What is periodontal disease?
Periodontal disease is a bacterial infection of the periodontium which include: Gingiva, Cementum, Periodontal Ligament, and Alveolar bone. The disease is categorized in two different types: gingivitis and periodontitis. For the progression of disease to occur, very specific pathogenic bacteria must be present.. It is crucial to understand that periodontal bacteria alone, is not sufficient enough to cause disease....it is the body's immune response to periodontal pathogens!. The term "periodontal disease" is often times used interchangeably for the stages of disease but, believe it or not, they are very different!
Periodontal disease is a bacterial infection of the periodontium which include: Gingiva, Cementum, Periodontal Ligament, and Alveolar bone. The disease is categorized in two different types: gingivitis and periodontitis. For the progression of disease to occur, very specific pathogenic bacteria must be present.. It is crucial to understand that periodontal bacteria alone, is not sufficient enough to cause disease....it is the body's immune response to periodontal pathogens!. The term "periodontal disease" is often times used interchangeably for the stages of disease but, believe it or not, they are very different!
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Health: in health, your gums should be pink, but may be pigmented, and should not bleed when brushing or flossing. They are firmly adapted to your teeth creating a scalloped outline. For instance, imagine that the tooth is your neck and the gums are the turtleneck of your shirt. The pocket depth should be 1 to 3 mm in health.
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Gingivitis: is a bacterial infection that only affects the gums. It is seen in 4-14 days after plaque attaches under the gums. Gingivitis consists of two types of disease: acute or chronic. Tissue damage from gingivitis is reversible and can exist for years without advancing to periodontitis. The pocket depth is between 3-4 mm in gingivitis.
-Acute Gingivitis: lasts for only a short period of time and the gums appear to be red and swollen. The tissue can be soft and spongy with bleeding on probe.
-Chronic Gingivitis: lasts for months or years. The gums may appear to be a bluish red or pale white with a leathery (fibrotic) texture and bleeding on probe.
-Acute Gingivitis: lasts for only a short period of time and the gums appear to be red and swollen. The tissue can be soft and spongy with bleeding on probe.
-Chronic Gingivitis: lasts for months or years. The gums may appear to be a bluish red or pale white with a leathery (fibrotic) texture and bleeding on probe.
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Periodontitis: disease that involves all structures of the periodontium. It is also a bacterial infection that results in irreversible destruction to the tissues. In periodontitis, gums pull away from the teeth and from spaces called "pockets" that become infected. Bacteria stick to the surface of tooth more easily and multiply. Our body’s immune system fights the bacteria as they spreads and grow below the gumline. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If not treated, the infection will progress and the alveolar bone around the teeth is slowly and progressively lost. The teeth may eventually become loose and have to be removed.Treatment is to clean out bacteria from the pockets around the teeth by professional dental cleaning or root planning and prevent further destruction of bone and tissue.
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The Process and Progression of Periodontal Disease:
The causative agents for periodontal disease and its progression are pathogenic bacteria and the way in which the host (the patient) will respond to it. There are 4 main stages of Periodontal Disease:
1. Early Bacterial Accumulation Phase : The bacteria are building up along the gingival margin (gum line) resulting in some tissue destruction which creates a pathway for the bacteria to get further into the pocket. The body may successfully destroy the bacteria, but if it fails, the infection will then progress into early gingivitis.
2. Early Gingivitis (Plaque Overgrowth Phase): As the bacteria continue to penetrate the tissue, the body attempts to stop the progression by calling on cells that are part of the immune system. As the immunity cells are responding, they are also inadvertently causing more tissue damage to the host.
3. Established gingivitis (Subginigval Plaque Phase): If the body is still unable to stop the bacteria, the bacteria as well as the plaque created, will extend further beneath the gingiva where the body continues to attack the invaders as well as the host's tissues.
4. Periodontitis (Tissue Destruction Phase): At this point the plaque biofilm (bacteria) has spread down to the roots and as a result the body's immune response has become chronic. The continuous response and inflammation causes repeated destruction to the periodontium, eventually leading to bone destruction and attachment loss.
The causative agents for periodontal disease and its progression are pathogenic bacteria and the way in which the host (the patient) will respond to it. There are 4 main stages of Periodontal Disease:
1. Early Bacterial Accumulation Phase : The bacteria are building up along the gingival margin (gum line) resulting in some tissue destruction which creates a pathway for the bacteria to get further into the pocket. The body may successfully destroy the bacteria, but if it fails, the infection will then progress into early gingivitis.
2. Early Gingivitis (Plaque Overgrowth Phase): As the bacteria continue to penetrate the tissue, the body attempts to stop the progression by calling on cells that are part of the immune system. As the immunity cells are responding, they are also inadvertently causing more tissue damage to the host.
3. Established gingivitis (Subginigval Plaque Phase): If the body is still unable to stop the bacteria, the bacteria as well as the plaque created, will extend further beneath the gingiva where the body continues to attack the invaders as well as the host's tissues.
4. Periodontitis (Tissue Destruction Phase): At this point the plaque biofilm (bacteria) has spread down to the roots and as a result the body's immune response has become chronic. The continuous response and inflammation causes repeated destruction to the periodontium, eventually leading to bone destruction and attachment loss.
