Inflammation of the tissues that support the teeth
Periodontitis affects many people over the age of 55 and is a major cause of tooth loss. In this condition, the gums become inflamed and the fibres that connect the gums to the teeth (the periodontal tissues) are destroyed. The teeth may become loose and may eventually fall out. The damage from periodontitis is irreversible, but further inflammation can be prevented with treatment and by improving oral hygiene (see Caring for your teeth and gums). There is evidence that if periodontal disease is left untreated, it may predispose to cardiovascular disease.
The most common form of periodontitis is chronic adult periodontitis. This condition often develops as a complication of gingivitis, in which the gums are inflamed, usually due to poor oral hygiene and/or smoking. If toothbrushing is neglected, plaque (a deposit of food particles, saliva, and bacteria) and calculus (hardened plaque) build up on the teeth. As a result of this build-up, the gums become inflamed. The periodontal tissues also become inflamed and are gradually destroyed. This leaves pockets between the gums and teeth in which more plaque and calculus collect, which leads to further inflammation and tissue destruction. The inflammatory process can also result in the loss of bone supporting the teeth, and teeth may fall out.
Periapical periodontitis is another form of periodontitis and is caused by tooth decay (see Dental caries), usually due to poor oral hygiene. If tooth decay is left untreated, the hard enamel that covers the tooth and the dentine underneath will eventually be destroyed, allowing bacteria into the pulp (central part) of the tooth (see Pulpitis).
Some rare genetic forms of the disorder, such as juvenile periodontitis, occur in children or young adults and are particularly severe.
In the early stages of periodontitis, there may be no symptoms. Symptoms of chronic periodontitis may include:
Red, soft, shiny gums that bleed easily and may recede.
Bad breath and an unpleasant taste.
Toothache when hot, cold, or sweet foods or drinks are consumed.
In the late stages of chronic periodontitis, there may be loosening of the teeth.
The symptoms of periapical periodontitis may include:
Toothache in a specific area, especially when biting.
Loosening of a tooth.
Swelling of the jaw.
In some cases, a dental abscess forms. If any of these symptoms occur, consult your dentist promptly.
Your dentist will examine your teeth and gums and check the depth of the pockets between them using a special probe. He or she may also take dental X-rays (see Dental checkup) to check how much of the bony support around the teeth has been lost.
Chronic periodontitis is treated by removing plaque and calculus from the teeth in a procedure known as scaling. In some cases, a gingivectomy (surgical trimming of the gums) may also be performed to reduce the size of the pockets between the gums and teeth. The diseased lining of the pockets may be removed to allow healthy tissue to attach itself to the teeth.
After surgery, you will probably be prescribed an antiseptic mouthwash, which you should use regularly. If the periodontitis is severe, your dentist may prescribe a course of antibiotics, or an antibiotic paste or pellet may be pushed into the deep pockets between the teeth and gums. Loose teeth may be fixed to other teeth in order to stabilize them.
Periapical periodontitis is treated by removing the bacteria from the tooth and carrying out root canal treatment. A tooth that cannot be saved may need to be extracted.
After treatment, your dentist will advise that you brush and floss your teeth at least twice a day to prevent further build-up of plaque and calculus. If you smoke, giving up will help to prevent further inflammation.
If you have chronic periodontitis, better oral hygiene and giving up smoking should help to prevent the gums from receding further and teeth becoming loose. It may also reduce the risk of complications. Periapical periodontitis may need root canal treatment. About 1 in 10 people with periodontitis has a rapidly progressive form of the condition, leading to loss of teeth around the age of 50.
From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.