Mouth Healthy : This general resource provides information on oral health, including nutrition and guidance on selecting products that carry the American Dental Association's seal of approval.
There is also advice on finding a dentist and how and when to see one. National Institute of Dental and Craniofacial Research : This government site covers a wide variety of topics related to oral and dental health in English and Spanish , including definitions of common terms and the latest information on clinical trials related to oral and dental diseases. Merck and Co. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world.
The Manual was first published in as a service to the community. Learn more about our commitment to Global Medical Knowledge. This site complies with the HONcode standard for trustworthy health information: verify here. Common Health Topics. More Information. Periodontal Diseases. Test your knowledge. Recurrent aphthous stomatitis canker sores is the presence of small, painful sores ulcers inside the mouth. The ulcers typically first appear in childhood and recur frequently throughout adulthood.
Which of the following is usually the first symptom of an attack? More Content. Periodontitis Pyorrhea By James T. Click here for the Professional Version. The gums swell and bleed, the breath smells bad, and teeth become loose. Repeated professional cleanings and sometimes dental surgery and antibiotics are needed.
Did You Know Periodontitis is the main cause of tooth loss in older people. The pockets get deeper, and the plaque hardens into tartar. More plaque accumulates on top. A dentist's evaluation. Treatment of risk factors. Was This Page Helpful? Yes No. Temporomandibular Disorders. Smoking is the most significant risk factor and can make periodontal disease treatment less effective.
Periodontal disease is broken up into four separate stages: gingivitis, slight periodontal disease, moderate periodontal disease, and advanced periodontal disease. Gingivitis is the only stage of periodontal disease that is reversible as it has not yet had time to attack the bones.
It is the result of a buildup of plaque around the teeth. There are only a few signs at this stage and most are painless. This is what makes periodontal disease so common and so concerning. It is silent until it is not. Beginning signs to watch out for include bad breath on occasion, swelling and redness of the gums, and bleeding when brushing or flossing. Good overall oral hygiene and regular checkups can treat and reverse gingivitis.
Slight periodontal disease is the second stage of periodontal disease. It is not reversible, but it is manageable. Once a patient reaches stage two, the infection has spread to the bone and begins its bone-destroying process. The bacteria evolves and becomes more aggressive, which is what causes the additional bone loss. Simple oral hygiene will no longer cut it. Signs include increased swelling or redness of the gums, bad breath, bleeding during brushing or flossing, and probing depths that are between four and five millimeters.
Like slight periodontal disease, the third stage of periodontal disease cannot be reversed. At stage three, the same symptoms as stage two occur but probing depths are greater at six to seven millimeters which allows for even more bacteria to attack, not only your bones, but. Treatment for stage two and stage three periodontal disease consists of scaling and root planing. Scaling and root planing are forms of deep cleaning that remove the deposits of bacteria that are deeply rooted in your gums.
If left untreated, these stages can progress to bone and tooth loss, gum sensitivity, increased bleeding, and the shifting of teeth. The final stage of periodontal disease occurs when the infection deepens even further and the bacteria, once again, evolves into disease-causing bacteria. Even if you change your oral-hygiene habits and clean your teeth less forcefully, gum recession will not be reversed.
In periodontitis, the initial damage to the tooth-supporting structure may not be visible and the gums may recede only after the disease has established itself. If you have receding gums, your dentist will be able to examine them and explain whether periodontitis is the cause and offer you the appropriate treatment.
The simple message is that periodontitis is always caused by the build-up of bacteria in the form of dental plaque. The natural defences of the body are also compromised as a result.
If this bacterial plaque, which is soft, is not removed by brushing, minerals are deposited within it and a hard deposit on the tooth called tartar or calculus is formed. The presence of tartar encourages the growth of the bacterial plaque towards the roots of the teeth.
This leads to a weakening of the attachment of the root to the gum and the creation of a gap — called a periodontal pocket — between tooth and gum. For example, the more aggressive the bacteria and the weaker the immune response of the patient, the more active will be the disease.
Some drugs — such as antihypertensive or vasodilating agents and immunotherapy — can affect the inflammatory response to plaque and make patients more susceptible to gingivitis. But it is very important to remember that without the accumulation of bacterial plaque, periodontitis will not occur. Tooth loss: If the progress of periodontal inflammation is not halted, the supporting structures of the teeth — including the surrounding bone — are destroyed.
The teeth eventually loosen and are either lost or need to be extracted. Problems with eating: Periodontitis weakens the structures that hold the teeth in place. Wobbly teeth can cause problems when chewing.
People affected can to some extent adapt and switch their chewing habits to the teeth that can still be used. But if the damage continues — and especially if teeth are lost — people can end up able to eat only soft foods.
Problems with speaking: the loose teeth caused by periodontitis can make it difficult to speak clearly. Singers and musicians who play wind instruments can also have problems if teeth start to move apart as a result of periodontitis. Problems with appearance: People with periodontitis can have problems with their appearance aesthetic problems. Gums are dark red because of inflammation, teeth look longer because of receding gums, and the roots which are darker than the crowns of teeth become visible — all of which can look unattractive.
