Types Of Periodontal Disease

       

   Gingivitis

   Chronic Periodontitis

   Aggressive Periodontitis

   Periodontitis As A Manifestation Of Systemic    Diseases

   Necrotizing Periodontal Diseases

   
   

               Periodontal disease can refer to any condition that affects the structures supporting your teeth. However, the most common forms of periodontal disease are caused by bacterial infections of the gums, connective tissue and/or bone around the teeth. Therefore, the term periodontal disease generally refers to diseases associated with dental plaque, which contains bacteria. These can range from mild gingivitis, in which only the gums are affected, to severe disease that results in tooth loss. There are several types of periodontal disease.

 

            Gingivitis

            Gingivitis is the mildest form of periodontal disease and involves the gums. It's caused by bacteria in plaque, which produce substances that can harm the gums. Gingivitis is quite common. Almost 75 percent of adults over age 35 have some evidence of this condition. Certain groups of people are at increased risk:

  • People with poorly controlled diabetes
  • Pregnant women
  • Women taking oral contraceptives
  • People taking steroids
  • People taking certain drugs, such as cyclosporine (Neoral, Sandimmune, SangCya), antiseizure medications and calcium channel blockers

       If you have gingivitis, your gums will be red and swollen, and bleed easily. There is usually little or no discomfort, but gingivitis can progress to a more serious form of periodontal disease, called periodontitis. Gingivitis is reversible with professional treatment (a thorough cleaning, including removal of plaque below the gum line) and good oral care at home.

Chronic Periodontitis

      Periodontitis is a more advanced form of periodontal disease than gingivitis. Periodontitis involves all of the supporting tissues of the teeth: the gums, connective tissue and bone.

Chronic periodontitis is the most common form of periodontitis. About 14 percent of adults ages 45 to 54, and 23 percent of those ages 65 to 74, have some degree of periodontitis. Smokers are four to seven times more likely than nonsmokers to get periodontitis.

      If you have periodontitis, your gums become detached from your teeth, causing spaces to form between the teeth and gums. These spaces are called periodontal pockets. The dental plaque that accumulates in these pockets eventually causes the destruction of bone that supports the teeth. In the more severe stages of periodontitis, teeth can become loose and may even fall out.

      Periodontitis usually is not painful. Some people notice that their gums are bleeding and receding, and that they have bad breath or a bad taste in their mouth. However, periodontitis sometimes does not produce any symptoms that you would notice, although your dentist can diagnose it during an examination. The condition usually progresses quite slowly, over several years (five to 10, or more).Unlike gingivitis, periodontitis is not fully reversible. However, treatment and good oral hygiene can improve your oral health and possibly prevent tooth loss and other serious consequences.

      Treatment for periodontitis typically includes a thorough cleaning called scaling and root planing. In certain situations, treatment of periodontitis may require antibiotic therapy and/or periodontal surgery.


Aggressive periodontitis

      Aggressive periodontitis progresses faster than chronic periodontitis. Aggressive periodontitis tends to run in families, and is more common in smokers.

      Aggressive periodontitis used to be considered a "young person's disease," but it is no longer classified this way. However, it is more common in younger people than chronic periodontitis. Similar to chronic periodontitis, aggressive periodontitis is caused by the bacteria found in dental plaque. Recent research has suggested that susceptibility to this form of periodontitis is an inherited trait.

     The treatment for this disease generally is the same as treatment for chronic periodontitis. However, aggressive periodontitis can be more difficult to treat than the chronic form of the disease, and some people do not respond to treatment.

Periodontitis As A Manifestation Of Systemic Diseases

         Periodontitis can be a symptom of one of several systemic diseases including certain types of leukemias, neutropenias and genetic disorders. The characteristics of this type of periodontitis usually depend on the underlying medical condition, although the disease can look and act like aggressive periodontitis. These gum conditions are most common in younger patients who do not have large accumulations of dental plaque.

