Inflammation of gums - involving bone

Alternative names
Pyorrhea - gum disease; Periodontitis

Definition
Periodonditis is a dental disorder that results from progression of gingivitis, involving inflammation and infection of the ligaments and bones that support the teeth.

Causes, incidence, and risk factors
Periodontitis occurs when inflammation or infection of the gums (gingivitis) is untreated or treatment is delayed. 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 childhood but increases during adolescence.

Plaque and tartar accumulate at the base of the teeth. Inflammation causes a pocket to develop between the gums and the teeth, which fills with plaque and tartar. Soft tissue swelling traps the plaque in the pocket. Continued inflammation eventually causes destruction of the tissues and bone surrounding the tooth. Because plaque contains bacteria, infection is likely and a Tooth abscess may also develop, which increases the rate of bone destruction.

Symptoms

     
  • Swollen gums  
  • 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  
  • Breath odor  
  • Loose teeth

Note: Early symptoms resemble gingivitis.

Signs and tests
Examination of the mouth and teeth by the dentist shows soft, swollen, red-purple gingiva. Deposits of plaque and calculus may be visible at the base of the teeth, with enlarged pockets in the gums. The gums are usually painless or mildly tender, unless a Tooth abscess is also present. Teeth may be loose and gums may be receded.

Dental x-rays reveal the loss of supporting bone.

Treatment

The goal of treatment is to reduce inflammation, eliminate pockets if present, and address any underlying causes. Dental irritants, such as rough surfaces of teeth or dental appliances, should be repaired. General illness or other conditions should be treated.

It is important to have the teeth cleaned thoroughly. This may involve use of various instruments or devices to loosen and remove deposits from the teeth (scaling). Meticulous home oral hygiene is necessary after professional tooth cleaning to limit further destruction. The dentist or hygienist will demonstrate brushing and flossing techniques. With periodontitis, professional tooth cleaning is often recommended more frequently than the standard twice a year.

Surgical treatment may be necessary. Deep pockets may need to be opened and cleaned. Loose teeth may need to be supported. Extraction (removal) of a tooth may be necessary for advanced periodontitis so destruction doesn’t spread to adjacent teeth.

Expectations (prognosis)
Removal of dental plaque from inflamed gums may be uncomfortable. Bleeding and tenderness of the gums should be reduced within 1 or 2 weeks of treatment. Healthy gums are pink and firm in appearance. Careful oral hygiene must be maintained lifelong or the disorder may recur.

Complications

     
  • Recurrence of periodontitis  
  • Tooth abscess  
  • Infection or abscess of the soft tissue (facial cellulitis)  
  • Infection of the jaw bones (osteomyelitis)  
  • Trench mouth  
  • Mobile or lost teeth  
  • Tooth flaring or shifting

Calling your health care provider
Consult your dentist if signs of gingivitis are present.

Call for an appointment with your health care provider if the dentist recommends medical treatment of underlying conditions that contribute to the development of periodontitis.

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

Johns Hopkins patient information

Last revised: December 6, 2012
by Simon D. Mitin, M.D.

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