Local Contributing Factors
Factors or conditions that will increase the likelihood that an individual will develop a periodontal infection. These include:
-dental calculus
-dental decay
-trauma
-anatomic factors
Factors or conditions that will increase the likelihood that an individual will develop a periodontal infection. These include:
-dental calculus
-dental decay
-trauma
-anatomic factors
Systemic Contributing Factors
Similar to local contributing factors, systemic contributing factors will increase the likelihood that an individual will develop periodontal disease through the modification or enhancement of the host's response to the disease. These include:
-smoking or smokeless tobacco-diabetes
-diabetes
-hormonal variations
-AIDS
-leukemia
-medications
Similar to local contributing factors, systemic contributing factors will increase the likelihood that an individual will develop periodontal disease through the modification or enhancement of the host's response to the disease. These include:
-smoking or smokeless tobacco-diabetes
-diabetes
-hormonal variations
-AIDS
-leukemia
-medications
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FAQs: 1. Are periodontal treatments generally covered under Medicare or Medicaid? Unfortunately, Medicare does not cover any dental treatments at this time; only medical treatments are covered. Medicaid programs are run by each individual state, so coverage is going to vary depending on which state you live in. Check with your dental care provider to determine if the periodontal treatment you need is covered by your plan.
2. How is gum disease linked to cardiovascular disease?
Research has shown that periodontal disease may increase the risk for developing cardiovascular disease. Both periodontal disease and cardiovascular disease are chronic inflammatory diseases, so researchers believe that inflammation may account for the association between the two. Untreated periodontal disease can increase inflammation in the body, which may increase the risk for development of more severe health complications, including cardiovascular disease. However, more research is needed to determine the exact relationship between the two conditions.
3. What are common signs and symptoms of periodontal disease?
Periodontal disease is often silent, meaning symptoms - particularly pain - may not appear until an advanced stage of the disease. However, you should still be on the lookout for the signs and symptoms, which include:
-red, swollen or tender gums or other pain in your mouth
-bleeding while brushing, flossing, or when eating certain foods
-gums that are receding or pulling away from the teeth, causing the teeth to look longer than before
-loose or separating teeth
-pus between your gums and teeth
-sores in your mouth
-persistent bad breath
-a change in the way your teeth fit together when you bite
-a change in the fit of partial dentures
If you notice any of these symptoms, be sure to contact your dentist or periodontist right away!
2. How is gum disease linked to cardiovascular disease?
Research has shown that periodontal disease may increase the risk for developing cardiovascular disease. Both periodontal disease and cardiovascular disease are chronic inflammatory diseases, so researchers believe that inflammation may account for the association between the two. Untreated periodontal disease can increase inflammation in the body, which may increase the risk for development of more severe health complications, including cardiovascular disease. However, more research is needed to determine the exact relationship between the two conditions.
3. What are common signs and symptoms of periodontal disease?
Periodontal disease is often silent, meaning symptoms - particularly pain - may not appear until an advanced stage of the disease. However, you should still be on the lookout for the signs and symptoms, which include:
-red, swollen or tender gums or other pain in your mouth
-bleeding while brushing, flossing, or when eating certain foods
-gums that are receding or pulling away from the teeth, causing the teeth to look longer than before
-loose or separating teeth
-pus between your gums and teeth
-sores in your mouth
-persistent bad breath
-a change in the way your teeth fit together when you bite
-a change in the fit of partial dentures
If you notice any of these symptoms, be sure to contact your dentist or periodontist right away!
Images from:
Bear Canyon Periodontics (2013). Image. periodontal disease. Retrieved from http://www.bearcanyonperio.com/patient-education/gum-disease-101-what-is-it-who-is-at-risk-how-is-it-treated/ [Accessed 19 February 2014]
Edgewood Dental (2013). Image. periodontics. Retrieved from http://edgewooddental.com/services.html [Accessed 19 February 2014]
Lost Dent (2009). Image. tissues_of_periodontium. Retrieved from http://www.lostdent.com/foundations_of_periodontics/tissues-of-the-periodontium/ [Accessed 19 February 2014]
Northwater Dental (2013). Image. stages_of_periodontal_disease. Retrieved from http://www.clearwater-dentistry.com/gum-treatment.php [Accessed 19 February 2014]
Work cited:
Nield-Gehring, J., & Willmann, D. E. (2011). Foundations of periodontics for the dental hygienist. (3rd edition ed., pp. 54-204). Philadelphia, PA: Wolters Kluwer Health. [Accessed 19 February 2014]
Bear Canyon Periodontics (2013). Image. periodontal disease. Retrieved from http://www.bearcanyonperio.com/patient-education/gum-disease-101-what-is-it-who-is-at-risk-how-is-it-treated/ [Accessed 19 February 2014]
Edgewood Dental (2013). Image. periodontics. Retrieved from http://edgewooddental.com/services.html [Accessed 19 February 2014]
Lost Dent (2009). Image. tissues_of_periodontium. Retrieved from http://www.lostdent.com/foundations_of_periodontics/tissues-of-the-periodontium/ [Accessed 19 February 2014]
Northwater Dental (2013). Image. stages_of_periodontal_disease. Retrieved from http://www.clearwater-dentistry.com/gum-treatment.php [Accessed 19 February 2014]
Work cited:
Nield-Gehring, J., & Willmann, D. E. (2011). Foundations of periodontics for the dental hygienist. (3rd edition ed., pp. 54-204). Philadelphia, PA: Wolters Kluwer Health. [Accessed 19 February 2014]