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Periodontal (gum) diseases, including the two most common forms of gum disease called Gingivitis and Periodontitis (Pyorrhea), are serious infections that can lead to tooth loss if left untreated. Periodontal disease results from a chronic bacterial infection that affects the gums and bone supporting the teeth.
There are many forms of periodontal disease. The most common ones include: - Gingivitis. This is the mildest form of periodontal disease, causing the gums to become red, swollen, and to bleed easily. There is usually little or no discomfort at this stage. Gingivitis is reversible with professional treatment and good home care.
- Aggressive Periodontitis. This is a form of periodontitis that occurs in patients who are otherwise clinically healthy. Common features include rapid attachment loss, bone destruction and familial aggregation.
- Chronic Periodontitis. This form of periodontal disease results in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss and is characterized by pocket formation and/or recession of the gum. It is recognized as the most frequently occurring form of periodontitis. While prevalent in adults, it can occur at any age. Progression of attachment loss usually occurs slowly, but periods of rapid progression can occur.
- Periodontitis as a Manifestation of Systemic Diseases. Periodontitis, often with onset at a young age, is associated with one of several systemic diseases, such as diabetes.
- Necrotizing Periodontal Diseases. This is characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions including, but not limited to, HIV infection, malnutrition and immunosuppression.
Causes & Development
Causes of Periodontal Disease:- Plaque. The main cause of periodontal disease is bacterial plaque.
- Genetics. Research shows that up to 30% of the population may be genetically susceptible to gum disease. Despite aggressive oral care habits, these people may be six times more likely to develop periodontal disease.
- Other systemic diseases. Diseases that interfere with the body's immune system may worsen the condition of the gums.
Signs & Symptoms
Periodontal disease can affect one tooth or many and begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) causes the gums to become inflamed. In the mildest form of the disease - gingivitis - the gums redden, swell and bleed easily.
Pain is usually not a symptom, which partly explains why the disease may become advanced before treatment is sought and why some patients avoid treatment even after periodontitis is diagnosed.
With time, plaque can spread and grow below the gum line and untreated gingivitis can advance to periodontitis. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself: the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms but eventually teeth can become loose and may have to be removed.
Gum Bleeding. Bleeding of the gums, even during brushing, is a sign of inflammation and the major marker of periodontal disease. One exception is juvenile periodontitis, in which symptoms are mild or even absent. It should be noted that the gums of smokers with periodontal disease tend to bleed less than nonsmokers.
Bad Breath. Debris and bacteria can cause a bad taste in the mouth and persistent bad breath.
Gum Recession and Loose Teeth. As the disease advances the gums recede, and supporting structure of bone is lost. Teeth loosen, sometimes causing a change in the way the upper and lower teeth fit together when biting down or a change in the fit of partial dentures.
Abscesses. Deepening periodontal pockets between the gums and bone can become blocked by tartar or food particles. The infection fighting white blood cells become trapped and die. Pus forms and an abscess develops. Abscesses can destroy both gum and tooth tissue, cause nearby teeth to become loose and painful, and may cause fever and swollen lymph nodes.
