Periodontal Disease is a bacterial infection of the gums, bone and ligaments that support the teeth and anchor them in the jaw. The bacteria are normal inhabitants of the mouth and form a film of dental plaque and calculus (tartar) which stick to the teeth. The bacteria produce poisonous toxins which stimulate the immune response to fight the infection. If the disease process is not stopped, the supporting structures of the teeth will continue to be destroyed. This eventually leads to tooth loss.

Periodontal disease can occur at any age. Over half of all people over the age of 18 have some form of the disease. After age 35, over 75% of all people are affected. Unfortunately, the disease process is usually asymptomatic and painless. The disease can be easily detected during regular dental examinations.

The most common type of periodontal disease are GINGIVITIS and PERIODONTITIS

HEALTHY GUMS AND BONE

PERIODONTITIS is classified as being Mild, Moderate or Severe, depending upon the amount of destruction to the gums, ligaments and bone that surround teeth. As the disease progresses, gums separate from the teeth and form gum pockets. These pockets get deeper as more underlying bone is destroyed. Gum pockets will collect increasing amounts of bacterial plaque and calculus (tartar) as the disease process worsens. Teeth will loosen as more bone is lost.

Lower teeth -SEVERE PERIODONTITIS - Upper teeth

CONTRIBUTING FACTORS TO PERIODONTAL DISEASE

The response of the gums and bone to dental plaque may be modified by one or more of the following factors.

	Poorly fitting dental restorations
	Smoking
	Crowded teeth, improper bite alignment
	Clenching or grinding of teeth
	Hormonal changes, including pregnancy, menstruation and menopause
	Diet
	Systemic diseases, including blood disorders and diabetes
	Medications, including calcium channel blockers and anti-convulsants

WARNING SIGNS OF PERIODONTAL DISEASE

	Bleeding gums
	Tenderness, swelling, red color
	Abscess (pus oozing from the gums)
	Foul odor
	Loose teeth
	Pain

DIAGNOSIS OF PERIODONTAL DISEASE

Periodontal disease can be easily detected by a general dentist or periodontist during regular examinations. A periodontist is a dentist who specializes in the diagnosis, prevention and treatment of gum disease. A periodontal charting should be performed for all teeth. A periodontal probe, with ruled millimeter markings, is used to measure the depth of the space between the teeth and gums. Ideally, normal measurements range between 1 and 3 millimeters. Depths greater than this may signify the presence of periodontal pockets and associated gum disease. X-rays should be taken to see if bone damage has occurred as a result of the disease process.

PHASE I

Initial treatment involves educating patients in the proper methods of effective, daily plaque removal and oral hygiene. This is a critical component of successful therapy.

Scaling and root planing are performed to clean the tooth structure and remove bacterial plaque and calculus deposits (the source of the infection) from the gum pockets. This may be the only treatment necessary in cases of gingivitis and very mild periodontitis.

PHASE II

In cases which demonstrate deeper gum pockets and underlying bone loss, it becomes necessary to eliminate the diseased gum pockets and bony destruction with osseous (bone) surgery. The gum is "flapped" and retracted away from the teeth to expose the underlying roots and bone deformities. The bone is contoured to approximate a normal physiologic profile, and the gum is sutured back to place. When the gum heals, normal probing depth is re-established between the gum and tooth (ideally 1-3mm). The attainment of minimal probing depth facilitates easy removal of plaque by patients at home and by hygienists during professional cleaning.

Additional treatment modalities may be necessary to treat periodontal disease and restore health.
These may include:

	Bone grafts for bone regeneration
	Gum grafts to treat gum recession and pathological root exposure
	Cosmetic plastic surgery of the gums to improve appearance
	Fabrication of night guards for bruxism (tooth grinding)
	Splinting or bonding teeth together for increased strength and stability
	Orthodontics (braces) to straighten and realign teeth
	Removal of diseased roots on some types of molars
	Use of medications such as antibiotics, fluoride and antimicrobial rinses

MAINTENANCE

Once the active phase of treatment is complete and health has been restored, it is extremely important that patients be seen by a hygienist for routine dental and periodontal cleaning on a regular basis. This regimen, along with diligent home care and oral hygiene, will give the best chance for preventing recurrence of disease and maintaining long term periodontal health.

This information was adapted from the ADA brochure " Periodontal Disease: Don't Wait Till it Hurts."

BIOLOGIC PRINCIPLES OF TREATMENT

It is known that bone heals more slowly than the gum tissues in the mouth. Without Guided Bone Regeneration techniques, the faster healing gum would prevent the bone from maximizing its full healing potential following surgical procedures. The concept of treatment is simple. A biocompatible membrane is placed between the gum and bone which acts as a barrier. This barrier prevents downgrowth of the gum into the underlying bone as it heals. Oftentimes, a bone graft is placed into the underlying bony irregularities, under the membrane, to help the body grow new bone. Membranes around teeth are typically designed to dissolve away, or resorb, after several weeks of healing have passed. Membranes used to restore bony ridges in association with implant therapy are typically non-resorbable, and must be removed at a later date.

SEQUENCE OF EVENTS DURING TREATMENT

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