Periodontal diseases – An overview

In its early stages, it is called gingivitis or inflammation of gums. When gingivitis is left untreated, it progresses to the inflammation of other structures, including bone and loss of periodontal ligament which anchors the tooth to the bone and maintains its position in the socket.
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Periodontal tissue or periodontium is the specialized structure surrounding each tooth of upper and lower jaws. It includes cementum, covering the roots of the teeth, gums, bone, and specialized fibers called periodontal ligaments, which join the tooth to the surrounding bone.

The main function of periodontal tissue or periodontium is to surround and support the tooth. It directs the forces, mainly the force of mastication, acting on the tooth to the surrounding bone equally, thereby, maintaining the position and strength of the tooth.

When this surrounding structure of the tooth or periodontium gets infected, it results in the inflammation of gums, which if left untreated results in inflammation of surrounding bone. This condition is called periodontal diseases or periodontitis.

 Symptoms of periodontal diseases include swollen, red, and tender gums, which generally bleed during brushing. Other common symptoms include bad breath or halitosis, which is caused by accumulation of blood and pus in between teeth and gums, painful chewing, gums pulling away from teeth, due to pocket formation between tooth and gums, and loose teeth because of loss of supporting structures of a tooth.

In its early stages, it is called gingivitis or inflammation of gums. When gingivitis is left untreated, it progresses to the inflammation of other structures, including bone and loss of periodontal ligament which anchors the tooth to the bone and maintains its position in the socket. In this condition, gums pull away, exposing the roots which may lead to sensitivity, eventually teeth become loose and may also fall.

The primary cause of gingivitis is poor oral hygiene or ineffective oral hygiene often caused by faulty tooth brushing technique. It leads to accumulation of bacteria and food on the surface of the tooth at the gum line, forming a matrix-like structure called dental plaque. Plaque gets accumulated and causes the inflammation of gums. If it still persists, calcium and other minerals get deposited in the plaque and form calculus which is detrimental for periodontal tissue.

In addition to poor oral hygiene, there are various risk factors predisposing to the periodontal diseases which include Diabetes Mellitus, inadequate nutrition, hormonal changes due to pregnancy and taking birth control pills, high stress, smoking, oral cancers, genetics and of lately Covid 19.

Periodontitis has been linked to the increased risk of various systemic conditions in the body like arthritis, hypertension, stroke, myocardial infraction and atherosclerosis. It is believed to be caused due to increase in the inflammatory markers like C reactive protein and tumor necrosis factor in the blood due to periodontitis and also due to direct influx of bacteria from the gums in the bloodstream.

Periodontitis affects about 70 percent of the adult population worldwide. It is considered as the main cause of tooth loss in adults. So, awareness and prevention are very important. It is important to visit your dentist every 6 months for regular checkups and get your professional cleaning done. It becomes even more important for patients suffering from diabetes and people who smoke. Women often complain of loose teeth and bleeding from gums during and after pregnancy. They should visit the dentist even during pregnancy.

Initial condition or gingivitis is not a painful condition. A person should be very mindful of plaque buildup and bleeding and inflamed gums and visit the dentist as soon they experience such a condition. Dentist will examine your gums for any signs of inflammation. They may use a periodontal probe which has markings like a ruler to measure the depth of the gingival pocket which might have developed because of loss of attachment of gums and tooth and can take dental X-rays to check for any bone loss.

The treatment of periodontal disease depends on the severity of the disease. In case of mild to moderate condition, deep scaling and root planning along with local and systemic antibiotic therapy might be employed. This procedure is similar to professional cleaning but can be done under local anesthesia because it is done beneath your gum line. This procedure sweeps away plaque, calculus or any bacteria which would have been accumulated. Root surface of each tooth is smoothened to prevent the further accumulation of plaque. Topical antibiotics are also used during this procedure to clean periodontal pockets. This procedure can be done in single or two sittings depending on the severity of the disease. Dentists may prescribe antibiotic therapy to wade off infection. Proper oral hygiene instructions and regimes are prescribed to manage the condition properly.

However, if the condition is more severe, and the bone loss is more intense, the general dentist may refer the patient to a specialist called periodontist, who can treat the condition by surgical intervention like flap surgery, bone grafting, and platelet rich plasma therapy. All these procedures are done under local anesthetic.

Periodontitis is not a completely curable condition but can be managed with proper care and treatment. The best way of prevention is to be watchful of symptoms of gum disease, go regularly every 6 months for professional cleaning and practice good oral hygiene at home by brushing your teeth twice every day for 180 seconds using a soft bristle brush on every surface of tooth, flossing your teeth, rinsing your mouth after each meal using medicated mouthwash.    

(Dr Mehreen Riyaz Kokiloo is Cosmetic Dentist and Medical Cosmetologist, C\o Sparkle Healthcare, Bund side KursooRajbagh)

DISCLAIMER: The views and opinions expressed in this article are the personal opinions of the author.

The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.

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