Doctor's Notes on Periodontal (Gum) Disease
Periodontal disease (periodontitis) is a chronic inflammatory disease that destroys gum and bone tissues that support the teeth. Gingivitis (gum swelling, bleeding, bad breath, bad taste in your mouth) usually occur before signs and symptoms of periodontal disease begin. Periodontal signs and symptoms include destruction of gums, connective tissue and bone, leaving tooth roots exposed and sensitive to temperature changes. Pus can develop between the teeth; teeth may fall out or need to be extracted.
Causes of periodontal disease include plaque and tartar deposits that support bacterial infections and contain bacterial toxins that injure or destroy gum and bone tissues; factors that aid the development of periodontal disease are genetics, infrequent dental care, low calcium intake, the body’s inflammatory response to infection, diabetes, poor saliva production, stress, steroid medications and other medications (antiseizure and some blood pressure medications) and changing hormone levels.
Periodontal (Gum) Disease Symptoms
- Gingivitis includes swelling and bleeding of the gums, bad breath, or a bad taste in your mouth. Good toothbrushing and flossing can reverse the affects of gingivitis.
- Acute necrotizing ulcerative gingivitis (ANUG) is an advanced and invasive form of gingivitis that causes sore gums and a whitish membrane on the gums. It requires antibiotics as part of the treatment.
- Periodontitis occurs when bacterial toxins and enzymes destroy the connective tissue and bone.
- The gums draw back, and the roots of the teeth are exposed. The teeth may become very sensitive to temperature changes, or new cavities can develop.
- The pocket between the tooth and the gums deepens; plaque in this area is very difficult to remove. Bacteria invade the surrounding structures.
- When the gums pull away from the teeth, pus develops between the teeth and the gums or the permanent teeth become loose in their sockets. Only a dentist can decide whether the teeth can be saved.
Periodontal (Gum) Disease Causes
Plaque is a sticky film of bacteria that clings to the surface of teeth and gums. Brushing and flossing every day may not completely remove all the plaque, especially around the gum line. The bacteria in the plaque produce toxins that may injure the gums and supporting tissues.
Plaque that is not completely removed within 48 hours hardens into a rough deposit called tartar or calculus. Once tartar develops, the only way to remove it is by having the teeth professionally cleaned. Tartar below the gum line causes inflammation and infection. Because this process is often painless, a person may be unaware a problem exists.
Causes or factors that worsen gum disease include the following:
- Inherited factors (genetics)
- Infrequent dental care
- Insufficient calcium intake
- Inflammatory response by the body occurs that creates further problems.
- Because of a dulled immune response and less oxygen in the mouth, smokers are two to seven times more likely to develop periodontitis than nonsmokers.
- Diabetes worsens periodontal disease. If a person's blood sugar level is poorly controlled, a worse infection, poor healing, and a greater loss of bone and connective tissue are likely.
- Sjögren's syndrome causes decreased saliva production that can lead to periodontal disease.
- Stress increases certain hormones that make a person more susceptible to infection. Pregnancy and birth control pills can also increase hormone levels.
- Steroids, antiseizure medicines, cancer medicines, and blood pressure medicines can all affect the gums. Some drugs decrease the flow of saliva, irritating the mouth and making it prone to infection.
Some studies show that people with gum disease are more likely to have heart disease than those with healthy gums. Researchers aren't sure why that is; gum disease isn't proven to cause other diseases. But it makes sense to take care of your mouth like you do the rest of your body.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.