Although there are a variety of steps adults can take to promote personal wellness, one area often overlooked (in both adults and children) is oral health. Failure to practice regular dental and oral health measures increases the risk for developing oral health problems, some of which are quite serious. One of these oral health issues is periodontal disease.

What is Periodontal Disease?

Periodontal disease, sometimes called "gum disease," affects the structures of the mouth that support the teeth, including the gums, bone, and other surrounding tissues. It is considered a silent disease because it often causes no symptoms in the early stages.

Without effective treatment, periodontal disease may continue to cause damage and eventually lead to tooth loss. Additionally, the bacteria causing periodontal disease may be linked to other health problems, such as diabetes, heart disease, and rheumatoid arthritis.

The disease begins when tartar (hardened plaque) and bacteria under the gum line lead to infection. As the body fights the infection, the gums become irritated and swollen. Pockets begin to form between the teeth and gums, which makes plaque harder to remove. As the disease progresses, bone damage occurs, which can lead to tooth loss.

The three general types of periodontal disease are described below:

• Gingivitis, the mildest form of the disease, is mild inflammation of the gums caused by plaque buildup. The gums may be red and/or sore and bleed when they are probed or brushed. Or, there may be no symptoms. Gingivitis usually can be reversed with regular dental cleaning and daily brushing and flossing. Left untreated, it can progress to periodontitis.
• Periodontitis occurs when infection and inflammation spread to the bone supporting the teeth. As bone is destroyed, teeth may start to feel loose.
• Advanced periodontitis takes place as periodontitis worsens. The gums may swell around the roots of the teeth, and bone loss continues. Teeth may be very sensitive to heat or cold, or hurt when brushed. Teeth loosen, and in some cases, they may need to be removed to keep the disease from spreading further.

Risk Factors

Any factor that affects the health of teeth and gums can put a person at risk for periodontal disease. Some of these factors are controllable, while others are not. Common risk factors include:

• Tobacco use
• Poor oral health habits, lack of proper brushing, and flossing
• Stress, teeth-grinding, or bite problems
• Taking certain medications
• Having diabetes, particularly if it is not managed well
• Hormonal changes, such as those that occur during pregnancy and puberty
• Having a weakened immune system
• Having a close family member with periodontal disease

Warning Signs

Here are some common warning signs of periodontal disease. See a dental health professional if you experience one or more of these signals:

• Gums that bleed easily
• Red, swollen, tender gums
• Gums that have pulled away from the teeth
• Persistent bad breath or bad taste
• Permanent teeth that are loose or separating
• Any change in the way teeth fit together when biting
• Any change in the fit of partial dentures

Treatment

During routine dental checkups, your dentist will look for signs of periodontal disease. A periodontal probe will be used to determine whether there is any deterioration of gum tissue attachment or whether pockets have developed between the teeth and gums.

The treatment used will depend upon the type of periodontal disease and how far the condition has progressed. Treatment options include scaling, root planing, and oral irrigation.

If deep pockets are located and bone has been destroyed, the dentist may recommend periodontal surgery. In addition, if teeth have been lost due to periodontal disease, dental implants may be required to replace permanent teeth.

Prevention

For healthy teeth and gums, there are important steps a person can take to prevent periodontal disease. Brush and floss teeth at least twice a day. In addition, try to brush or at least rinse the mouth after each snack and meal. Schedule dental cleaning and checkups every six months. If teeth grinding is an issue, ask a dentist for a special appliance to wear at night.

Eat a balanced diet that is rich in a variety of nutrients Avoid consuming excess sugar.

Practice stress management techniques. Prevent or modify any risk factors that are controllable such as tobacco use.

Periodontal disease often begins with few or no symptoms. Good oral hygiene is essential for keeping periodontal disease at bay. Brushing and flossing regularly, eating a nutrient-dense diet, and regularly visiting the dentist are significant steps to take to maintain a healthy smile for a lifetime.

Marilyn Massey-Stokes, EdD, CHES, FASHA, Associate Professor, Department of Health Studies, Texas Woman’s University

Resources

American Academy of Periodontology, 737 N. Michigan Ave., Ste. 800, Chicago, IL 60611-6660; 312-787-5518; www.perio.org

Internet Resources

American Dental Association, www.ada.org/public/topics/periodontal_diseases.asp

National Institutes of Health, Medline Plus, www.nlm.nih.gov/medlineplus/gumdisease.html

National Institute of Dental and Cranial Research, www.nidcr.nih.gov/HealthInformation/DiseasesAndConditions/GumPeriodontalDiseases