Periodontitis
Periodontitis, also known as gum disease or pyorrhea, is an advanced stage of gum disease that occurs when gingivitis, typically marked by inflammation of the gums, is left untreated. This condition leads to inflammation and infection of the tissues that support the teeth, including the bones and ligaments. Key symptoms often include swollen, tender gums that may bleed easily, bad breath, and the presence of mouth sores. Over time, untreated periodontitis can result in the gums pulling away from the teeth, causing increased looseness and potential loss of teeth due to significant damage to the supporting structures.
Several factors contribute to the development of periodontitis, including poor oral hygiene and the use of smokeless tobacco, which can irritate the gums. Treatment options range from thorough oral hygiene practices and scaling to surgical interventions aimed at controlling the disease. The long-term success of treatment often relies on patient compliance and regular dental maintenance. While periodontitis is more commonly seen in adults, adolescents can also be affected, especially those with certain risk factors such as diabetes or smoking. Overall, awareness and early intervention are crucial to managing this progressive condition effectively.
Periodontitis
ALSO KNOWN AS: Pyorrhea, gum disease
ANATOMY OR SYSTEM AFFECTED: Bones, gums, teeth
DEFINITION: A disorder of the teeth resulting from advanced gingivitis, inflammation and infection of the bones and the ligaments supporting the teeth.
CAUSES: Untreated inflammation or infection of gums; may result from use of smokeless tobacco
SYMPTOMS: Swollen gums that are tender, bright red or reddish-purple, shiny, and bleed easily; mouth sores; bad breath
DURATION: Chronic, progressive if not treated
TREATMENTS: Proper oral hygiene, plaque control (scaling, root planing, surgery), antibiotics
Causes and Symptoms
Periodontitis is the advanced stage of gum disease (or periodontal disease) that occurs when the earlier stage of gum disease, gingivitis, is left untreated or if treatment is delayed. Gingivitis is caused by bacteria in plaque and tartar, which if left on the teeth for too long can inflame and infect the gums. In periodontitis, the infection and inflammation spread from the gums (gingiva) to the ligaments and bones that support the teeth. Dental plaque begins to spread down the roots of the teeth, and the gums become infected, which causes damage to the bone and fibers (periodontal ligament) that support the teeth. As the disease progresses, the gums pull away from the teeth, allowing more food and plaque to be trapped under them and inviting more damage to occur. In advanced stages of the disease, the teeth become increasingly loose, and shifting may occur because of widespread damage to the bone and ligaments holding the teeth in place. The bite may therefore shift, and there may be difficulty chewing. Loss of support causes the teeth to become increasingly loose and eventually fall out.
Periodontal disease can be caused by the use of smokeless tobacco. In the areas where the tobacco is held against the cheek, the tobacco and by-products cause irritation and infection of the gums. The gums begin to recede, and periodontal disease affects the teeth in the area. The area is also highly prone to oral cancer.
The early symptoms of periodontitis tend to resemble those of gingivitis, with mouth sores and swollen gums that are tender when touched but otherwise painless. Progressive symptoms include swollen gums that are bright red or reddish-purple. The gums may appear shiny and may bleed easily, and there may be odor to the breath.
Treatment and Therapy
Treatment methods for advanced (chronic) periodontal disease include aggressive oral hygiene instruction and reinforcement and evaluation of the patient’s plaque control. Scaling and root planing to remove microbial plaque and calculus below the gum line, followed by surgery to reduce the depth of the periodontal pocket, is the most common office-based procedure to help manage the disease. Lesions may be treated with adjunctive antimicrobial therapy and antibiotics. Long-term maintenance is necessary. Flossing, more frequent brushing, and mouthwashes are recommended to the patient between regular dental visits.
The long-term outcome of treatment may depend upon patient compliance and professional maintenance at appropriate intervals. If the primary teeth are affected, then the infection should be monitored closely in order to avoid possible attachment loss. The goals of periodontal therapy include altering or eliminating the causative microbes and contributing risk factors for periodontitis, thereby arresting advancement of the disease and preserving the teeth. Ultimately, it is desirable to prevent the recurrence of periodontitis. Because of the complexity of aggressive periodontal disease with regard to systemic factors, immune defects, and microbial flora, however, control may not be possible in all instances. In such cases, a reasonable treatment objective is to slow the progression of the disease.
Perspective and Prospects
Periodontitis is the primary cause of tooth loss in adults. This disorder is uncommon in childhood, but the incidence rate increases during adolescence. In addition to a lack of good oral hygiene, certain risk factors have been associated with periodontitis. It is more severe and occurs with a frequency two to five times greater among patients with diabetes mellitus. Smoking can increase the risk of developing severe periodontitis by a factor of three to six times, depending on smoking duration and number of cigarettes.
While periodontitis can be managed effectively with current surgical and nonsurgical therapies in some patients, other patients are less responsive to the treatment options available. Most people with periodontitis receive little or no treatment at all.
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