As teeth loosen, they can move apart leaving dark spaces black triangles between them, and if teeth are lost as a result of periodontitis there can be unattractive gaps. Bad breath: The bacteria that cause the inflammation involved in periodontitis can also cause bad breath halitosis. The kinds of bacteria that cause periodontitis thrive in gum pockets and produce foul-smelling volatile sulphur compounds. Bad breath needs to be treated by professional teeth cleaning and good oral hygiene at home.
Negative effects on general health: It is now known that untreated periodontal disease can have serious consequences for general health.
Periodontitis means an increased risk of suffering diabetes, heart disease, cerebrovascular disease, and complications in pregnancy pre-eclampsia, premature birth and low birth weight. There are several factors that increase your chance of developing periodontitis and make the disease more likely to progress.
Among the common risk factors are:. Inflammation of the gums is neither normal nor inevitable. Gum diseases — gingivitis and periodontitis — can be prevented by looking after your teeth and gums. This means adopting good habits in oral hygiene and getting regular professional check-ups at least once a year.
Special care should be taken to clean thoroughly around crooked or crowded teeth, and around fillings, crowns, and dentures because plaque builds up easily in these places which might be hard to access.
Optimal oral hygiene can therefore vary widely from person to person. It is important to consult your dentist or dental hygienist about which are the best techniques in your case and to ask them for instructions. There are two main tooth-brushing techniques. The Bass tooth-brushing technique is the most commonly recommended technique both for people with healthy gums and with periodontitis. The Stillman technique is often recommended for patients with gingival recessions.
But your dentist or periodontist a dentist who specialises in periodontal health can identify these deposits during a regular check-up and remove them as part of professional cleaning. Once the tartar is removed, the teeth are polished using special cups and pastes to create a smooth surface that is less likely to accumulate plaque.
Addressing risk factors can also help prevent the onset of periodontitis. So, giving up smoking, avoiding or reducing stress, eating a healthy diet, and exercising can all play a role in supporting good oral hygiene in preventing periodontitis. A clinical examination in the dental practice is the only way to properly assess the condition of the gums and the tooth-supporting structures.
In an initial check-up, the dentist or hygienist will perform a basic periodontal examination that takes only a few minutes.
This examination quickly determines if gingivitis or periodontitis is present. The dentist or dental hygienist will use a special probe called a periodontal probe and the depth of penetration at the gum line is measured gently and precisely at various sites in the mouth.
At healthy sites, the probing depth is 3mm or less, but where periodontitis is present, the depth is 4mm or more. After this short examination, further tests are carried out only if there is evidence of periodontitis — i. In addition, in what is termed a periodontal chart, the height of the jawbone attachment level is recorded precisely.
A periodontal chart is indispensable for the correct diagnosis of periodontitis and for planning subsequent treatment. The diagnosis of periodontitis can be confirmed only by carrying out X-rays. The selection of the X-rays needed to diagnose periodontitis is made after the clinical examination. These X-ray images show the jawbone surrounding the tooth and make it possible to estimate the severity of bone loss.
In each X-ray made at the dental practice, teeth must be checked for caries as well as for periodontitis. Microbiological tests examine the composition of the dental plaque for specific harmful bacteria:. The results of these tests can provide information that will enable the dentist or periodontist to provide the appropriate care and avoid unnecessary treatment. There is an internationally recognised system for classifying cases of gingivitis and periodontitis. Cases of periodontitis are classified according to four stages and three grades.
The stages describe the severity and extent of the disease, while the grades describe the likely rate of progression. By classifying cases of periodontitis in this way, dentists and periodontists can provide the appropriate form of treatment for each individual patient.
With careful professional assessment and treatment, it is usually possible to completely halt the progress of periodontitis. The key to success is eliminating the bacterial plaque that triggers the disease process and establishing excellent oral-hygiene practices.
There are six stages in the successful treatment of periodontitis:. Regular follow-up appointments are vitally important to ensure that periodontitis does not return and cause further destruction of the gums and the bone and ligament that support the teeth. If there are signs of continuing disease, your dentist will be able to treat it at an early stage.
You will also be given advice on how to change your oral-hygiene practices to tackle the inflammation. Successful periodontal treatment requires your full co-operation in daily oral-hygiene practices and attendance at regular follow-up appointments. Periodontology is the study of the specialised system of hard and soft tissues that support your teeth and keep them in their place in the jaw.
This apparatus, known as the periodontium , has some very important functions:. Because the different parts of the periodontium are made from living tissues, they can adapt to changes in our mouths over time, making the tiny changes in shape and thickness that keep the position of the teeth stable. In many ways, the mouth acts as a mirror of the general condition of our bodies.
Our periodontal status can often tell us more than simply what is happening locally in our gums. Although periodontitis is always triggered by the accumulation of plaque on the teeth, diseases affecting the rest of the body — known as systemic diseases — can weaken the supporting structures of the teeth.
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