The term “periodontal”means “around the tooth.”  Periodontal disease (also known as periodontitis and gum disease) is a common inflammatory condition which affects the supporting and surrounding soft tissues of the tooth; also the jawbone itself when in its most advanced stages.

Periodontal disease is most often preceded by gingivitis which is a bacterial infection of the gum tissue.  A bacterial infection affects the gums when the toxins contained in plaque begin to irritate and inflame the gum tissues.  Once this bacterial infection colonizes in the gum pockets between the teeth, it becomes much more difficult to remove and treat.  Periodontal disease is a progressive condition that eventually leads to the destruction of the connective tissue and jawbone.  If left untreated, it can lead to shifting teeth, loose teeth and eventually tooth loss.

Periodontal disease is the leading cause of tooth loss among adults in the developed world and should always be promptly treated.

Types of Periodontal Disease

When left untreated, gingivitis (mild gum inflammation) can spread to below the gum line.  When the gums become irritated by the toxins contained in plaque, a chronic inflammatory response causes the body to break down and destroy its own bone and soft tissue.  There may be little or no symptoms as periodontal disease causes the teeth to separate from the infected gum tissue.  Deepening pockets between the gums and teeth are generally indicative that soft tissue and bone is being destroyed by periodontal disease.

Here are some of the most common types of periodontal disease:

• Case Type 1 - Gingivitis
  - Mild marginal and papillary redness and edema
  - 1-3 mm pockets (4's localized to the posterior)
  - Light to moderate plaque, bleeding and calculus build-up
• Case Type 2 - Early Periodontitis
  - Mild to moderate marginal papillary redness and edema
  - 4-5 mm pockets (5's localized to the posterior)
  - Moderate plaque, bleeding and calculus build-up
  - Slight bone loss starting
• Case Type 3 - Moderate Periodontitis
  - Moderate marginal and papillary redness and edema
  - 5-6 mm pockets (4's and 5's generalized in posterior)
  - Moderate to heavy plaque, bleeding and calculus build-up
  - Moderate bone loss
  - Mobility possible
• Case Type 4 - Advanced Periodontitis
  - Severe marginal and papillary redness and edema
  - 7 mm pockets or greater
  - Heavy plaque, bleeding and calculus build-up
  - Moderate to severe bone loss
  - Mobility
• Case Type 5 - Refractory Progressive Periodontitis
  - Several unclassified types of periodontitis characterized by rapid bone and attachment loss or slow but continuous attachment loss, usually associated with inflammation and continued pocket formation even with good plaque control.  Frequently there is vertical and uneven bone loss, especially around the first molars and lateral incisors.

Treatment for Periodontal Disease

There are many surgical and nonsurgical treatments the periodontist may choose to perform, depending upon the exact condition of the teeth, gums and jawbone.  A complete periodontal exam of the mouth will be done before any treatment is performed or recommended.

Here are some of the more common treatments for periodontal disease:

Scaling and root planing – In order to preserve the health of the gum tissue, the bacteria and calculus (tartar) which initially caused the infection, must be removed.  The gum pockets will be cleaned to help alleviate the infection.  A prescription toothpaste may be incorporated into daily cleaning routines.

Ultrasonic scaling  - One of the most effective procedures for treating periodontal disease.  An ultrasonic scaler consists of a wand with a small scaling tip that produces a soft ultrasonic vibration.  The small quick vibrations, in combination with a gentle water flow, thoroughly remove tartar, while decreasing the number of destructive bacteria below the gumline.

Ultrasonic scaling has many benefits over using hand scaling alone.  These include:
- More efficient removal of plaque and tartar.
- Less need for hand removal of stubborn deposits.
- Greater comfort for you.

Dental implants – When teeth have been lost due to periodontal disease, the aesthetics and functionality of the mouth can be restored by implanting prosthetic teeth into the jawbone.  Tissue regeneration procedures may be required prior to the placement of a dental implant in order to strengthen the bone.

Ask your dentist if you have questions or concerns about periodontal disease, periodontal treatment, or dental implants.