Periodontology – Periodontal Disease

Periodontal disease, or gum disease, includes inflammatory conditions which affect the tissues surrounding the teeth. In the early stages, this condition is called gingivitis. Gingivitis results in swollen, red gums which can sometimes bleed from brushing or flossing. As the condition progresses into the more serious form, it becomes periodontitis. Periodontitis can result in the gums pulling away from the tooth, bone loss and loose teeth which can even fall out. It can also cause bad breath or halitosis.

In most cases, periodontal disease is caused by high levels of bacteria in the mouth which infects the tissue surrounding the teeth. Some of the most prevalent risk factors for the disease include smoking, diabetes, HIV/AIDS, a family history and some medications. A diagnosis of the disease includes the inspection of the gum tissue around the teeth visually or with the use of a probe. In some cases, X-rays aid in evaluating the amount of bone loss.

Treatment for periodontitis includes incorporating effective oral hygiene practices and regular dental visits, including professional teeth cleaning. A recommended oral hygiene regimen includes brushing at least twice each day and regular flossing. Antibiotics or dental surgery may be required in some cases for treatment. Nearly 538 million people are affected by the disease throughout the world. In the United States specifically, about half of patients over the age of 30 are affected and nearly 70% of patients over the age of 65 have the condition. It is more common for the disease to affect males than females.

Signs & Symptoms

In the early stages, periodontitis does not have many noticeable symptoms. In many cases, the disease will progress significantly before a patient seeks treatment.

Some of the most common symptoms associated with periodontitis include:

  • Bad breath, halitosis or a metallic taste in the mouth
  • Deep pockets between the teeth and the gums
  • Gingival recession, giving the appearance of longer teeth
  • Loose teeth, often occurring in the later stages of the disease
  • Redness or bleeding of gums when brushing teeth, using dental floss or eating
  • Reoccurring swollen gums

It is important to note that gingival inflammation and bone destruction do not always cause pain. Patients often assume that bleeding without any pain can be ignored, however, it may be a sign of periodontitis.

Associated Conditions

Patients with periodontitis have a higher risk of a stroke, myocardial infarction, atherosclerosis and hypertension. The condition has also been linked with impairments in delayed memory and calculation abilities patients over the age of 60. Individuals who have impaired fasting glucose and diabetes mellitus often have higher degrees of periodontal inflammation. In addition, they can have difficulty in balancing their blood glucose level due to the constant systemic inflammatory state caused by the periodontal inflammation. While there is not a scientific proven causal association, an association has been found between chronic periodontitis and erectile dysfunction, heart disease and pancreatic cancer.


Periodontitis is an inflammation of the tissues which support the teeth or the periodontium. The periodontium includes the following four types of tissues:

  • Alveolar bone: bony sockets which anchor the teeth
  • Cementum: outer layer of the roots of teeth
  • Gingiva: gum tissue
  • Periodontal ligaments (PDLs): connective tissue fibers which run between the cementum and the alveolar bone

The main cause of gingivitis is due to poor or ineffective oral hygiene practices. The lack of properly cleaning the teeth, leads to the accumulation of plaque at and around the gum line. Other factors which can contribute to the disease include poor nutrition and underlying medical issues such as diabetes. People who have diabetes need to be extremely careful with their oral care at home in order to control and prevent periodontal disease.