Periodontal (gum) diseases, including gingivitis and periodontitis, 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.
It 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. There is usually little or no discomfort. 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.
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.
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.
Types of Periodontal Disease
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.
Signs, symptoms & indicators of Periodontal Disease - Gingivitis
Gums that bleed easily
Bleeding gums are nearly always a symptom of gingivitis.
Conditions that suggest Periodontal Disease - Gingivitis
Having periodontal disease
Counter Indicators
Absence of periodontal disease
Risk factors for Periodontal Disease - Gingivitis
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]
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]
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.
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]
Possible 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.
Periodontal Disease - Gingivitis suggests the following may be present
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]
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.
Recommendations for Periodontal Disease - Gingivitis
Neem
Throughout India and South East Asia millions of village people use Neem twigs and leaves to brush their teeth, and keep their gums free of disease and infection even though they have limited access to modern dental care. The ancient Ayurvedic practice of using Neem to heal and rejuvenate gum tissue and to prevent cavities and gum disease is verified in modern clinical studies. Studies showed that Neem bark is more active then the leaves against certain bacteria and that Neem based tooth pastes and mouth washes significantly improved Pyorrhea, at various stages, in 70 patients. In another study Neem toothpaste prevented and even reversed gingivitis.
Oregano Oil
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.
Oral Hygiene / Dental Care
Flossing regularly removes plaque and prevents the buildup of calculus.
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.
Chewing Gum
Xylitol reduces the incidence of periodontal disease. Periodontal disease is also a risk factor for damage to heart and blood vessels. In the presence of xylitol, bacterial adhesion to epithelial cells is disrupted. In an in vitro assay using a 5% solution of xylitol, researchers demonstrated that the mucosal attachment of Streptococcus pneumoniae and Haemophilus influenzae was reduced by factors of 68% and 50%, respectively.
Antibiotics
The commonly used antibiotic doxycycline (Periostat), is widely used to treat gum disease, when normal home care methods are insufficient.
Conventional Drugs / Information
Some drugs, such as oral contraceptives, anti-depressants and certain heart medicines, can affect your oral health.
Essential Fatty Acids
Borage oil improved gingival inflammation and probing depth in a controlled study of 30 adults with periodontal disease. The dosage used was 3000mg per day for a period of 3 months.. Fish oil alone (3,000mg per day) or a combination of borage oil (1,500mg per day) and fish oil (1,500mg per day) had no effect. [Prost Leuk Ess Fatty Acids 2003;68(3): pp.213-8]
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.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Proven definite or direct link |
| Very strongly or absolutely counter-indicative |
| May do some good |
| Likely to help |
| Highly recommended |
| May have adverse consequences |
Glossary
Gingivitis
Inflammation of the fibrous tissues that surround the teeth.
Periodontitis
Inflammation of the area around a tooth.
Chronic
Usually Chronic illness: Illness extending over a long period of time.
Bacteria
Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Calculus
A hard yellow to brown deposit that forms slowly on teeth as plaque hardens. Calculus is also known as tartar.
Immune System
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.
Diabetes Mellitus
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.
Necrosis
Death of one or more cells, or of a portion of a tissue or organ.
Alveolar
Pertaining to a small hollow space, as in the lung, e.g. pulmonary alveolus.
HIV
Abbreviation for human immunodeficiency virus, a retrovirus associated with onset of advanced immunodeficiency syndrome (AIDS).
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.