Periodontal Disease: Causes, Symptoms, Complications, and Treatments Explained

What is Periodontal Disease?

Periodontal disease (also known as gum disease) is a chronic inflammatory condition that affects the supporting structures around the teeth, including the gums, periodontal ligaments, and alveolar bone. When dental plaque accumulates on the surface of the teeth over time and is not effectively removed, it can harden into tartar, which in turn causes gum redness, swelling, and bleeding. As the condition worsens, it may lead to the resorption of alveolar bone and the loosening of teeth. Periodontal disease is one of the leading causes of tooth loss among adults in Hong Kong.

"Periodontal disease" literally means that the tissues around the teeth are sick, but this also includes the bones of the teeth and the gums below. A tooth is like a big tree, and the surrounding area is like soil. If the quality of the soil deteriorates, no matter how strong the roots of the tree are, it will eventually collapse.

Lurking culprit

Periodontal disease is basically a chronic disease. If the bones and gums gradually shrink, the patient usually may not feel so uncomfortable resulting in the problem not being detected in time. Often, the patient may not realize how serious the problem is until the teeth become loose or even fall out, affecting the normal use of the teeth, but by then the golden treatment time may have already been missed.

How is periodontal disease caused?

Many patients often complain that they have the habit of brushing their teeth every day, but why do they still suffer from periodontal disease? Is brushing your teeth useless at all? In fact, this is a big misunderstanding. Brushing your teeth every day and brushing your teeth correctly are two different things. And, brushing your teeth is only one part of maintaining oral hygiene, so let's look at the following common causes of periodontal disease.

What causes periodontal disease?

1. Improper cleaning of the mouth. Periodontal disease is a relatively common dental disease. Many patients have suffered from this due to improper or insufficient oral cleaning, which leads to gaps between teeth and teeth, forming periodontal pockets. Moreover, the bacteria that cause periodontal disease are anaerobic bacteria that can survive without oxygen. They can also survive well in the deep layers of the teeth, which further leads to the disease of the teeth and even destroys the tissue of the teeth.

2. Not having regular cleanings. Many people feel that there is a gap between the teeth, or the gap becomes larger after cleaning, and sometimes they feel that the teeth are loose or bleeding, so they are very resistant to cleaning. However, the root cause is the damage to the teeth caused by calculus. Failure to regularly clean your teeth can worsen your oral hygiene and keep the bacterial army raging.

3. Have diabetes. The mouth, like the rest of the body, are closely related with each other, and there is a strong relationship between diabetes and periodontal disease. According to medical research, people with diabetes are twice as likely to suffer from periodontal disease. If you don't exercise control over your eating habits, you can make your oral hygiene and diabetes worse, making it easy to get periodontal disease. According to clinical data, good management of periodontal disease can also play a role in the auxiliary control of diabetes and can reduce the damage caused by the incidence of diabetes to the body.

Quick to find out if you have periodontal disease!

In the early stages of periodontal disease, patients usually do not have any particularly noticeable changes in sensation and appearance. However, after a period of time, the patient can feel the following situation. Have you encountered the following situation?

1. Odor, bad breath, etc. in the mouth;

2. Receding gums or slightly loose teeth; or

3. The calculus causes the gums to bleed or injure easily.

However, some patients may not feel very uncomfortable even if the above conditions occur, so they may miss the best treatment time. Most of them may just sit and wait until the teeth becomes very loose or even fall, or when the pain affects their diet and life, which finally causes them to consult a dentist.

The above situation will not only affect your appearance, but also make your oral health gradually worsen. If detected in time and treated appropriately, such disease can often be controlled. However, if the golden opportunity is missed, the treatment difficulty will be increased, and the treatment effect will be greatly reduced.

How can periodontal disease affect me?

Periodontal disease is not as simple as just destroying a single tooth, it can also affect the surrounding teeth, make a mouthful of teeth sick, and even indirectly lead to other serious diseases.

1. Irreversible damage to teeth and gums. Our gums do not have a strong self-recovery function, so the gum recession caused by periodontal disease cannot be restored to its original appearance even with medical treatment. Therefore, if the teeth are loosened or lost without periodontal treatment, the fallen teeth will not be able to grow back, so artificial dental implants or dentures may be required in the follow-up treatment.
2. Affects the cardiovascular system of the body. Periodontal disease may also pose a burden on the cardiovascular system, which may have been neglected by many people. It increases the risk of heart attack or stroke in patients. And the bacteria that cause periodontal disease may enter the bloodstream, bringing these chronic diseases and bacteria to other parts of the body, thereby causing other problems in the body.
3. Increase the risk of respiratory pneumonia. The periodontal disease bacteria can also enter the patient's respiratory tract, causing pneumonia.
4. Premature birth occurs in pregnant women. Periodontal disease bacteria could flow along the patient's blood to the uterus, and even into the amniotic fluid of the placenta, causing the mother to produce a defensive response and cause premature birth.

The magic weapon for the treatment of periodontal disease

Treatment of early periodontal disease

The common cleaning method is to remove the calculus on the surface of the teeth through regular scaling, but this surface cleaning method cannot cure periodontal disease. If you want to completely cure periodontal disease, you still need to thoroughly clean the deep layer of the teeth, that is, root planing. This method is sufficient to enable most people with early periodontal disease to initially solve the problem.

Treatment of middle and advanced periodontal disease

However, if the periodontal disease is already in the middle and late stages, or the periodontal pocket of more than 5 mm remains after the root of the tooth is scaled, it is difficult to recover, and there will be occasional bleeding gums, so it may be necessary to carry out "periodontal flap debridement surgery". If the treatment conditions permit, the periodontist can also perform "guided tissue regeneration therapy" for the patient, which can achieve a more ideal treatment effect.