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Signs, symptoms & indicators of Periodontal Disease - Gingivitis:
Risk factors for Periodontal Disease - Gingivitis: | | | | | Addictions |  Cigarette Smoke Damage | Studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease [Journal of Periodontology, May 2000]. Smokers' teeth fall out faster than those of non-smokers. |
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Mental |
Stress| | Research demonstrates that stress can make it more difficult for the body to fight off infection, including periodontal disease. [Journal of Periodontology July 1999] |
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Metabolic |
Bruxism (Clenching/Grinding Teeth)| | Clenching or grinding your teeth can put excess force on the supporting tissues of the teeth and speed up the rate at which these periodontal tissues are destroyed. |
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Organ Health |
Diabetes Type II| | If you are diabetic, you are at higher risk of developing infections, including periodontal diseases. These infections can in turn impair the body's ability to process and/or utilize insulin, creating a vicious circle in which your diabetes may be more difficult to control and your infection more severe than in a non-diabetic. [Journal of Periodontology November 1999] |
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Symptoms - Head - Mouth/Oral |
Loose teeth| | As gingivitis progresses, the gums recede and the supporting structure of bone is lost. Teeth loosen, sometimes causing a change in the way the upper and lower teeth fit together when biting down or a change in the fit of partial dentures. |
 Occasionally/never flossing teeth |
Uro-Genital |
Pregnancy-Related Issues| | During pregnancy the body experiences hormonal changes. These changes can affect many tissues, including the gums. Gums can become sensitive and at times react strongly to the hormonal fluctuations, which may in turn increase the susceptibility to gum disease. Additionally, the more the mouth is affected by periodontal disease, the more likely a woman is to deliver a premature baby, according to an ongoing study of more than 2,000 pregnant women. |
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Periodontal Disease - Gingivitis suggests the following may be present: | | | | | Metabolic | Bruxism (Clenching/Grinding Teeth)| | Clenching or grinding your teeth can put excess force on the supporting tissues of the teeth and speed up the rate at which these periodontal tissues are destroyed. |
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Recommendations and treatments for Periodontal Disease - Gingivitis: | | | | | Botanical |  Neem| | Neem is a most effective gum disease treatment. In a German study of 70 patients with pyorrhea of varying stages, after just 5 to 10 treatments with a neem-based toothpaste and mouthwash there was significant improvement. Bleeding gums had healed and the secretion from pockets around the teeth had stopped. The bluish-colored gums returned to a healthy pale pink color. [Zeppenfeldt, undated].
Neem bark extracts can reduce the ability of some streptococci to colonize tooth surfaces [Wolinsky and Mania, 1996; Patel and Venkatakrishna, 1988]. Gingivitis has been prevented or even reversed with regular use of neem toothpaste and mouthwash [Elvin-Lewis, 1980].
One patient even reported a reversal of the loss of gum tissue by chewing fresh neem leaves. Scientists believe that antibacterial compounds and neem's ability to improve the immune response in the gums and tissues of the mouth account for these results. |
 Oil of Oregano| | Dilute oregano oil in a small amount of water and dab onto the affected tissues 3-4 times per day to kill the bacteria causing inflammation. |
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Dental |
Adequate Dental Care| | Gingivitis is often caused by inadequate oral hygiene and is reversible through professional cleaning to remove calculus and good oral home care to remove plaque and prevent the buildup of calculus. |
Floss/Tongue Comb| | Flossing regularly removes plaque and prevents the buildup of calculus. |
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Drug |
Conventional Drug Avoidance| | Some drugs, such as oral contraceptives, anti-depressants and certain heart medicines, can affect your oral health. |
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Surgery/Invasive |
Surgery| | Your periodontist may recommend periodontal surgery. This is necessary when your periodontist determines that the tissue around your teeth is unhealthy and cannot be repaired by non-surgical means. Special deep cleaning procedures may prevent the need for surgery. |
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Preventive measures against Periodontal Disease - Gingivitis: | | | | | Diet | Sugars Avoidance / Reduction| | The bacteria that come together to become plaque use sugar as a form of energy. They multiply faster and the plaque grows in size and thickness. Some of the bacteria turn sugar into a kind of glue and use it to stick themselves to the surface of the teeth. This makes it harder for the bacteria to get washed away by saliva. |
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KEY | | Weak or unproven link | | | Strong or generally accepted link |  | | Proven definite or direct link | | | May do some good | | | Highly recommended |
GLOSSARY
Alveolar
Pertaining to a small hollow space, as in the lung, e.g. pulmonary alveolus.
Bacteria (Bacterial, Bacterium)
Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Boil (Abscess, Abscesses, Boils, Carbuncle, Carbuncles, Cystic Acne, Furuncle, Furuncles, Hidradenitis Suppurativa, Pilonidal Cyst, Pilonidal Cysts)
A localized infection deep in the skin. A boil generally starts as a reddened, tender area. Over time, the area becomes firm and hard. Eventually, the center of the abscess softens and becomes filled with white cells that the body sends to fight the infection (pus). Finally, the pus forms a "head" and drains out through the skin. A furuncle or carbuncle is an abscess in the skin caused by the bacteria Staphylococcus aureus. It can have one or more openings onto the skin and may be associated with a fever or chills. Cystic acne is a type of abscess formed when oil ducts become clogged and infected. Cystic acne is most common in the teenage years. Hidradenitis suppurativa is an illness in which there are multiple abscesses that form under the arm pits and in the groin area. These areas are a result of local inflammation of the sweat glands. A pilonidal cyst is a special kind of abscess that occurs in the crease of the buttocks. These frequently form after long trips that involve sitting.
