What is periodontal disease? Types of gum disease

Periodontal (gum) disease, including gingivitis and periodontitis, is a condition which if left untreated, can lead to tooth loss. Periodontal disease is caused by bacteria, leading to chronic inflammation that affects the gums and bone supporting the teeth. In fact, the most common cause of tooth loss in adults worldwide is periodontal disease.

What causes periodontal disease?
Periodontal disease is caused by Dental Plaque. Plaque is a collection of germs (bacteria), which grows around teeth. When accumulated this collection of germs releases toxins that lead to inflammation of the gums or else gingivitis. With time plaque can harden, and this is known as calculus.

Gingivitis is the mildest form of periodontal disease. It causes the gums to become red, swollen, and bleed easily. There is usually little or no discomfort at this stage. Gingivitis is reversible with professional treatment and good oral home care.

When gingivitis is left untreated, plaque and calculus then burrow underneath the gums and create a widening of the normal space between the teeth and the gum (gingival sulcus) resulting in the formation of a periodontal pocket. Once the plaque is inside the pocket it causes further inflammation and progression of periodontal disease. As the disease progresses, the pockets deepen and there is gradual bone loss around the teeth. This bone loss is usually IRREVERSIBLE. This process is known as periodontitis and unfortunately, has very mild and pain free symptoms at the beginning. Eventually, though if left untreated, this inflammation can lead to movement, mobility and even loss of teeth.

There are many forms of periodontitis. The most common ones include the following

  • Aggressive periodontitis occurs in patients who are otherwise clinically healthy and is characterised by rapid disease progression and familial aggregation.
  • Chronic periodontitis is the most frequently occurring form of periodontitis and though it is prevalent in adults, it can occur at any age. Progression of disease usually occurs slowly, but periods of rapid progression can occur.
  • Periodontitis as a manifestation of systemic diseases Systemic conditions such as heart disease, respiratory disease, and diabetes are associated with this form of periodontitis.
  • Necrotizing periodontal disease is an infection characterized by necrosis of the gums and the bone. These lesions are most commonly observed in individuals with systemic conditions such as HIV infection, malnutrition and immunosuppression.

Periimplant gingivitis and Periimplantitis are the corresponding infections that develop around implants.


Risk Factors 

The main cause of periodontal (gum) disease is plaque. However, there are some other factors that affect the health of your gums and predispose negatively the progression and prognosis of periodontal disease.

The major ones are

  • Age
  • Smoking/Tobacco Use
  • Family History (Genetic Factors)
  • Other Systemic Diseases (cardiovascular disease, diabetes, and rheumatoid arthritis)
  • Stress
  • Medications (drugs, such as oral contraceptives, anti-depressants, and certain heart medicines)
  • Hormonal changes (puberty, pregnancy, menopause)
  • Clenching or Grinding Your Teeth
  • Poor Nutrition and Obesity


Gum disease symptoms

Gum disease is often silent, meaning symptoms may not appear until an advanced stage of the disease. However, warning signs of gum disease that prompt us to have a periodontal examination include the following:

  • Red, swollen or tender gums or other pain in your mouth
  • Bleeding while brushing, flossing, or eating hard food
  • Gums that are receding or pulling away from the teeth, causing the teeth to look longer than before
  • Loose or separating teeth
  • Persistent bad breath
  • A change in the way your teeth fit together when you bite
  • A change in the fit of partial dentures
  • Pus between your gums and teeth
  • Sores in your mouth


Periodontal Disease and Systemic Health

Research has shown that periodontal disease is associated with several other diseases.               

For a long time it was thought that bacteria was the factor that linked periodontal disease to other disease in the body; however, more recent research demonstrates that inflammation may be responsible for the association. Therefore, treating inflammation may not only help manage periodontal diseases but may also help with the management of other chronic inflammatory conditions.

According to research in

  • Diabetes diabetic patients are more likely to develop periodontal disease, which in turn can increase blood sugar and diabetic complications
  • Heart Disease periodontal disease increases the risk of heart disease and stroke, but can also exacerbate existing heart conditions
  • Respiratory Disease bacteria that grow in the oral cavity can be aspirated into the lungs to cause respiratory diseases such as pneumonia, especially in people with periodontal disease
  • Osteoporosis a link is suggested between periodontal disease and osteoporosis due to the occuring bone loss in the jaw
  • Cancer periodontal disease is associated with some types of cancer in men


Gum disease in Women & Children

A woman's periodontal health may be impacted by a variety of hormonal and non-hormonal factors during the following time periods

  • Puberty
  • Menstruation
  • Pregnancy
  • Menopause

During these periods there seems to be increased appearance of gingivitis, periodontitis and/or gingivostomatitis, while lately a link is also suggested between periodontal disease and premature birth.


Types of periodontal diseases in children & basic signs

The following types of disease are seen in children & teenagers

  • Chronic gingivitis is common in children. It is both preventable and easily treatable. However, left untreated, it can eventually advance to more serious forms of periodontal disease.
  • Localised Aggressive periodontitis is found in teenagers and young adults who are otherwise healthy and can even have optimal oral hygiene. It mainly affects specific teeth and is characterized by severe bone loss
  • Generalized Aggressive periodontitis may begin around puberty and usually involves multiple teeth. It is marked by severe inflammation of the gums of rapid progression.

Signs of periodontal disease
Four basic signs will alert you to periodontal disease in your child and indicate the need for a periodontal examination:

  • Bleeding bleeding gums during tooth brushing, flossing or any other time
  • Puffiness swollen and bright red gums
  • Recession of the gums sometimes exposing the roots
  • Bad breath constant bad breath that does not clear up with brushing and flossing