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Periodontal Disease

What are periodontal diseases?

The word periodontal literally means "around the tooth." Periodontal diseases, also called gum diseases, are serious bacterial infections that destroy the gums and the surrounding tissues of the mouth. If the inflammation is left untreated, the disease will continue and the underlying bone around the teeth will dissolve and no longer be able to hold the teeth in place. Generally, periodontal disease isn't painful, so it is possible to have it and not be aware of it. A dentist specializing in periodontal disease is called a periodontist.

What causes periodontal disease?

As with many other oral health diseases, bacteria and plaque buildup are often the culprits. In fact, bacterial plaque build-up is the leading cause of gum disease. Other factors that contribute to gum disease include the following:

  • Genetics
  • Poor oral hygiene
  • Food stuck in the gums (may be due to a malocclusion)
  • Mouth breathing (may lead to severe drying of the gums and teeth in the front of the mouth)
  • A diet low in nutrients and/or a vitamin C deficiency
  • Smoking / the use of smokeless tobacco
  • Autoimmune or systemic diseases
  • Diabetes
  • Hormonal changes in the body
  • Bruxism (incessant clenching and grinding of the teeth)
  • Certain medications (some medications cause an overgrowth of the gums that can lead to periodontal disease)

What are the signs and symptoms of periodontal disease?

The following are the most common signs and symptoms of gum disease. However, each child may experience symptoms differently. Signs and symptoms may include:

  • Red, swollen, tender gums
  • Bleeding while brushing and/or flossing
  • Receding gums (gums that pull away from the teeth)
  • Loose or separating teeth
  • Persistent bad breath
  • Dentures no longer fit
  • Pus between the teeth and gums
  • A change in bite and jaw alignment

The signs and symptoms of gum disease may resemble other conditions or medical problems. Consult your child's dentist or other oral health specialist for a diagnosis.

How is periodontal disease diagnosed?

Periodontal disease is usually diagnosed based on a complete history and physical examination of your child and your child's mouth. Your child's physician will probably refer the child to a dentist for complete evaluation and treatment. At the dentist, x-rays (a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film) of the teeth may be taken to help in the diagnosis and treatment of the problem.

What are the different types of periodontal disease?

The different types of periodontal disease are often classified by the stage the disease has advanced to at the time of evaluation, including:

  • Gingivitis. With gingivitis, the mildest form of periodontal disease, the gums are likely to become red, swollen, and tender, causing them to bleed easily during daily cleanings and flossing. Gingivitis can be divided into four groups, including:
    • Acute. Gingivitis that has sudden onset, does not last long and is painful.
    • Subacute. A less severe form of acute gingivitis.
    • Recurrent. Gingivitis that returns after treatment.
    • Chronic. Gingivitis that has slow onset, lasts a long time, and is usually painless.

    Treatment by your child's dentist and proper, consistent care at home help to resolve the problems associated with gingivitis. If the gingivitis is not treated, it may lead to periodontitis.

  • Mild periodontitis. Untreated gingivitis leads to mild periodontitis. This stage of gum disease shows evidence of the development of periodontal pockets (gums pulling away fro the teeth, causing the crevice between the teeth and gums to deepen) and early loss of bone around the teeth. The following are the most common symptoms of periodontitis:
    • Red, bleeding gums
    • Bad taste in the mouth
    • Pockets around the bottom of the teeth in the gumline
    • The teeth may become loose and spread apart as the disease worsens
    • Tooth loss

    Prompt medical attention is necessary to prevent further erosion and damage.

  • Moderate to advanced periodontitis. This most advance stage of gum disease shows significant bone loss, deepening of periodontal pockets, and possibly receding gums surrounding the teeth.

What are the treatments for periodontal disease?

Specific treatment for periodontal disease will be determined by your child's dentist based on:

  • Your child's age, overall health, and medical history
  • Extent of the disease
  • Your child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Your opinion or preference

Treatment may include any, or a combination of, the following:

  • Tartar and plaque removal beneath the gums. Deep cleaning (also called scaling and root planing) can help remove the plaque and calculus beneath the gum and infected tissue in the early stages of the disease, while smoothing the damaged root surfaces of the teeth. The gums can then reattach to the teeth.
  • Medication. Antibacterial medication may be placed topically in the periodontal pockets or taken orally.
  • Surgery. When the disease is advanced, the infected areas under the gums will be cleaned, and the tissues will then be reshaped or replaced. Types of surgeries include: 
  • Pocket reduction.
  • A regeneration procedure.
  • Soft tissue graft.
  • Crown lengthening.

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