachment loss on at least three permanent teeth in addition to first molars and incisors.

Periodontitis as a Manifestation of Systemic Disease: As the name indicates, this form is associated with one ofseveral systemic diseases that are related to periodontitis, such as diabetes.

Necrotizing Periodontal Diseases: These types of periodontal diseases cause ulcers in the gums between the teeth and are most commonly observed in individuals with certain conditions including, but not limited to, HIV infection, malnutrition and immunosuppression. Stress, smoking, and poor oral hygiene sometimes can contribute to this problem.