Periodontal disease is diagnosed by your dentist or dental hygienist during a periodontal examination. This type of exam should always be part of your regular dental check-up.

A periodontal probe (small dental instrument) is gently used to measure the sulcus (pocket or space) between the tooth and the gums. The depth of a healthy sulcus measures three millimetres or less and does not bleed. The periodontal probe helps indicate if pockets are deeper than three millimetres. As periodontal disease progresses, the pockets usually get deeper.

Your dentist or hygienist will use pocket depths, amount of bleeding, inflammation, tooth mobility, etc., to make a diagnosis that will fall into a category below:

Gingivitis

• Gingivitis is the first stage of periodontal disease. Plaque and its toxin by-products irritate the gums, making them tender, inflamed, and likely to bleed.

Periodontitis

• Plaque hardens into calculus (tartar). As calculus and plaque continue to build up, the gums begin to recede from the teeth. Deeper pockets form between the gums and teeth and become filled with bacteria and pus. The gums become very irritated, inflamed, and bleed easily. Slight to moderate bone loss may be present.

Advanced Periodontitis

• The teeth lose more support as the gums, bone, and periodontal ligament continue to be destroyed. Unless treated, the affected teeth will become very loose and may be lost. Generalized moderate to severe bone loss may be present.

Periodontal treatment methods depend upon the type and severity of the disease. Your dentist and dental hygienist will evaluate your stage of periodontal disease, present you with all the necessary information and recommend the appropriate treatment.

If the disease is caught in the early stages of gingivitis, and no damage has been done, one to two regular cleanings will be recommended. You will also be given instructions on improving your daily oral hygiene habits and having regular dental cleanings.

If the disease has progressed to more advanced stages, a special periodontal cleaning called scaling and root planing (deep cleaning) will be recommended. It is usually done one quadrant of the mouth at a time, while the area is numb. In this procedure, tartar, plaque, and toxins are removed from above and below the gum line (scaling) and rough spots on root surfaces are made smooth (planing). This procedure helps gum tissue to heal and pockets to shrink. Medications, special mouth rinses, and an electric tooth brush may be recommended to help control infection and help the healing process.

If the pockets do not heal after scaling and root planing, periodontal surgery may be required to reduce pocket depths, making teeth easier to clean. Your dentist may also recommend that you see a Periodontist (specialist of the gums and supporting bone). Some treatment options that may be employed include:

• Laser treatment – This can be used to reduce the size of the pockets between the teeth and the gums.
• Tissue & bone grafting – Where a considerable amount of bone or gum tissue has been destroyed, the dentist may elect to graft new tissue by inserting a membrane to stimulate tissue growth.

Pocket elimination surgery – The dentist may choose to perform “flap surgery” to directly reduce the size of the gum pockets.

It only takes twenty four hours for plaque that is not removed from your teeth to turn into calculus (tartar)! Regular brushing and a thorough oral hygiene routine helps control plaque and tartar formation, but those hard to reach areas will always need special attention and a professional clean at regular check-ups.

Once your periodontal treatment has been completed, your dentist and dental hygienist will recommend that you have regular maintenance cleanings (periodontal cleanings around four times a year. At these cleaning appointments, the pocket depths will be carefully checked to ensure that they are healthy. Plaque and calculus that is difficult for you to remove on a daily basis will be removed from above and below the gum line.

There are genetic and environmental factors involved in the onset of gum disease, and in many cases the risk of developing periodontitis can be significantly lowered by taking preventative measures.

