Periodontal Disease

Abigail Lincoln-Klele

February 20th 2017

Periodontal disease is a gum disease that occurs around the tissues that surround teeth. The main cause of

the disease is by bacterial plaque, which inflames the gingival sulcus. There are many health conditions

that can factors into why people get gum disease; however, there are ways that you can prevent getting it.

Periodontal disease is very serious and can cause many problems that can affect your oral health. There

are many different stages of periodontal disease, but there are different treatment options that you can do

to try and reverse the effects of the disease.

Periodontal disease involves the periodontium which is the tissues that support the teeth such. The tissues

would include the gingiva (the tissue that surrounds the teeth), epithelial attachment (the bottom of the

sulcus where the gingiva attaches to the tooth), the periodontal ligaments (fibers of connective tissue that

surrounds the root of the tooth and attaches the cementum to the bone), the alveolar bone (the bone that

forms the socket at the root of the tooth), the cementum (the hard surface that covers the dentin on the

root of the tooth), and the sulcus (the space between the tooth and the free gingiva). Periodontal disease is

caused when bacterial plaque forms around the gingiva. If the plaque is left on the gingiva the plaque

hardens and turns into calculus and leaves a brown or yellow deposit on the teeth. When the calculus and

the deposit is not removed it then grows onto the supragingival and subgingival surfaces. (Dental

Assisting A Comprehensive Approach, Pg. 673)

Periodontal disease is preventable it all depend on how much you maintain your oral health. There are

many ways that you can maintain your teeth, first is brushing. Every day you should brush twice a day to

remove plaque and food debri from areas of your teeth and gingiva sulcus. Flossing at least once a day

also helps with reducing your chance of getting gum disease, by flossing you are removing food particles

and the plaque that is between the teeth that the toothbrush is not able to get. Rinsing with an mouthwash

to help reduce the bacteria in the plaque and the food particles that were missed while brushing. Lastly
you should always see your dental hygienist every six months for teeth cleanings, at the checkups you can

have the hygienist check with a periodontal probe to insure that you do not have gingivitis and if so, how

severe the disease is. (https://www.perio.org/consumer/prevent-gum-disease)

During the clinical examination the dentist will check for any factors that could indicate or contribute to

periodontal disease. There are six different types of examinations, the first is to check the teeth for

mobility. Normal teeth should only move slightly, however if the teeth have an excessive amount of

mobility then it is an important sign of periodontal disease. The dentist or the dental hygienist can also

check the oral tissues and the supporting structure, during this examination the amount of plaque and

calculus that is on the gingiva, any changes in the gingival health and the level of bone that is exposed.

The third examination that can be done is periodontal probing, this checks the width and depth of

periodontal pockets. During periodontal probing the severity of gingival inflammation is measured by the

bleeding index, this is done by observing much much the gingiva slucas bleeds during the probing.

Another evaluation is called the occlusal adjustment, which is where a person's bite is evaluated for areas

of unequal pressure. The last thing that is checked by the dentist is the radiographs, the images is very

valuable while diagnosing periodontal disease because it can accurately show bone height along the root

surface. (Modern Dental Assisting, Pg. 936-938)

A periodontal probe is an instrument used by either the dentist or the dental hygienist to measure the

depth and locate periodontal pockets. The probe measure how much of the epithelial attachment has been

lost. The working end of the periodontal probe is marked in millimeters, to allow the operator to measure

the depth easily. The millimeter markings can either be indents or they can be color coded. The probe can

vary in shape, it can be oval, flat, or round in the cross sections as long as the working end is thin enough

to fit easily in the gingiva slucas. A normal sulcus measures to 3mm or less, the greater the depth the
greater the loss of epithelial attachment and bone. To determine the depth six measurements are taken

and recorded for each tooth. There are three sites on the facial, including mesiofacial, midfacial, and

distofacial and three sites are on the lingual side, including mesiolingual, midlingual and distolingual. (A

computerized probe system is used to detect and store the information of the periodontal pocket depths,

recession, involvement and the mobility of the teeth. (Dental Assisting a Comprehensive Approach, Pg.