       The treatment for this type of periodontitis involves controlling the underlying medical problem first, followed by treatment similar to that for chronic or aggressive periodontitis.

      Other medical conditions, such as diabetes and HIV infection, can intensify all forms of periodontitis. People with these diseases are more prone to developing severe periodontitis. However, unlike people who have periodontitis as a manifestation of systemic disease, these individuals usually have a fair amount of dental plaque and/or calculus (tartar) on their teeth.

Necrotizing Periodontal Diseases

       Necrotizing periodontal diseases are rapidly progressing forms of disease that are characterized by loss of the little triangles of tissue between the teeth, bleeding gums and significant pain. Other symptoms include bad breath and a whitish film on the surface of the gums. Patients with these forms of periodontal disease also may develop a fever and swollen glands.

      The American Academy of Periodontology recognizes two forms of necrotizing periodontal diseases: ulcerative gingivitis (NUG) (link) and necrotizing ulcerative periodontitis (NUP). As the names imply, NUG results in destruction of gum tissue while NUP affects the gums, connective tissue and alveolar bone.

     These conditions most commonly are observed in people whose immune systems have been suppressed. Risk factors include smoking, poor nutrition, psychological stress, and HIV infection.

     The treatment for NUG typically involves oral-hygiene instruction, scaling and root planing, systemic antibiotics, and the use of a mouth rinse containing chlorhexidrine. Because NUP, a relatively rare form of periodontal disease, may be associated with underlying medical conditions such as HIV infection, your dentist will consult with your physician. The treatment is very similar to that for NUG, and may include use of antifungal medications.

 

Your First Visit To A Periodontist

 

           If you are referred to a periodontist, your first visit will be for an evaluation. This typically involves a review of your dental, medical and social histories. If you have any medical problems, it is crucial that you describe them to the periodontist because so many systemic diseases can affect your mouth and the health of your gums. He or she also will want to know about any medications you are taking, since these also can affect your gums.

If you smoke, your periodontist will ask you to make an earnest effort to quit whatever the condition of your gums.           This is especially important before a surgical procedure. Smoking increases the risk of periodontal disease, makes the disease worse once you have it, and decreases the effectiveness of periodontal treatment by affecting your body's ability to heal properly.

          The first visit always includes an examination of your head, neck, and jaw joints (TMJs); a general oral examination of all of the structures in your mouth and throat (tongue, tonsils, cheeks, etc.); evaluation of your teeth; and a full examination of the health of your gums, called a periodontal examination.

In addition to the examination, your periodontist also will need X-rays of your teeth. Periapical X-rays help the dentist or periodontist determine the extent and pattern of bone loss around each tooth. These X-rays show the entire tooth from the crown (top) to the end of the root, which anchors the tooth in your jaw. You also may need an X-ray of your entire head, known as a panoramic radiograph. This type of picture provides information about other important structures in your skull, such as the maxillary sinuses and jaw joints (temporomandibular joints or TMJs).

         Once the examination is done, your periodontist will develop a plan to treat your periodontal problems. Since people have different wants and needs, there is no single treatment that is best. Some people desire state-of-the-art treatment, regardless of cost. Other patients may be constrained by insurance and other financial issues. Still others may want the treatment that takes the least amount of time.

        In addition, you may find that periodontists differ in their treatment philosophies. Some periodontists believe in attacking the disease aggressively with surgical treatment, while others believe in more conservative, nonsurgical approaches. It's important that you understand why your periodontist is recommending a particular form of therapy and that you feel comfortable with the proposed treatment plan.

      Regardless of the specific form of treatment, all patients will be placed in a maintenance program in which they will be asked to come in for regular follow-up examinations and cleanings. These cleanings and checkups are critical to maintain the health of your mouth and gums, and to help to prevent the disease from worsening again in the future. For a patient who has gingivitis and no other problems, most periodontists will recommend twice-yearly visits. For patients with more significant periodontal problems, the schedule might be once every three months.