Some of the most common causes of gum disease include,

• Poor dental hygiene - Preventing dental disease starts at home with good oral hygiene and a balanced diet. Prevention also includes regular dental visits which include exams, cleanings, and x-rays. A combination of excellent home care and professional dental care will help preserve the natural dentition and supporting bone structures. When bacteria and calculus (tartar) are not removed, the gums and bone around the teeth become affected by bacteria toxins and can cause gingivitis or periodontitis, which can lead to tooth loss.
• Tobacco use – Research has indicated that smoking and tobacco use is one of the most significant factors in the development and progression of gum disease. In addition to smokers experiencing a slower recovery and healing rate, smokers are far more likely to suffer from calculus (tartar) build up on teeth, deep pockets in the gingival tissue and significant bone loss.
• Genetic predisposition – *Despite practicing rigorous oral hygiene routines, as much as 30% of the population may have a strong genetic predisposition to gum disease. These individuals are six times more likely to develop periodontal disease than individuals with no genetic predisposition. Genetic tests can be used to determine susceptibility and early intervention can be performed to keep the oral cavity healthy.
• Pregnancy and menopause – During pregnancy, regular brushing and flossing is critical. Hormonal changes experienced by the body can cause the gum tissue to become more sensitive, rendering them more susceptible to gum disease.
• Chronic stress and poor diet – Stress lowers the ability of the immune system to fight off disease, which means bacterial infections can defeat the body’s defense system. Poor diet or malnutrition can also lower the body’s ability to thwart periodontal infections, as well as negatively affecting the health of the gums.
• Diabetes and underlying medical issues – Many medical conditions can intensify or accelerate the onset and progression of gum disease including respiratory disease, heart disease, arthritis and osteoporosis. Diabetes hinders the body’s ability to utilize insulin which makes the bacterial infection in the gums more difficult to control and cure.
• Grinding teeth – The clenching or grinding of the teeth can significantly damage the supporting tissue surrounding the teeth. Grinding one’s teeth is usually associated with a “bad bite” or the misalignment of the teeth. When an individual is suffering from gum disease, the additional destruction of gingival tissue due to grinding can accelerate the progression of the disease.
• Medication– Many drugs including oral contraceptive pills, heart medicines, anti-depressants and steroids affect the overall condition of teeth and gums; making them more susceptible to gum disease. Steroid use promotes gingival overgrowth, which makes swelling more commonplace and allows bacteria to colonize more readily in the gum tissue.

*Reference from American Academy of Periodontology, Causes of Gum disease, accessed on July 2011

Periodontal disease, heart disease and stroke may seem to be unlikely bedfellows, but *researchers have found that gum disease sufferers are nearly twice as likely to suffer from coronary heart disease. In addition, *research has discovered that oral infection is a risk factor for stroke. People diagnosed with acute cerebrovascular ischemia (or silent stroke) were more likely to also be experiencing some degree of periodontal disease.

Coronary heart disease occurs when the walls of the coronary arteries become progressively thicker due to the build-up of fatty proteins. The heart then suffers from a lack of oxygen and must labour significantly harder to pump blood to the rest of the body. Coronary heart disease sufferers sometimes experience blood clots which obstruct normal blood flow and reduce the amount of vital nutrients and oxygen the heart needs to function properly. This phenomenon often leads to heart attacks.

Reasons for the Connection

There is little doubt that the presence of periodontal disease can exacerbate existing heart conditions. The periodontist and cardiologist generally work as a team in order to treat individuals experiencing both conditions.

There are several theories which may explain the link between heart disease, stroke and periodontal disease, including the following:

• Oral bacteria affecting the heart – There are many different strains of periodontal bacteria. Researchers assert that some of these strains of bacteria enter the bloodstream and attach to the fatty plaques in the heart blood vessels (coronary arteries). This attachment then contributes to clot formation causing grave danger to the individual.
• Inflammation – Periodontal disease causes severe inflammation in the gum tissue which elevates the white blood cell count and also the high sensitivity C-reactive protein levels. Research studies have shown that elevated levels of C-reactive proteins have been linked to heart disease.
• Infectious susceptibility – Individuals who experience particularly high levels of oral bacteria may have weaker immune systems and an inadequate host inflammatory response. These factors may induce specific vascular effects which have previously been shown to contribute in the onset of certain forms of heart disease.

*Reference from American Academy of Periodontology, The Mouth-Body Connection, accessed April 2011