679, 683)

There are four different stages of periodontal disease, the stages go from minor gum disease which is

called gingivitis to the most severe stage called advanced periodontitis. Gingivitis is the first stage, during

this stage the gingival tissue is more red, bleeds easily, and is swollen. The second stage is called mild

periodontitis, the tissues continue to be inflamed and bone loss are the the structure of the teeth begins

making pockets. The third stage is moderate periodontitis, the inflammation of the gingival tissue proceed

to worsen and the destruction of the bone continues and extends into the roots of the teeth. The final and

most severe stage is called advanced periodontitis, this late into the stage the bone loss is so great that

teeth become mobile if mobile enough you are likely to lose teeth.

(http://www.dentalarts.net/treatments/periodontal-therapy/)

Gingivitis is the beginning stage of periodontitis, it can lead to serious problems to your oral health if

untreated. However, if you realize that you have the disease then it can be prevented and your oral health

can be restored before it is too late. Most people do not realize that they have gingivitis because they only

have mild symptoms, but the sooner you realize it the easier it will be to reverse it. Gingivitis is when

bacteria in the plaque builds up on the teeth and causes inflammation, even though the gingiva is inflamed

your teeth are still secure in their sockets and the bone structure isnt affected. If you are examined with a

periodontal probe at this time it should be 2mm to 4mm. You know when have gingivitis if: your teeth
bleed easily while brushing, your gums are swollen or appear bright red or somewhat purple, if your gums

are tender and if you have a continuous bad breath or bad taste.

(http://www.colgateprofessional.com/patient-education/articles/what-is-gingivitis)

Mild periodontitis is the second stage, it is cause when gingivitis is left untreated. In this stage the

inflammation spreads and starts to extend into the bone structure of the teeth. The gingiva begins to

detach from the surround teeth, forming pockets that are called periodontal pockets. Diagnosis can be

done to see the extent of the ongoing disease by a dentist checking the pockets with a periodontal probe.

The bigger the periodontal pocket get the more gingival tissue and bone structure is destroyed. The

measurements of the probe are usually 4mm to 5mm. It is important that if you havent started treating

the disease at this point in the stage you begin to so that it does not continue into extreme bone loss of

your teeth. The symptoms of periodontitis include: gums that are tender and bright red, spaces that

develop between teeth, pus between teeth, and bad breath or a bad taste in your mouth.

(http://www.lorenzanaperio.com/Lorenzana_Periodontics/Stages_of_Periodontal_Disease.html)

Moderate periodontitis is where the periodontal pockets deepen and the gingiva continues to recede thus

causing infect to extend deeper into the tissue. In this stage the gingiva and the periodontal ligaments

continue to pull away from the surrounding teeth and the bone structure continues to worsen. The

surrounding teeth begin to loosen in the socket due to the lack of support they have. At this point in the

disease the periodontal probe usually reads from 5mm to 7mm. When a person notices that the have

moderate periodontitis, it is extremely important that they have it taken care of because they are close to

loosing their teeth. The symptoms of moderate periodontitis is mostly the same as mild periodontitis, the

difference is that in this stage all of the symptoms worsen and the teeth that are affected begin to loosen.

(http://www.dentalarts.net/treatments/periodontal-therapy/)
Advanced Periodontitis is the final and most severe stage of gum disease. In this stage the periodontal

pockets continue to deepen, and the the gingiva continues to recede. Due to the pockets detaching more

and more of the gingiva, and the periodontal ligaments away from the teeth, teeth start to shift and loosen

in their sockets because the bone that supports the teeth is destroyed. Once the teeth begin to shift and

loosen, it will affect a person's bite and teeth will either have to have aggressive treatment, be removed, or

will fall out on their own. When you have advanced periodontitis, you will experience: chronic breath,

misaligned teeth or loosen teeth, severe receding gums, and deep periodontal pockets.

