Periodontal disease usually begins with poor oral hygiene. It is caused by the bacteria found in plaque. If plaque is allowed to build up, it can spread below the gum line over time. The bacteria in plaque produces toxins that irritate the gums. Left untreated, these toxins can stimulate a chronic inflammatory response where your body's immune system, in an effort to fight the infection, begins to attack the tissues and bone that support the teeth. The gums begin to separate from the teeth, forming spaces between the teeth and gums. As these pockets grow deeper, more gum tissue and bone is destroyed. Eventually, the teeth become loose and have to be removed.

Causes of Periodontal Disease
The main cause of periodontal disease is the buildup of bacterial plaque. The following factors can also affect the health of your gums.

• Smoking and Tobacco Use - Tobacco use may be one of the most significant risk factors in the development of periodontal disease
• Genetics - Up to 30% of the population may be genetically predisposed to gum disease
• Pregancy and Puberty - As your body experiences hormonal changes, your gums can become sensitive and at times react strongly to hormonal fluctuations
• Stress
• Medications
• Clenching or Grinding Your Teeth
• Diabetes
• Poor Nutrition
• Other Systematic Diseases

Gingivitis
Gingivitis, which you may already know from toothpaste and mouthwash commercials, is the mildest form of periodontal disease. Gingivitis causes the gums to become inflammed; they become swollen, red, and bleed easily. Gingivitis is reversible with professional treatment and good oral hygiene at home. At this stage, the discomfort may only be minor, but left untreated can advance to periodontitis.

Aggressive Periodontitis
A form of periodontitis that has a rapid breakdown of support tissues despite the patient being otherwise healthy. Immune deficiencies and a genetic links have been shown to be possible factors for all types of aggressive periodontitis. If caught early, it can be treated, however, if the infection is widespread, tooth loss can occur.

Chronic Periodontitis
Also referred to as adult periodontitis, it may begin in adolescence that becomes clinically significant during middle age and continues throughout life. This is the most frequently occurring form of periodontitis. At this stage, progressive attachment and bone loss can occur, forming pockets between teeth and gums and gingiva (gum) resession.

Disease-Related Periodontitis
Periodontitis, often with onset at a young age, can also be associated with a number of systemic diseases, including type 1 diabetes, Down syndrome, AIDS, and several rare disorders of white blood cells.

Necrotizing Periodontal Disease
Necrotizing periodontal disease is an acute infection in the gums. The gum tissue becomes black and dead (necrosis), bleeds spontaneously, along with a foul odor and pain. Stress, poor diet, smoking, and viral infections, including HIV, are predisposing factors for necrotizing periodontal disease.

Once periodontal disease has been identified, the goals of treatment are to control the progress of the disease, leave the periodontal tissues in a managable state, and if possible, restore the support structures including bone, gums, and ligaments.

Deep Cleaning: Scaling and Root Planning
The first step is a deep cleaning to remove calculus or calcified deposits on the teeth. Our dentists and hygenists may use an ultrasonic instrument to remove the calcium buildup as well as a water pique to prevent overheating and flush out debris that is dislodged. Additionally, the removal of dead inner tissue from a gum pocket, also known as curettage, may be necessary. Plaque is scraped above and below the gum line in a procedure known as scaling. Any rough spots left behind will then need to be smoothed over to remove bacteria as well as aid the gums in reattachment.

After the initial cleaning, our periodontist will check the pocket depths around the teeth after the cleaning process to determined if further treatment is necessary. If an abscess is present, you may need surgery.

Periodontal Surgery
Surgery allows access to root surfaces for deep cleaning, removal of diseased tissue, and repositioning and shaping of the bones, gum, and tissues supporting the teeth. The type and scope of surgery depends on the specific nature and advancement of the disease. The basic procedure is known as open flap curettage.

Open flap curettage begins when the periodontal surgeon lifts, or flaps, the gums away from the tooth and surrounding bone. Then, the diseased root surfaces are cleaned and scraped to remove deposits. Gum tissue is replaced and repositioned minimize pocket depth. In more extreme cases, bone grafts to regenerate lost bone may be necessary as well as guided tissue regeneration to stimulate bone and tissue growth.

Following treatement for periodontal disease, some patients wish to have further cosmetic and restorative dental work done to restore the look of their teeth. These restorations include implants, dentures and bridges. You can read more about these and other procedures on our restorative and cosmetic dentistry pages.