Periodontal or gum disease is both very common and a serious oral health condition. An estimated 50% of adults over the age of 30 have some level of gum disease, with the percentage increasing with age. Periodontal disease is a slow and progressive disease that can result in tooth and bone loss in the jawbone, as well as increase your risk for other health problems. Understanding the stages of gum disease and your treatment options can be helpful to avoid serious complications from this oral disease.
What Causes Gum Disease?
The main culprit of periodontal disease is bacteria. There are always bacteria in your mouth, but when there is food debris available, they feed and multiply. This causes plaque to form on the teeth, which can harden into tartar. Removing plaque daily with flossing and brushing can help prevent tartar formation, but it is difficult to remove all plaque. Dental cleanings at least twice a year can remove any tartar that does form, but if this does not occur, a gum infection can begin.
Periodontal disease is caused by the bacteria that cause plaque and tartar. If tartar exists in the mouth, bacteria can hide in the porous material. The gum tissue around the tooth can become inflamed and irritated. Over time, the gums become infected and diseased. Certain lifestyle and health issues can increase the risk of gum disease. Smokers are much more likely to have gum disease, as well as those with diabetes. Certain medications and hormonal changes can impact saliva, increasing risk of periodontal disease.
There are four stages of periodontal disease that can progress over many years. Only the first stage is completely reversable, but there are treatments and management options for the later stages of gum disease.
First Stage: Gingivitis
For those who do not brush or floss twice a day or skip dental cleanings, gingivitis is likely to occur. When plaque and tartar are not removed, the beginning stage of periodontal disease, gingivitis, may affect the gums. Most people with gingivitis do not have serious symptoms – many have no symptoms at all. If there are any symptoms, they can include:
- Red or swollen gums
- Bleeding gums when flossing or brushing
- Bad breath
Gingivitis is most commonly caused by poor oral hygiene and can often be reversed by more frequent brushing and flossing, as well as professional dental cleanings. At this point, there is no damage to the bone in the jaw.
Second Stage: Slight Periodontal Disease
If gingivitis is allowed to progress, the infection can begin to impact the teeth and bone. During this stage, the gum tissue may begin to recede away from the teeth, creating gaps. These gaps make it easier for the bacteria to hide below the gum line and attack the deeper gum tissue and bone around the teeth. During this second stage, patients will have gaps around the teeth that may measure 4-5 mm and officially are diagnosed with slight periodontal disease versus gingivitis.
The symptoms in stage two are similar to gingivitis. Red, swollen gums, bad breath and bleeding gums are to be expected, but not everyone experiences symptoms. While the damage to the bone cannot be reversed, slight periodontal disease is manageable with deep cleanings and improved oral hygiene.
Stage Three: Moderate Periodontal Disease
If periodontal disease is not stopped at stage two, the gums can recede farther away from the teeth and the bacteria infection can progress deeper. The gaps around the teeth become deeper – 6-7 mm when measured by a dental hygienist – and it is harder to remove bacteria and plaque with regular brushing and flossing. The symptoms may become more pronounced, with worsening breath odor and bleeding of the gums. The tissue around the teeth may be more sensitive or painful when brushing or eating crunchy foods. There is more pronounced damage to the bone surrounding the teeth and some teeth may become loose or shift. The infection can be spread to the bloodstream and begin impacting overall health.
The treatment for moderate periodontal disease is deep cleaning to remove the plaque and tartar below the gum line. Tartar can only be removed by a dental professional and will not come off the teeth with brushing or flossing. To reach the teeth roots and scrape off the tartar, scaling and root planing may be recommended to treat moderate gum disease. Patients may need to have their gums numbed since the deep cleaning is below the gum line.
Stage Four: Advanced Periodontal Disease
The final and most severe stage of periodontal disease is the advanced stage. There are deep pockets around the teeth, 8 mm or deeper, and the gum tissue is very red, swollen and diseased. Some patients may have bloody or pus-filled gum tissue, which can result in extremely bad breath, or halitosis. The breakdown of the gum tissue and bone can result in painful chewing, sensitivity and loosening teeth. The teeth may begin to shift and tooth loss is likely unless aggressive treatment is performed.
Advanced periodontal disease treatment involves oral surgery. The diseased gum tissue needs to be removed and continual deep cleanings are required to manage the disease. There is no cure for stages two through four of periodontal disease, but there are options to manage the disease to stop or slow the progression of bone and tooth damage. Treatments for advanced stages of gum disease include:
- Flap surgery. For deep pockets around the teeth, flap or osseous surgery may be recommended. This involves pulling back the gum tissue to scrape and clean the roots, then repositioning the flaps of gum tissue against the teeth. This can reduce the pockets around the teeth and help prevent bacteria from flourishing below the gum line. This surgery may require incisions and sutures in the gum tissue.
- LANAP. One of the more advanced options in gum disease treatment is laser-assisted new attachment procedure (LANAP®). This involves using a laser device to remove the diseased gum tissue while cleaning and disinfecting the roots of the teeth below the gum line. There are no incisions or stitches with LANAP and the recovery may be less painful than traditional osseous surgery.
- Bone graft surgery. If there is extensive bone loss around the teeth, bone graft surgery may be suggested to add more support to the teeth. Small grafts of bone are placed around the teeth to stimulate more bone growth.
Preventing Progression of Gum Disease
Periodontal disease is the leading cause of tooth loss and increases risk for stroke, cardiovascular disease and type 2 diabetes. While most people will experience gum disease in their lifetime, in the early stages it can either be reversed or well managed. Simply increasing brushing and flossing combined with routine dental cleanings can go a long way in preventing or slowing the progression of periodontal disease.
If you have not had a checkup or dental cleaning in more than six months, it is time to schedule an appointment. Ignoring gingivitis or later stages of gum disease is dangerous for your oral and overall health. Call our team at Aesthetic & Implant Dentistry of Atlanta to schedule your next dental cleaning and exam. We offer gingivitis and periodontal disease treatment to help protect your smile and wellness.