Periodontal Disease: Causes, Stages & Prevention

Periodontal Disease: Causes, Stages & Prevention

Periodontal disease is a disease that affects the supporting structures of the teeth, including the gums and bone. Bacteria in dental plaque cause periodontal disease. If plaque is not removed through proper daily brushing and flossing, it hardens into a substance called calculus (also known as tartar).

Toxins produced by bacteria in plaque irritate the gums. While they remain in place, these toxins trigger a chronic inflammatory response that destroys the gum and bone tissue supporting the teeth. This leads to the formation of periodontal pockets, which fill with plaque, toxins and bacteria.

As the disease progresses, gums begin to recede, pockets deepen and more plaque accumulates below the gumline. Over time, the supporting bone is destroyed, and the affected teeth may become loose or require extraction.

Stages of Periodontal Disease

Several types of periodontal disease exist. The most common include:

• Gingivitis: This is the mildest form of periodontal disease. It results in red, swollen gums that bleed easily. Pain is usually minimal or absent in this stage. Gingivitis is reversible with professional treatment and good oral care at home.
• Periodontitis: If gingivitis is not treated, it can progress to periodontitis. In this stage, the disease begins to destroy the bone and tissue that support the teeth.
• Advanced Periodontitis: Advanced periodontitis develops if the steps needed to stop the disease are not taken. This is the most severe stage, where extensive loss of supporting tissue occurs.
• Juvenile Periodontitis: Localized juvenile periodontitis (LJP) occurs in adolescents and is characterized by rapid loss of bone around the permanent teeth. Interestingly, young people with LJP often have very little plaque or calculus. Generalized juvenile periodontitis is generally considered a disease of young adults, although it may begin at puberty. It is characterized by severe gum inflammation and heavy plaque and tartar accumulation. Pockets form around the teeth, creating areas prone to infection. If left untreated, the infection can lead to tooth loss as the teeth become loose.

Signs and Symptoms to Watch For

Periodontal disease can progress without any symptoms or pain. Regular dental checkups allow the dentist to detect periodontal disease early, when it is easier to treat.

• Gums that are soft, swollen or red.
• Bleeding or sore gums when brushing or flossing.
• Receding gums or longer-looking teeth.
• Loose or shifting teeth.
• Pus appearing between the teeth and gums.
• Persistent bad breath.
• A change in the way the teeth fit together when biting.
• Changes in the fit of partial dentures.

Prevention and Diagnosis of Periodontal Disease

Brushing and flossing at least twice a day is the most effective way to prevent periodontal disease.

Professional cleaning every 3 to 6 months, performed by a dentist or dental hygienist, removes hard-to-reach plaque and calculus, helping to prevent the gum disease that can follow.

At regular dental visits, the dental professional will examine the spaces between the teeth and gums to check for signs of periodontal disease. If signs of disease are found, the dentist may refer the patient to a periodontist, a dental specialist in the treatment of periodontal disease.

Tooth decay (dental caries) is a multifactorial disease, meaning several factors contribute to its development. Tooth decay is the destruction of hard tissues of the tooth caused by demineralization, which results from acids produced by bacteria in dental plaque. These acids come from sugars and carbohydrates in the diet. Other factors include dental anatomy, poor oral hygiene, lack of fluoride exposure, and saliva function. Once decay destroys the enamel, it attacks the dentin and reaches the dental pulp, causing inflammation (pulpitis) and eventually necrosis (pulp death). If untreated, the infection can spread to the root apex, producing apical periodontitis and possibly an abscess, cellulitis or even a phlegmon.

Dental caries is a multifactorial disease, meaning several factors contribute to its development. Researchers have identified key factors determining caries risk, including dental anatomy, diet, time, saliva, and the bacterial composition of dental plaque. Teeth in the back of the mouth, such as molars and premolars, are more susceptible due to their grooves, pits and fissures, which are difficult to clean. Socioeconomic, cultural and lifestyle factors, including diet and oral hygiene habits, also play a role. Saliva acts as a natural buffer, neutralizing acids and helping to remineralize enamel. Frequent consumption of fermentable carbohydrates allows acid-producing bacteria to keep enamel demineralized for long periods, which is why limiting sugar intake to specific times of the day is recommended.

Relationship between oral hygiene and dental health: if you do not keep your teeth clean, you will be at risk of disease. Maintaining good oral hygiene is one of the most effective ways to keep your teeth and gums healthy.