(http://www.colgate.com/en/us/oc/oral-health/conditions/gum-disease/article/the-three-phases-of-periodo

ntal-disease-symptoms-0814)

There are many ways of getting periodontal disease. One way you can get the disease is by having poor

oral hygiene, by not brushing and flossing your teeth twice a day plaque begins to build up. Chewing and

smoking tobacco products contain many chemicals that are harmful for the body, there are different risk

factors for chewing tobacco and smoking it. Chewing tobacco can recede the gingival margins and cause

the roots of the teeth to be more susceptible to bacteria and infection. Smoking tobacco lowers the blood

flow to the gums and prevents the gums from healing properly, it also weakens the bone structure of the

teeth because of the heat, and causes plaque and calculus to grow more on your teeth because of the

bacteria therefore causing infection. Stress can also cause periodontal disease, stress causes the hormone

cortisol which is an anti-inflammatory agent to be produces more than it would normally be. The cortisol

is produced in the gums and turns into a mass of cells therefore cause inflammation of the gums. There

are many other ways of getting periodontal disease such as being pregnant, diabetes, different types of

medication and improper nutrients. (Dental Assisting a Comprehensive Approach, Pg. 674)

(http://www.mouthhealthy.org/en/az-topics/g/gum-disease)
There are multiple treatment options that can be used to treat periodontal disease. There are two main

types of treatment options: non-surgical, and surgical. In these three treatments there are many different

options you can take. In most cases you will need to take some type of medication no matter what

treatment plan you decide to do. The medication that is prescribed is used to help kill the infection that

grows in the gingiva slucas. In order for non-surgical and surgical procedures to work as intended then the

infection has to be at a minimal.

There are two main types of non-surgical procedures, scaling and root planing and after this the tray

delivery system can be used. The scaling and root planing procedure consist of cleaning the root surfaces,

by removing the plaque and calculus that extends into the periodontal pockets. The purpose of this

treatment is to smooth the tooth and to remove the bacteria in the pockets. Medication can then be used if

the periodontitis feels that it is needed, some medications would include a antiseptic chip, gel, or

microspheres that is placed in the pockets after the treatment, this medication is used to control the

bacteria and to minimize the size of the pockets. The second non-surgical procedure is the tray delivery

system, in this treatment plan a customized tray of the individual's mouth is used. The tray delivery

system is a tray that is custom to a person's mouth that is filled medication prescribed to them. This

treatment is mainly used after a procedure has been done, such as the scaling and root planing treatment

and is used for therapy. (https://www.perio.org/consumer/non-surgical)

There are several surgical treatment options that can be done, such as flap surgery, gingival grafting,

guided tissue regeneration, and osseous surgery among many others. A flap surgery is procedure that is

done by surgically removing the gingiva from the tissue that lays under is allowing visibility to the bone.

Once the flap is done, the diseased tissue is then removed and roots are then planted and the alveolar bone
is then contoured. Gingival grafting consist of the removal diseased by removing the periodontal pockets

which exposes the bone and connective tissue. The graft is then placed over the site and sutured into

place. In guided tissue regeneration, barrier membranes are used to keep a space between gingival

margins and the root surface to allow tissues to regenerate in the periodontal defect. Osseous surgery

consist of the removal of the defect in the bone caused by periodontal disease. There are two main types

of bone surgery, the first is osteoplasty which is the reshaping of the bone, and ostectomy which is the

removal of bone. A bone graft is then done to hopefully restore the lost bone and to regenerate a

functional attachment of the periodontium. (Dental Assisting a Comprehensive Approach, Pg. 694, 696)
 Work Cited

Books:

Dental Assisting A Comprehensive Approach

Modern Dental Assisting

Websites:

https://www.perio.org/consumer/non-surgical

http://www.dentalarts.net/treatments/periodontal-therapy/

http://www.colgateprofessional.com/patient-education/articles/what-is-gingivitis

http://www.mouthhealthy.org/en/az-topics/g/gum-disease

https://www.nidcr.nih.gov/OralHealth/Topics/GumDiseases/PeriodontalGumDisease.htm

http://www.webmd.com/oral-health/guide/gingivitis-periodontal-disease#1

http://www.lorenzanaperio.com/Lorenzana_Periodontics/Stages_of_Periodontal_Disease.

html

https://www.perio.org/consumer/prevent-gum-disease

http://www.colgate.com/en/us/oc/oral-health/conditions/gum-disease/article/what-is-perio

dontal-disease