Periodontitis is the inflammation and degeneration of the deep tissues of gum, including the bone, which may arise from an untreated case of gingivitis. The degree of damage in periodontitis can result in loss of teeth and severe deformity of the gum and oral cavity. Professional dental attention is necessary to treat periodontitis effectively.
What Happens in Periodontitis?
Gum disease may include a wide spectrum of disorders ranging from the milder gingivitis to the more severe periodontitis. The causes, risk factors and even some of the symptoms of periodontitis are the same as gingivitis.
As gum disease advances to involve the deeper structures around the tooth, the gums pull away from the tooth to form pockets which harbor more plaque and bacteria. As the pockets get deeper, the plaque hardens to form tartar, over which more plaque is deposited.This causes breakdown of the gums, bone and connective tissue supporting the tooth, which results in loosening of the tooth in its socket, causing it to eventually fall out.
The development and progression of periodontitis will vary among people since many factors are involved, such as the type of bacteria contained in the plaque as well as individual response to infection
Types of Periodontitis
- Aggressive periodontitis
- This is an acute form of periodontitis which develops quite rapidly.
- It occurs in people who are otherwise healthy.
- Aggressive periodontitis tends to run in families and may be more common in smokers.
- Chronic periodontitis
- This is the more common type of periodontitis.
- There may be occasional bursts of rapid progression, followed by relatively slower activity.
- Periodontitis related to systemic diseases
- Systemic diseases such as diabetes and HIV infection may be associated with this type of periodontitis.
- Necrotizing periodontal disease
- In this type of periodontitis, there is extensive necrosis of the bone, gums, and deeper tissues.
- It is seen more commonly in immunocompromised patients such as those suffering from AIDS and cancer, and also in cases of severe malnutrition.
Difference between Gingivitis and Periodontitis
- Gingivitis is the first stage of gum disease which may progress to the next stage, which is periodontitis.
- Gingivitis is usually a mild form of gum disease while periodontitis is more severe and extensive.
- In gingivitis only the gums are inflamed while in periodontitis there may also be additional involvement of deeper structures, including bone and connective tissue.
- Only the superficial layer of the gum is involved in gingivitis while in periodontitis the deeper layers of the gums may be pulled back from the tooth to form pockets.
- Gingivitis is usually a reversible form of gum disease while periodontitis may cause irreversible bone and tissue damage.
- The tooth remains firmly fixed in place in gingivitis while in periodontitis it may become loose in its socket or fall off.
- Good self-care, including daily brushing and flossing, following a professional dental cleaning can usually take care of gingivitis. The treatment of periodontitis may require repeat professional care and more extensive measures, including surgery.
Treatment of Periodontitis
Brushing and flossing can clean only about 2 to 3 mm below the gum line. While good oral hygiene is a requisite, treatment of periodontitis requires more aggressive measures. The following dental procedures may be necessary.
Scaling and Root Planing
- Scaling and root planing can clean pockets up to 4 to 5 mm deep.
- It effectively removes tartar and by smoothing the root surface it helps to deter plaque deposition.
- Used effectively, a laser procedure to remove plaque and tartar has the advantage of causing less discomfort, bleeding and swelling than other methods used for deep cleaning.
Surgery for Periodontitis
Surgery may be required when the pockets are 5 mm or more in depth.
- Flap Surgery
- A surgical incision allows for the gums to be lifted back as a flap.
- It is then possible to clean the tooth thoroughly and reduce the depth of the pocket to facilitate easy cleaning in the future.
- Correction of any bone defects present as a result of infection is also possible.
- After the procedure, the gums are sutured back so that they may grip the tooth tightly again. This may result in the tooth appearing longer than normal.
- Bone and Tissue Grafts
- Bone and tissue grafts may be needed in addition to flap surgery in the case of excessive bone and tissue destruction by periodontitis.
- Guided tissue regeneration is a technique that may be used along with bone grafting, where a tiny piece of mesh-like material is inserted between bone and gum tissue.
- This helps to segregate the gum tissue from the bone, allowing each to re-grow in its own place.
- In some cases, a gingivectomy (surgically excising or removing a part of the infected and separated gum) may become necessary so that the remaining healthy gum can re-attach to the teeth.
- Post-Operative Measures
- Oral antibiotics may be necessary, particularly in case of abscess formation.
- Antibiotic-impregnated gels or filaments may be inserted into deep gum pockets.
- Chlorhexidine gluconate mouth rinse may be used after surgery.
- If a tooth affected by periodontitis cannot be saved, extraction or tooth removal will be done.
- Dental implants (permanent tooth replacement) may be done after a tooth extraction or in the case of a tooth falling out.