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Periodontitis
Signs and symptoms
Complications
Early-stage periodontal disease (gingivitis) is seldom painful and causes relatively minor signs, such as red, swollen and bleeding gums. But untreated gingivitis can progress to periodontitis, a serious infection that destroys the soft tissue and bone that support your teeth, and eventually may cause tooth loss.
What's more, long-term periodontitis can lead to even more-serious problems, including higher blood sugar levels and an increased risk of heart attack and stroke. Gum disease may even affect your unborn child. Pregnant women with periodontitis are much more likely to give birth to premature babies than are women with healthy gums.
Yet periodontitis is both preventable and treatable. Although factors such as smoking, heredity, medications and lowered immunity make you more susceptible to gum disease, the most common cause is poor oral hygiene. Daily brushing and flossing and regular professional cleanings can greatly reduce your chances of developing periodontitis.
PeriodontitisPeriodontitis begins with plaque. This invisible, sticky film forms on your teeth when starches and sugars in food interact with bacteria normally found in your mouth. Although you remove plaque every time you brush your teeth, it re-forms quickly, usually within 24 hours.
Plaque that stays on your teeth longer than two or three days can harden under your gumline into tartar (calculus), a hard substance that makes plaque more difficult to remove by acting as a reservoir for bacteria. Unfortunately, brushing and flossing can't eliminate tartar - only a professional cleaning can remove it.
The longer plaque and tartar remain on your teeth, the more damage they can do. Initially, they may simply irritate and inflame the part of your gum around the base of your teeth. This condition is called gingivitis, the mildest form of periodontal disease. But ongoing inflammation eventually causes pockets to develop between your gums and teeth that fill with plaque, tartar and bacteria. In time, the pockets become deeper and more bacteria accumulate, eventually advancing under your gum tissue. These deep infections cause a loss of tissue and bone. If too much bone is destroyed, you may lose one or more teeth.
Although the destructive cycle that starts with the accumulation of plaque is the most common cause of periodontal disease, a number of other factors can contribute to or aggravate the condition. These include:
- Tobacco use: Smoking is the most significant risk factor for periodontal disease. Chewing tobacco also contributes to periodontal disease. Tobacco use in any form damages your immune system, putting you at greater risk of periodontal infection. It also creates a favorable environment for harmful bacteria and interferes with the normal mechanisms for limiting bacterial growth in your mouth. Even exposure to secondhand smoke appears to contribute to periodontal disease. And because smoking impairs healing, smokers are less likely to respond to treatment than nonsmokers are.
- Heredity: Sometimes you may do everything right and still develop periodontal disease. In that case, you - along with close to one-third of the population - may have inherited a predisposition to gum problems.
- Drugs: Hundreds of prescription and over-the-counter antidepressants, cold remedies and antihistamines contain ingredients that decrease your body's production of saliva. Saliva has a cleansing effect on your teeth and helps inhibit bacterial growth, so a reduction in saliva means that plaque and tartar can build up more easily. Other drugs, especially anti-seizure medications, calcium channel blockers (used to treat high blood pressure) and drugs that suppress your immune system, sometimes cause an overgrowth of gum tissue, known as gingival hyperplasia, making plaque much tougher to remove.
- Diabetes: A number of health problems can take a toll on your gums. One of the most significant of these is diabetes, which makes you more prone to many infections, including gum infections. But the relationship between diabetes and periodontal disease doesn't end there. Gingivitis and periodontitis impair your body's ability to utilize insulin, making diabetes harder to control. And because diabetes and periodontal disease may make you more susceptible to heart attack and stroke, having both conditions increases your risk of cardiovascular disease.
- Hormonal changes: Changes in hormone levels that occur during pregnancy, menopause or even menstruation can make your gums more susceptible to periodontal disease.
- Nutritional deficiencies: A poor diet, especially one deficient in calcium, vitamin C and B vitamins, can contribute to periodontal disease. Calcium is important because it helps maintain the strength of your bones, including the bones that support your teeth. Vitamin C helps maintain the integrity of connective tissue. It's also a powerful antioxidant that counters the tissue-destroying effects of free radicals - substances produced when oxygen is metabolized by your body.
In the earliest stages, periodontal disease causes few signs or symptoms, and you may not be aware of a problem until your gums become soft and bleed slightly when you brush your teeth. As the disease progresses, you may notice more-serious changes, including:
- Swollen, bright red or purple gums
- Gums that feel tender when touched
- Gums that pull away from your teeth (recede), making your teeth look longer than normal
- New spaces developing between your teeth
- Pus between your teeth and gums
- Persistent breath odor or a bad taste in your mouth
- Loose teeth or a change in the way your teeth fit together when you bite
Because several types of periodontitis exist, you may experience problems that are unique to a particular form of the disease. For instance, aggressive periodontitis, which affects otherwise healthy young people, causes an unusually rapid deterioration of their teeth and gums. The condition can also occur episodically, with periods of severe disease alternating with periods when signs and symptoms improve or even seem to disappear.
Other types of periodontitis and their characteristics include:
- Chronic periodontitis: This most common type of gum disease is characterized by progressive loss of the bone and soft tissues that surround and support your teeth. The damage usually develops more slowly than it does in aggressive periodontitis.
- Periodontitis as a manifestation of systemic disease: This usually develops at a young age and occurs in conjunction with another health problem, such as diabetes.
- Necrotizing periodontal disease: A severe form of periodontitis, this causes the death of gum tissue, tooth ligaments and even bone. People suffering from malnutrition or living with HIV/AIDS are especially vulnerable.
Having periodontal disease may put you at greater risk of a number of serious medical conditions:
- Heart disease and stroke: Having long-term gum disease may increase your risk of heart attack and stroke. The more severe your gum problems, the greater your risk. Research suggests that the bacteria responsible for periodontitis can travel through your bloodstream to the arteries in your heart where they trigger a cycle of inflammation and arterial narrowing that contributes to heart attacks. Oral bacteria also make you more prone to develop blood clots, increasing the likelihood of a stroke.
- Complications of pregnancy: Women with moderate to severe periodontal disease may be much more likely to give birth to a premature baby than are women with healthy gums. Although the exact association between oral bacteria and low birth weight isn't clear, having gingivitis or periodontitis appears to limit the growth of the fetus in the womb and may trigger high levels of substances that induce labor. This is especially true if gum disease is initially severe to begin with or worsens during pregnancy. The problem is exacerbated in women with diabetes, who are already considered at high risk of pregnancy problems.
- Uncontrolled blood sugar: Diabetes puts you at greater risk of developing periodontal disease and other infections. It also makes blood glucose levels harder to control. That's because infection anywhere in your body can raise your blood sugar level, requiring more insulin to keep it in check.
- Pneumonia. If you have serious gum disease and lung problems, inhaling (aspirating) bacteria from your mouth into your lungs may result in aspiration pneumonia, a condition that's especially common in hospitals
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