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Periodontitis

Periodontitis is inflammation and infection of the ligaments and bones that support the teeth.

Alternative Names

Pyorrhea - gum disease; Inflammation of gums - involving bone

Causes

Periodontitis occurs when inflammation or infection of the gums (gingivitis ) is allowed to progress without treatment. Infection and inflammation spreads from the gums (gingiva) to the ligaments and bone that support the teeth. Loss of support causes the teeth to become loose and eventually fall out. Periodontitis is the primary cause of tooth loss in adults. This disorder is uncommon in young children, but increases during the teen years.

Plaque and tartar build up at the base of the teeth. Inflammation from this build-up causes a pocket to form between the gums and the teeth, which fills with plaque and tartar. Soft tissue swelling traps the plaque in the pocket. Continued inflammation leads to damage of the tissues and bone surrounding the tooth. Because plaque contains bacteria, infection is likely, and a tooth abscess may also develop. This also increases the rate of bone destruction.

Symptoms

  • Breath odor
  • Gums that appear bright red or red-purple
  • Gums that appear shiny
  • Gums that bleed easily (blood on toothbrush even with gentle brushing of the teeth)
  • Gums that are tender when touched but are painless otherwise
  • Loose teeth
  • Swollen gums

Note: Early symptoms resemble gingivitis.

Exams and Tests

An exam of the mouth and teeth by the dentist shows soft, swollen, red-purple gums. Deposits of plaque and tartar may be seen at the base of the teeth and the pockets in the gums may be enlarged. In most cases, the gums are painless or mildly tender, unless a tooth abscess is also present. Teeth may be loose and gums may be pulled back exposing the base of the teeth.

Dental x-rays show the loss of supporting bone. They may also show the presence of plaque deposits under the gums.

Treatment

The goal of treatment is to reduce inflammation, remove "pockets" in the gums, and treat any underlying causes of gum disease.

Rough surfaces of teeth or dental appliances should be repaired.

It is important to have the teeth cleaned thoroughly. This may involve use of various tools to loosen and remove plaque and tartar from the teeth. Proper flossing and brushing is always needed, even after professional tooth cleaning, to reduce your risk of gum disease. Your dentist or hygienist will show you how to brush and floss properly. You may benefit from medicines that are put on your gums and teeth. Patients with periodontitis should have a professional tooth cleaning every three months.

Surgery may be necessary. Deep pockets in the gums may need to be opened and cleaned. Loose teeth may need to be supported. Your dentist may need to remove a tooth or teeth so that the problem doesn't get worse and spread to nearby teeth.

Outlook (Prognosis)

Some people find the removal of dental plaque from inflamed gums to be uncomfortable. Bleeding and tenderness of the gums should go away within 1 or 2 weeks of treatment. (Healthy gums are pink and firm in appearance.)

You need to perform careful home brushing and flossing for your entire life or the problem may return.

Possible Complications

  • Infection or abscess of the soft tissue (facial cellulitis )
  • Infection of the jaw bones (osteomyelitis )
  • Return of periodontitis
  • Tooth abscess
  • Tooth loss
  • Tooth flaring or shifting
  • Trench mouth

When to Contact a Medical Professional

Consult your dentist if signs of gum disease are present.

Prevention

Good oral hygiene is the best means of prevention. This includes thorough tooth brushing and flossing, and regular professional dental cleaning. The prevention and treatment of gingivitis reduces the risk of development of periodontitis.

References

Amsterdam JT. Oral medicine. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, Pa: Mosby Elsevier; 2013:chap 70.

Kawar N, Gajendrareddy PK, Hart T. Periodontal disease for the primary care physician. Dis Mon. 2011;57(4):174-183.

Chow AW. Infections of the oral cavity, neck, and head. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 60.

Updated: 2/25/2014

Ilona Fotek, DMD, MS, Palm Beach Prosthodontics Dental Associates, West Palm Beach, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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