Periodontal-Health-&-Treatm

After the age of 35, gum disease or periodontitis is the major cause of tooth loss in adults, far more so than tooth decay. In fact, about 80% of tooth loss can be ascribed to periodontal disease in this age group. A lot of time and money could be saved by early detection and treatment of the disease and many more people would keep their teeth if they were aware of this fact.

 

Sequela of gum disease

Sequela of gum disease

 

Periodontal disease affects the support structures of the teeth: the bone, gums and ligament (Click here for Dental Anatomy). It is long-term and slow-moving disease: painless in its initial stages, but later presenting as a chronic inflammation that damages both the gums and bone holding the teeth in place. Bacterial plaque is the main culprit here, and only fastidious daily brushing and flossing can effectively remove it.

The most common form of periodontitis is adult periodontitis. It can be localized or generalized and appears to progress episodically. During periods of exacerbationthere is advancing loss of epithelial attachment, increase periodontal pocket depth, increased gingival crevicular fluid, loss of alveolar bone and connective tissue attachment and gingival bleeding.

The predominant species associated with adult periodontitis ace Actinobaccillus actinomycetemcomitans (25-30%), Actinomyces naeslundii, Bacteriods forsythus, Campylobacter rectus, Eikenella corrodens, Eubacterium species, Fusobacterium nucleatum, Peptostreptococcus micros, Prevotella intermedia, Prophyromonas gingivalis, Selenomonas sputigena, Streptococcus intermedius and Treponema species

Types of periodontitis

Adult periodontitis can be devided into  3 types base on severity:

i) Mild (Early) Adult Periodontitis

Mild periodontitis. From Colour Atlas of Common Oral Disease

Mild periodontitis. From Colour Atlas of Common Oral Disease

Clinical features:

  • 3mm epithelial attachment loss or less (gum recession)
  • periodontal pocket depths of 3-5mm (determine by using a periodontal probe)
  • class I furcation involvement
  • alveolar bone loss of 2mm or less (Alveolar bone loss is determined by vertical periapical bitewing radiograph)

ii) Moderate Adult Periodontitis

Moderate periodontitis. From Colour Atlas of Common Oral Disease

Moderate periodontitis. From Colour Atlas of Common Oral Disease

Clinical features:

  • 4-5mm epithelial attachment loss
  • periodontal pocket depths of 4-6mm
  • alveolar l bone loss of 3-5mm
  • gingival exudate and bleeding
  • horizontal, vertical  bone loss and osseous defects
  • mobile teeth and class II furcation involvement

iii) Advanced Adult Periodontitis

Advanced periodontitis. From Colour Atlas of Common Oral Disease

Advanced periodontitis. From Colour Atlas of Common Oral Disease

Clinical features:

  • At least 6mm epithelial attachment loss
  • periodontal pocket depths exceed 6mm
  • alveolar crestal bone loss is more than 5mm
  • gingival recession
  • significant tooth mobility and class III furcation involvement (A through-and-through bony defect)

 Other types of periodontitis

  • Early-onset periodontitis which can be prepubertal periodontitis and juvenile periodontitis
  • Rapidly progressing periodontitis
  • Necrotizing ulcerative periodontitis (HIV periodontitis)
  • Responsiveness to therapy (refactory periodontitis)

Treatment

Treatment depends on the causal factors but generally involves:

Dental Scaling

Dental Scaling

  • the removal of plaque, calculus and diseased cementum by scaling, curettage and root planing
  • Topical antibiotics, short-course therapy with systemic antibiotics (tetracycline and metronidazole)
  • periodontal surgery

More info

Treatments of gum disease: