Periodontal, or advanced gum disease, could be described as a silent problem, since the signs and symptoms are not at all obvious unless you know what to look for. Getting to know what to look for in terms of the stages and progression involved can help you seek treatment earlier – and ultimately help you hold on to your teeth for longer.
This article is aimed at helping by explaining the stages and pointing to the appropriate treatment for each.
Periodontal disease is all too common amongst our adult population. Even though most people do clean their teeth, unfortunately many don’t do a thorough job, as they are often in a rush. Many don’t appreciate the importance of removing absolutely all the sticky plaque around the base of their teeth. It is the plaque which holds the bacteria that can damage the gums over time.
The problem is mostly caused by bacteria which are normally present in the mouth anyway. But it is the sheer weight of numbers, when they are allowed to proliferate freely, which results in the progressive loss of tooth support tissue.
Periodontal disease is slowly progressive unless positive action is taken to stop it. But the good thing is that, if you establish good oral hygiene early enough, you can actually reverse the condition and get your gums back to normal health. If you leave it too long, however, you can probably only at best stabilize the situation and prevent it from getting worse.
The stages are slowly progressive in a more or less continuous way, although it is observed that it can have periods of greater or lesser activity, depending possibly on various systemic and local factors. Such factors include:
- Areas of increased plaque build up (this can be down to the patient not doing a thorough job, and/or down to issues within the mouth that impair effective cleaning)
- Cigarette smoking
- Medical problems such as diabetes
The underlying cause however, is chronic irritation from bacteria concentrated in plaque which sticks to the teeth adjoining the gums. Although the problem is usually slow in its progression there are several stages which can be observed.
Note that there are aggressive forms, which can very rapidly destroy gingival and bone tissues, and may occur in younger patients. But this article will focus on the chronic disease, which is much more common.
Thus periodontal disease can be classified according to the signs and symptoms, and the amount of damage caused to the oral tissues in terms of gum loss, bone loss, and tooth mobility.
The teeth are normally held firmly in their sockets in the jaw bone by a large number of strong fibres, which constitute the periodontal membrane. But periodontitis slowly destroys these fibres, and there follows stages with loss of gum tissue, then bone, and eventually loosening of teeth.
The first phase – Gingivitis
The initial stages involve inflammation of the superficial gingiva, which causes it to redden and sometimes become slightly puffy. Normal healthy gum is a light pink colour in most people and has a very slightly “stippled” surface.
In the first stages of gum disease this “orange peel” appearance is lost, as fluid builds up under the gum surface and small blood vessels enlarge to give a redder appearance as well.
This stage is termed gingivitis and can be reversed by careful attention to daily plaque removal using a toothbrush and floss. If you’re not sure how to do this get your dentist or hygienist to show you, since an effective technique for plaque removal from all tooth surfaces (without damaging the teeth or gums in the process) is essential.
Effective oral hygiene on a regular daily basis is the only way to ensure that gum disease doesn’t take hold in your mouth. Gingivitis is also characterised by the gums tendency to bleed easily when brushed or sometimes even when touched with a finger. If you notice bleeding or undue redness of the gums then you should get professional advice as to how exactly to improve your oral hygiene and get things back to health.
The second stage of chronic periodontal disease
If these early signs of disease go unnoticed, or are ignored, then the continued bacterial irritation causes the gums to loosen around the necks of teeth and sometimes shrink away as well. If the gum loosens, it forms a pocket which traps food particles and plaque and this is even more difficult to remove with a toothbrush, since it is often hidden from sight.
Without proper removal of plaque, though, further deterioration takes place with periodontal ligament fibres being damaged and lost and then even bone begins to gradually disappear. A vicious cycle can easily arise once pockets begin to form.
This second stage of periodontitis thus involves pockets in possibly both the soft tissue of the gums, and of the inter-dental bone.
Once pockets are formed, there may be other different types of bacteria involved in the process along with the normal “commensals” in the mouth, or they may even virtually supplant them, causing more destruction of periodontal fibres and resorption of bone from between teeth. Periodontal disease is driven by nasty microbes that thrive in the dark, unaired spaces that exist within the pockets.
The stage where bone is involved in the disease process is rather more difficult to treat, but may necessitates some form of surgical procedure to remove diseased tissues followed by scrupulous daily oral hygiene measures to stabilize the situation.
Early periodontitis, where pocketing and bone loss are minimal will respond well to treatment, but the greater the loss of bone between the teeth and the deeper the pockets the more difficult it becomes to satisfactorily treat the condition.
The third stage – Advanced Breakdown
If the condition is allowed to proceed further, it gets to a critical point. Here so much bone is lost, that chewing forces are able to move the teeth and they then gradually loosen.
This stage is termed advanced periodontitis, whereby there is extensive bone loss from between the teeth and obvious mobility. Once a few teeth become loose, it is usually very difficult to firm them up again, because of the continuous unfavourable forward component of forces on them during biting and chewing. Teeth can sometimes be splinted to other firmer neighbours, but this usually only extends their useful life to a certain extent.
Eventually they simply have to be extracted, once they can cause pain or discomfort during chewing, or when periodontal abscesses occur.
There is a type of acute (ANUG) and more aggressive forms of periodontal disease. But by far the most common type is the chronic progressive type as just described, and this is wholly preventable.
Prevention is through proper and thorough cleaning of your teeth on a daily basis which is well worthwhile when you look at the above scenario. Keeping your teeth for life is entirely possible and extremely desirable since they are important not only for their essential function, but also for maintaining the appearance of your face as well.
If you are worried about any of the above, tell your dentist! The sooner any periodontal disease stage is detected and treated the better!