If the tooth has severe periodontal disease, this situation may require the doctor to extract the patient's tooth.

Picture: Full-mouth dental X-ray showing advanced bone loss and damaged tooth roots in a periodontal disease patient

Detailed explanation of the steps of deep root debridement/root planing:

Root debridement/root planing is a treatment for deep scaling and cleaning of the root of the tooth. The treatment can penetrate deep and bottom of the patient's inflamed gums to clean the root calculus, bacteria, and inflamed tissue of the teeth, which can restore the health of the periodontal tissue in the fastest time.

This treatment method is not surgical and will not cause trauma. Even if the treatment effect cannot be permanent, it can also play a very good role in stabilizing periodontal disease and maintaining healthy teeth. However, it should be noted that this treatment cannot regenerate damaged tissue around the teeth.

The steps of non-surgical "root debridement/root planing" are as follows:

1. Anesthesia. Local anesthesia is applied to the affected area of the mouth so that the patient can perform root treatment without pain.

2. Clean. This is different from teeth cleaning. The periodontist will use a special instrument to penetrate deep into the root of the tooth and thoroughly clean the bottom, so that the bacteria, calculus, and contaminated tissue on the surface and inside of the tooth are well cleaned.

3. Maintenance. After the treatment, the periodontist will instruct the patient on how to clean and care for the teeth afterwards, because if you want to get good treatment results, you should not rely only on the doctor, but also on your active cooperation as patient.

4. Observe. Ordinary periodontal disease may take two to three months to treat. It is also convenient to observe the changes and improvement of the teeth after treatment, to see if the previously inflamed and bleeding gum tissue has re-fitted the teeth, and the roots of the teeth are re-fitted. However, it should be noted that after periodontal treatment has lasted for a period of time, it will become impossible for the teeth to return to their original healthy condition. Because periodontal disease is a controlled oral disease, it can be treated to achieve a much better health and function, but it cannot be completely restored to the original healthy condition.

5. Remedy. Once the condition has stabilized, you can begin to fix the teeth that have become loose due to periodontal disease. Doctors have use many ways to connect the loose teeth to the adjacent teeth, so that the original single force of the teeth becomes the support point evenly divided into multiple teeth, which can reduce the burden on the diseased teeth. Doctors can also make periodontal splints for patients, which can hold loose teeth in place and play a remedial role.

6. Follow up. Many people with periodontal disease can achieve satisfactory results after the above treatment, but after that, they cannot be ignored and relaxed, and they should also follow the doctor's instructions to regularly check and clean their teeth, which can maintain and stabilize the condition of the teeth, allowing existing teeth to live longer.

7. Flap debridement surgery. If the periodontal disease is relatively serious, or if the ideal condition is still not achieved after root planing, this surgical treatment can also be performed to allow the patient to better stabilize the condition.

The steps of the surgical "periodontal flap debridement surgery" are as follows:

1. Anesthesia. Anesthesia is given to the affected area of the mouth, which allows the patient to perform the surgery without pain.

2. Debridement. The doctor will open the gums directly through surgery, clean the calculus for the patient under the condition that can be seen clearly, and clean up the damaged tissue.

3. Suture. After treating the diseased part of the tooth, the wound is sutured.

4. An operation to regrow periodontal tissue. If medical conditions permit, artificial bone meal can be implanted, or other regenerative biological materials can be placed in the place where the tooth is missing. These substances can help the periodontal cells to grow again, so that the previously damaged bone or functionally degraded teeth and gums can be restored to good usability and stability. This treatment is to allow the alveolar bone to regenerate and achieve better natural recovery than single debridement and scaling. It is important to be clear, however, that not all bone fractures are suitable for this surgical repair, and ultimately it depends on the condition of the individual tooth whether this material is suitable for use.

5. Extract the diseased tooth. Our natural teeth are very precious, so keep them if you can. However, if the diseased tooth has no bone protection and is very loose, even if the tooth is retained, it will affect the patient's use and life, and even affect the surrounding teeth, leading to bacterial infection or loosening. Therefore, the dentist may recommend extraction at this time.

Things to keep in mind after periodontal treatment:

1. Regular follow-up and maintenance. After the treatment is completed, the doctor will determine the period for dental maintenance and arrange the follow-up consultation according to the specific conditions of the patients. Basically, the follow-up time for patients is within three months. When the patient's dental condition is stable, the follow-up time is changed to once every six months or once a year. If the teeth are already in ideal health, and the patient desires to restore the appearance of the teeth and gums, further treatment may be required.

2. Usual care. People with periodontal disease should pay attention to maintaining oral hygiene. Patients need to actively cooperate with doctors and face it bravely. Like other chronic diseases in the body, periodontal disease cannot be completely cured and restored to its original state but can only be effectively controlled. Therefore, if the patient is slack in the treatment, and usually does not pay attention to the oral cavity, it will cause the recurrence of periodontal disease.

For teeth, prevention is better than cure. No matter what the disease is, don't delay. The tissue around the teeth is like a piece of fertile land, and the teeth are the big trees on it. If the land is gone, the big trees will not survive, so what we can protect the land and prevent it from being damaged.

If we miss the opportunity to treat periodontal disease in the early stage, then there will be more troubles in the later treatment. When periodontal disease becomes more severe, the bones that support the teeth may also be damaged, thereby prolonging the treatment time. Therefore, if you feel that your teeth are abnormal, you should check and deal with the condition in a timely and active manner and treat it according to the professional advice of your doctor.