Periodontal diseases affect millions of people. These diseases start very early in life and cause the loss of more teeth than all other reasons combined. In most cases you are not aware that problems exist until the disease is quite advanced.

Many people who have gum infections, even in advanced stages, may have gums that look essentially normal. That is why only a thorough examination by a dental professional can detect most gum problems.


STAGES OF PERIODONTAL DISEASES

Periodontal diseases can be divided in two stages:

· Gingivitis

· Periodontitis


GINGIVITIS

Gingivitis is a superficial infection that is limited to the gum tissue and does not yet affect the underlying bone. The gums may look normal, but may have some of the following signs:

1. Redness and puffiness

2. bleeding when brushed

3. Bad odor.


PERIODONTITIS

When the infection spreads from the gum to the underlying bone, it is termed periodontitis (once called pyorrhoea). In this stage, bone that supports the teeth is lost. There are several types of periodontitis, some more aggressive than others, if periodontitis is untreated, tooth loss can occur.

In some cases the gums appear red and swollen, and other signs may warn you of the trouble:

1. Spaces begin to appear between the teeth. This can be a sign of an advanced problem.

2. Loosening of one or more of the teeth. This almost always a sign of severe bone loss.

3. Receding gums. Periodontal diseases may cause gums to shrink away from the crown and expose some of the root. This makes the teeth look longer. Gum recession is not normal at any stage.

4. Vague aching, itching, or other discomfort of the gums.


PERIODONTITIS

Periodontal diseases are almost always painless, and only rarely do you notice changes, especially in the early stages. Therefore, you probably will not notice gum puffiness or pay attention to occasional bleeding when you brush. Or you may think that the longer look of your teeth is normal for the age.

But the fact is, four out of five teenagers and adults have periodontal disease, and most don’t know it. That is why people lose more teeth from periodontal diseases than from all other reasons combined.

But the good news is that most periodontal diseases can be prevented or, if already started, can be treated. This is particularly true if action is taken in the early stages of disease.

PLAQUE IS THE PRIMARY CAUSE OF PERIODONTAL INFECTION

Every day a sticky, almost invisible film forms on the teeth. This film is plaque, a continually spreading mass of disease-causing bacteria and their waste products. Plaque grows on the teeth and down into the crevice between the gum and tooth. When the underlying bone is lost, this crevice deepens and is called pocket.

In very large amounts, plaque can be seen or can be felt with the tongue as a fuzzy, unclean coating on the teeth.

The bacteria of plaque produce toxins (poisons) that damage the gums and underlying bone.

PLAQUE BECOMES CALCULUS

If you do not completely remove the plaque every day by tooth brushing and flossing, it leads to the formation of calculus (tartar), a stony crust with a pitted, rough surface.

It takes only a little more than a day for any plaque left on your teeth to turn into calculus. You can’t remove calculus yourself. It clings to the teeth with such force that only a dentist or a hygienist can remove it.

It is possible to see calculus that forms above the gums. It appears as brownish or black deposit around the necks of the teeth. However, it is the hidden calculus under the gums that does the most harm.

Calculus greatly complicates the problem of preventing periodontal diseases. Each day’s new plaque embeds itself in the rough surface of calculus in such a way that no toothbrush, or dental floss, or any other home dental device can ever remove it!!

Thus, all calculus will always have plaque embedded on its surface. And all plaque is capable of starting or worsening periodontal disease.


PLAQUE TOXINS DESTROY BONE

The toxins produced by the bacteria in plaque not only infect the gum, but also destroy the underlying bone that supports the teeth.

As the gum infection continues, so does the bone destruction, usually without any symptoms, especially in early stages of the disease.

When sufficient bone has been lost, the tooth loosens. When a tooth loosens, the destruction of the bone around it may accelerate.

Finally, when deprived of most of the supporting bone, the tooth becomes so loose that it either falls out or must be removed.


NATURAL RESISTENCE OR SUCEPTIBILITY TO PERIODONTAL DISEASES


Very few people are totally resistant to periodontal diseases. Most are quite susceptible. However, most people have a varying resistance to these diseases at different times in their lives. For example, a person’s resistance may be normal for years. Then resistance temporarily diminishes and periodontal disease appears, or disease that was under control flares up.

While periodontal diseases cannot be cured, in most cases you and your dentist together can slow down or arrest the disease. For the majority of people, tooth loss can be prevented.

For all these reasons, even if you never have cavities, and your mouth feels fine, go for regular dental checkups. Your dentist and hygienist can spot disease early, when is the easiest and least costly to treat. This early detection is possible only with a measuring instrument called periodontal probe. This device can find periodontal diseases long before they show up on x-rays.


PERSONAL ORAL HYGIENE

One of the most important things a dental professional will do is take time to teach your proper flossing and brushing. Few people do correctly without an instruction. The coast of not learning to floss and brush the right way could be the loss of your teeth.

It is important to floss every day.

Dental floss removes the plaque from between the teeth, where the toothbrush can’t reach. If you brush but don’t floss, you are doing only half the job.

It is important to brush at least three times a day.

Toothbrush bristles remove the plaque from exposed surfaces of the teeth. It is the tips of the bristles of a toothbrush that do the work. Therefore, when the bristles have bent over or curled from use, replace your brush.

PROFESSIONAL REMOVAL OF PLAQUE AND CALCULUS

Your dentist or dental hygienist will gently remove the calculus above and below the gum.

Your dentist will check any restorations for correct shape and fit. Fillings and crowns that no longer fit will trap bacteria and food debrids. This can cause severe periodontal problems. Have such fillings or crowns repaired or replaced.


PROFESSIONAL MAINTENANCE

It is very common for periodontitis to recur. Patients should have regular checkups to catch recurrence early, before silent damage occurs. Many patients with periodontitis will have to get checkups, usually accompanied by a professional tooth cleaning every 3 months. These checkups, which catch disease in early stages, will prevent suffering, save money, and provide the best chance against tooth loss.


MAINTENANCE THERAPY


What is maintenance therapy?

Maintenance or supportive periodontal therapy is an ongoing program designed to prevent periodontal disease from recurring in patients who have undergone periodontal treatment. This ongoing phase of treatment will allow your periodontist to assess your periodontal health and make sure infection stays under control. During maintenance therapy, your mouth is examined, new calculus and plaque are removed, and, if necessary your teeth are polished and your bite is checked.

How often do I need maintenance therapy?
The answer varies from person to person. Your dentist or periodontist will recommend a schedule that best that is tailored to protect your periodontal health. The intervals between visits may range from every few weeks to four times per year, in addition to checkups by your general dentist.