Calculus
A hard yellow to brown deposit that forms slowly on teeth as plaque hardens. Calculus is also known as tartar.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Diabetes Mellitus (Diabetes, Diabetic, Diabetics)
A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.
Gingivitis
Inflammation of the fibrous tissues that surround the teeth.
Human Immunodeficiency Virus (HIV)
A retrovirus associated with onset of advanced immunodeficiency syndrome (AIDS).
Immune System (Immune Response, Immunity)
A complex that protects the body from disease organisms and other foreign bodies. The system includes the humoral immune response and the cell-mediated response. The immune system also protects the body from invasion by making local barriers and inflammation. The process may involve acquired immunity (the ability to learn and remember a specific infectious agent), or innate immunity (the genetically programmed system of responses that attack, digest, remove, and initiate inflammation and tissue healing).
Insulin
A hormone secreted by the pancreas in response to elevated blood glucose levels. Insulin stimulates the liver, muscles, and fat cells to remove glucose from the blood for use or storage.
Lesion (Lesions)
Any damage to tissue structure or function; an abnormal change in body tissue caused by disease or injury. A scar is a lesion, as is cancer, a stomach ulcer or a pimple.
Lymph Nodes (Axillary Nodes, Inguinal Nodes, Lymph Gland, Lymph Glands, Lymph Node, Lymphatic)
Small, bean-shaped nodes at various points throughout the body that function to filter the lymph fluid and attempt to destroy the microorganisms and abnormal cells which collect there. The most common locations are the neck (both sides and front), armpit (axillary) and groin (inguinal), but also under the jaw and behind the ears. Swollen or painful lymph nodes generally result from localized or systemic infection, abscess formation, or malignancy. Other causes of enlarged lymph nodes are extremely rare. Physical examination for lymph nodes includes pressing on them to check for size, texture, warmth, tenderness and mobility. Most lymph nodes can not be felt until they become swollen, and then will only be tender when pressed or massaged. A lymph node that is painful even without touching indicates greater swelling. Lymph nodes can usually be distinguished from other growths because they generally feel small, smooth, round or oval-shaped and somewhat mobile when attempts are made to push them sideways. Because less fat covers the lymph nodes in children, they are easier to feel, even when they are not busy filtering germs or making antibodies. Childrens' nodes enlarge faster, get bigger in response to an infection and stay swollen longer than an adult's. Also known (incorrectly) as lymph glands.
Necrosis
Death of one or more cells, or of a portion of a tissue or organ.
Periodontitis (Pyorrhea)
Inflammation of the area around a tooth. Broadly, any discharge of pus, but usually referring to periodontitis or Pyorrhea alveolaris, with inflammatory and degenerative conditions in the gums, jaw bone and cementum. There may be alveolar bone resorption, tooth loss and receding gums.
Pus
White cells that the body sends to fight an infection.
Saliva (Salivary)
The watery mixture of secretions from the salivary and oral mucous glands that lubricates chewed food and moistens the oral walls.
White Blood Cell (WBC, White Blood Cells)
A blood cell that does not contain hemoglobin: a blood corpuscle responsible for maintaining the body's immune surveillance system against invasion by foreign substances such as viruses or bacteria. White cells become specifically programmed against foreign invaders and work to inactivate and rid the body of a foreign substance. White blood cells are composed primarily of neutrophils, monocytes and lymphocytes. Lymphocytes are either T-cells or B-cells. T-cells (CD3 cells) are divided into T-helper (CD4 cells) and T-suppressor/cytotoxic (CD8 cells) cells.
Last updated: Apr 13, 2008
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