You may have wondered in the past, “why do people get dentures?” The number one reason a person ends up with dentures is because they didn’t get treatment for periodontal disease.
What is periodontal disease?
This disease occurs from a chronic infection and autoimmune response in the periodontium. The periodontium is the area around your tooth—the bone and gums that support the tooth and keep it strong and solid in your mouth.
Periodontal disease can cause bone loss from the periodontium. The end result of untreated and severe periodontal disease is your permanent teeth loosening and falling out. Many people around the world get dentures when their teeth are so loose that it becomes difficult to eat. When this occurs, they ask their dentist to remove their teeth and fit them for dentures.
What makes up the periodontium?
It may surprise you to learn that there are two kinds of bone in your jaws. There is basal bone, which is hard and everyone has. You will never lose this bone from periodontal disease. Basal bone, however, can be affected by osteoporosis and sometimes bone infections called osteonecrosis. Basal bone is similar in structure to the long bones of your body, such as your arm and leg bones.
The second type of bone that dentists are more concerned with is alveolar bone. This kind of bone is special. It makes up the bony component of the periodontium. While still hard, it’s softer than basal bone.
For example, when a dentist pulls your tooth our, they’re actually pushing the alveolar bone away from the tooth. It is very easy to push this bone on a young person. A person’s alveolar bone becomes harder and denser as they age. For this reason, the younger you are when you are diagnosed with periodontal disease, the faster this disease can cause alveolar bone loss.
What are periodontal disease symptoms?
Periodontal disease is a painless condition, and therefore it is something you may not even know is happening!
If you are experiencing symptoms, they’re likely subtle. You may have noticed:
- Your teeth have appeared “longer” as you age
- There is more root showing when you smile
- Your gums aren’t covering as much of your tooth structure as they did before
- A slightly loose tooth, or teeth, in your mouth
- Gums that appear puffy
- Sensitivity to cold, air, or sweetness
What are risk factors of periodontal disease?
Periodontal disease affects more than just our teeth. Remember, your mouth is not separated from the rest of your body. An infection with an autoimmune component can translate to the rest of your body and overall health and wellness.
For example, there is a connection between heart disease and periodontal disease. There is also a risk to unborn babies in mothers who are affected by periodontal disease. This is because the bacteria that cause periodontal disease do travel through the blood stream. They tend to settle in heart and placental tissue.
If you know that you have heart disease, it is important to get your periodontal disease treated at the dentist. Also be diligent about brushing your teeth twice a day and flossing daily. If you are pregnant, it is also important that you get your periodontal disease treated and that you brush your teeth twice daily and floss once daily.
What causes periodontal disease?
To have periodontal disease, you must first have a genetic susceptibility. You also have a higher likelihood if you have poor oral hygiene. If flossing is not a daily event, and tooth brushing is not occurring twice per day, you could be at a greater risk.
Plaque, which is a bacterial by-product and old food debris combined, can build up along your gum line. When the plaque sits over time, it becomes tartar, also known as calculus or calcified plaque. The calcified plaque acts as a ledge, where more plaque can grow under it.
A person with a genetic susceptibility to periodontal disease has a body that does not like this situation. It determines that it will “fight” the bacterial invaders under, around, and through the ledge of calculus. When this happens, your body sends immune cells to attack the bacteria. The gum tissue over the bone swells because of your body’s fight to get rid of the bacteria around the calculus, and even the calculus itself.
But, the bacterial by-products are everywhere next to your tooth, even inside the alveolar bone. Your body’s immune system gets confused. In its quest to destroy the bacteria, it ends up eating away the very alveolar bone that is supporting your teeth. When the alveolar bone is eaten away, the gums follow the bone. This clinically looks like “gum recession.” You may notice that your teeth are more sensitive than they were before to cold and air.
How is periodontal disease diagnosed?
There are different things that your dentist will look at during your examination that will lead her to a diagnosis of periodontal disease. No one symptom leads to a diagnosis of periodontal disease.
The first thing that your dentist will look at is your X-rays. There is a special X-ray that your dentist will take called a “bitewing.” It’s taken at a 90-degree angle to your bite. This view of the teeth and periodontium shows these structures straight on. The bone levels that are supporting your teeth are shown accurately because of this angle.
Alveolar bone measurement
When your dentist looks at your bitewing X-ray, she can measure the level of your alveolar bone. Your tooth has a root, which is in the alveolar bone. It’s surrounded or coated with a special ligament, called the periodontal ligament. This is not a string-like structure; it is more like a coating on the root that acts as the interface between the tooth and alveolar bone. On the X-ray, the periodontal ligament will look like a tiny black space or outline around the root of the tooth.
The alveolar bone should come to the level of the crown of the tooth. The area that the root surface connects to the crown of the tooth is called the CEJ, or cemento-enamel junction. In a healthy mouth without any periodontal disease, the entire root of the tooth below the CEJ will be submerged in alveolar bone. Only the areas of the tooth that have enamel will be exposed to saliva and variable acid levels. The enamel of a tooth can withstand this. The root of the tooth is more delicate, and fares far worse when exposed to the oral environment.
When a person has periodontal disease on a bitewing X-ray, the dentist will see a gradual loss of the alveolar bone around the root of your tooth. She will quantify exactly how much bone you’ve lost from around your tooth. It is smart to ask your dentist how much bone loss you’ve sustained if you are diagnosed.
Probing depths
The second piece of information that a dentist utilizes to diagnose periodontal disease are what hygienists and dentists call “probing” or “probing depths.” It is a clinical measure of inflammation.
Your dentist or hygienist will take an instrument called a periodontal probe—like a tiny ruler—and place it gently between your gum and tooth. They’ll then move it along the root of your tooth until it reaches the alveolar bone.
This tiny measuring stick measures how thick your gums are covering your alveolar bone. There are six spots on each tooth that these measurements are taken. A measurement between one millimeter and three millimeters is normal. Gums can be that thick without inflammation. If the measure is four millimeters or more, we begin to get a little concerned. If your gums measure five millimeters or more, your dentist will let you know that you have inflammation of your gums. This can signal an active infection and autoimmune response, and therefore means there is ongoing bone loss in that area.
The clinical measurement of inflammation combined with bone loss evidence on X-rays allows your dentist to diagnose periodontal disease with confidence.
How do you treat periodontal disease?
When we see periodontal disease in the dentist office, we will recommend a few treatments. The initial treatment for periodontal disease is a deep cleaning, or scaling and root planing.
You will be numbed for this treatment, with a strong numbing gel called oraquix or an injection. Your mouth is divided into quadrants, and you and your dental professional will decide how many quadrants to scale and root plane, or deep clean, in one visit.
If that doesn’t work, your dentist can suggest more advanced treatments, like removing the damaged gums or teeth.
If you think you may have periodontal disease, it’s important to get a diagnosis. This can help you find the appropriate treatments and avoid more severe complications that occur. To get started, give one of our Phoenix area dental clinics a call today at or click the button below to schedule an appointment with Dr. Janne Lynch.