Periodontal disease
The periodontium involves all the supporting tissues around the teeth, ie the gingiva (gum) and the alveolar bone (the bone supporting the teeth).  It speaks for itself that the periodontal tissues should be cared for as well as the teeth themselves, because without the support of a healthy periodontium the teeth will be unstable, will eventually become loose and can even fall out!  While there are many ways of restoring lost tooth structure, there are very few ways of successfully restoring lost periodontal structure.

Periodontal disease is a (normally) painless bacterial infection of the bone and gingiva.  These bacteria are normally present in the (healthy) mouth.  The actual infection occurs when these bacteria are allowed to multiply out of control – something which is bound to happen if the teeth and gums are not cleaned correctly, or not cleaned at all.  Plaque, which contains lots of bacteria, then forms on the tooth surface and will start infecting the gum around the teeth (as well as causing decalcification of the teeth and tooth decay).

Bleeding of the gums (including bleeding during brushing and flossing)  is the first sign that there is a periodontal problem.  Bleeding should never be ignored!

Gingivitis
The very first stage of periodontal disease is gingivitis.  Only the gingiva (gum) is infected at this stage, and the disease is still reversible with the right treatment.  The signs and symptoms of gingivitis include:

• gums that bleed easily
• gums that are red, swollen and tender
• bad breath

Periodontitis
When gingivitis progresses, it also starts destroying the bone around the teeth.  This is then called periodontitis or periodontal disease.  Remember it is normally a painless disease, so it can sometimes be far advanced before it is detected.  As more and more bone gets destroyed, the teeth can become mobile.  Where there is too much bone loss, the teeth will eventually be lost.  A bone that has been destroyed around the teeth can never grow back.  Regeneration of bone around teeth by surgical means has very limited success.  The result is invariably an appearance of “long teeth” with dark spaces between them where bone and gum has been lost.

Although periodontitis is normally the result of long-standing neglect of proper care (and therefore plaque accumulation), not everybody is equally susceptible to periodontitis.  Everyone has a different immune response to the development of periodontal disease.  Some of the risk factors are:

• diabetes;
• hormonal changes;
• smoking;
• alcohol;
• family history;
• certain medications;
• grinding or clenching;
• age;
• stress; and
• foreign objects such as removable dentures.

Periodontal diseases may increase one’s risk for some conditions, including:

• stroke and cardiovascular disease;
• diabetes; and
• respiratory diseases.

Detecting periodontitis
It is vital to visit a dentist or an oral hygienist every six months for scaling of all plaque and calculus (hard deposits) on the tooth surfaces and below the gum level.  This will greatly diminish the chances for gingivitis or periodontitis.  The pockets between the gum and the teeth should regularly be measured and charted to give an indication of the amount and progression of bone loss, if any.  Regular x-rays will also give an indication of any bone loss or other bony defects.

Treating periodontitis
The best treatment is to prevent periodontal diseases from starting!  The correct brushing method and daily flossing is absolutely essential, as is visiting an oral hygienist twice a year (or more often, in certain cases) for scaling, polishing, and early detection of any possible infection.  It is also vital to eliminate as many of the risk factors for periodontitis as possible.  The negative effect that especially smoking has on the periodontal status cannot be stressed enough.  When gingivitis or periodontitis is already present, flossing, brushing and regular professional cleaning is still the most effective way of controlling the disease.  Bone loss around teeth is permanent and will never grow back, but the disease can be controlled.  In some cases more intensive procedures may be needed (see below) and sometimes antimicrobial treatment may be prescribed.

Some periodontal procedures

• Deep scaling or curettage:  where there is already necrotic tissue and bone, it may be necessary to anaesthetize the gum and do a deep clean from time to time around the teeth in order to help stabilize the process and re-establish the attachment between bone, gum and tooth.
• Periodontal surgery:  in more advanced cases the gum gets anaesthetized, and lifted surgically for re-contouring of necrotic bone and gum.  After disinfecting of the bone, the gum gets sutured back in place to form a new attachment.  Teeth that cannot be rescued will also be removed so the mouth can have the best chance of getting healthy again.
• Bone regeneration:  in case of certain bone lesions due to a periodontic problem or loss of teeth, a bone regeneration procedure can be attempted to improve the amount and quality of the available bone, either to help stabilize the local periodontal situation or to provide bone for placement of implants.

Care of the supporting tissue around the teeth
In summary, it is often possible to restore teeth, but very difficult to restore damaged periodontal tissue (bone and gum).  Flossing, brushing and professional cleaning strengthens periodontal tissues.  Removable dentures should be kept clean meticulously and removed regularly for proper cleaning of the remaining teeth.  Eliminating smoking and controlling diseases such as diabetes will also improve the periodontal status.