Periodontitis: The Advanced Form of Gingivitis

What It Is?

Periodontitis is an advanced form of gingivitis that results in severe infection of the tissues surrounding your teeth. When gingivitis is left untreated, bacteria infiltrate deep into the supporting tissues, eliciting a robust inflammatory response from the body. In its effort to combat these invasive bacteria, the body’s defense mechanisms inadvertently damage the periodontium—the tooth’s supporting structure. This defensive response leads to the hallmark of periodontitis: the loss of periodontal attachment and subsequent bone degradation. As the gum and bone support deteriorate, teeth become loose and mobile, ultimately at risk of falling out due to the lack of structural integrity.

Causes

The human mouth harbors hundreds of different types of bacteria, most of which are harmless in healthy individuals. However, inadequate daily oral hygiene allows these bacteria to proliferate and accumulate on the teeth, significantly increasing the risk of dental issues.

Periodontitis is typically caused by poor dental hygiene. When you don’t brush your teeth and clean in hard-to-reach places in your mouth, the following happens:

1. Bacterial proliferation in the oral cavity leads to the formation of dental plaque.
2. If not adequately removed, plaque becomes mineralized over time, resulting in tartar
3. This tartar facilitates further bacterial colonization, extending towards the tooth root.
4. The body’s immune response to the bacterial presence triggers gingival inflammation.
5. Chronic inflammation disrupts the gingival attachment to the tooth root, forming periodontal pockets.
6. These pockets become colonized by anaerobic bacteria, which release toxins that progressively damage the gums, teeth, and supporting bone structures.

Risk factors

The risk factors for periodontitis can either be modifiable, meaning that you have control over them, or unmodifiable, factors you can’t control.

Modifiable risk factors:

• Smoking tobacco, which is one of the biggest risk factors for periodontitis
• Poor oral hygiene
• Diabetes mellitus or type 2 diabetes 
• Obesity
• Pregnancy and other conditions that cause hormonal changes in women (such as menstruation or menopause), which can make the gums more sensitive
• Conditions affecting your immune system, like HIV or leukemia
• Medications that reduce the flow of saliva in your mouth
• Poor nutrition, including a deficiency in vitamin C

Unmodifiable risk factors:

• Age
• Genetic predisposition

Stages of Periodontitis

Early periodontal disease

In the initial stage of periodontitis, bacteria penetrate beyond the gums into the bone. This progression causes the gums to recede, forming small pockets between the gums and teeth. These pockets create a sanctuary for harmful bacteria, as they are difficult to reach and clean with a toothbrush or floss. The body’s immune response to the infection exacerbates gum tissue recession. At this stage, patients typically experience bleeding gums during brushing and flossing, accompanied by some degree of bone loss.

Moderate periodontal disease

If left unchecked, the bacteria progress to damage and erode the periodontal ligament, advancing into the underlying alveolar bone. This stage of periodontitis often manifests with noticeable signs like pus around the gum line, chronic bad breath, and discomfort. As the infection undermines the periodontium, your teeth will gradually lose essential bone support, leading to increased mobility. Moreover, there’s a heightened risk of the infection worsening, potentially sparking a widespread inflammatory reaction throughout the body.

Advanced periodontal disease

The periodontium, or the support system of the tooth, is a connective tissue comprising the periodontal ligament, alveolar bone, cementum, and the gingivae that hold the tooth in place. When the disease has advanced, the periodontium undergoes deterioration, and the bone loss continues. 

If you have advanced periodontitis, you might experience severe pain while chewing, bad breath, and a foul taste in your mouth. Without bone support, your teeth will become extremely wobbly, and you will likely lose them. 

If gum disease is caught early, it can be reversed. However, once bone loss around the teeth occurs due to infection, the disease becomes too advanced to reverse. Nevertheless, it can be managed with proper treatment and consistent, thorough oral hygiene.

Symptoms

• Pain that’s more intense than with gingivitis
• Bleeding worse than with gingivitis
• Swelling in the gums more than with gingivitis
• Halitosis (bad breath) that won’t go away
• An unpleasant metallic taste in the mouth
• Pus oozing from your gums 
• Difficulty eating 
• Tooth mobility or loosening of teeth
• Teeth falling out
• Abscesses
• A difference in the way your teeth come together (altered bite)
• The development of new spaces between your teeth that look like ‘black triangles’

Complications

Untreated periodontitis can lead to:

• Recurring gum abscesses
• Loose or mobile teeth
• Tooth loss
• The alveolar and periodontal membranes can become damaged – bone and tissue surrounding the root of teeth can become damaged.
• Gum recession. Your gums may start to pull away from your teeth, making them appear longer than usual. 
• Medical conditions, such as heart disease and stroke. Studies show that people with recurring periodontitis are much more likely to develop heart problems or suffer a stroke.
• Premature birth – a pregnant woman with periodontitis has a significantly higher risk of giving birth prematurely compared to other women.

Untreated ANUG can lead to:

• Widespread infection: Untreated ANUG can cause the infection to spread throughout the gums and bones surrounding the teeth. The gums between the teeth can become so damaged that teeth become loose and start falling out.
• Recurrent ANUG. The patient will have frequent episodes of bleeding gums and halitosis (bad breath).
• Gangrene. In rare cases, untreated ANUG causes the surrounding tissue to become so severely infected that it dies. 

Prevention

The most effective way to prevent periodontitis is to get into the habit of vigilantly caring for your teeth and gums. This includes regular visits to your dentist for professional cleanings and check-ups. Your dentist can identify early signs of periodontitis and provide appropriate treatment, which can prevent the disease from progressing. Create a good oral hygiene regimen at a young age and then stick to following it religiously throughout your life. 

 The significance of practicing good oral hygiene cannot be overstated. A wealth of research supports the idea that individuals who maintain a thorough oral care routine are far less likely to develop gingivitis, periodontitis, or ANUG. This knowledge empowers you to take control of your oral health and prevent these conditions. 

A comprehensive oral care regimen includes:

• Brush for two minutes twice daily using a soft toothbrush and rinse after meals to prevent any plaque buildup. 
• Floss between the teeth and around the gums to remove any loose food particles stuck there. 
• Use a mouthwash occasionally to get rid of bacteria in your mouth. 

• Regular dental checkups and follow-ups: For people with good oral condition, it is recommended that they see their dentist at least once every two years. If you only see your dentist once every two years, make sure you don’t forget to make an appointment. 

Some dentists advocate for more frequent dental visits, especially for individuals with gum disease who should ideally see their dentist at least once a year. It’s crucial to schedule a follow-up appointment after treatment to ensure ongoing oral health maintenance.

For patients at higher risk of gum disease, such as those with diabetes, dry mouth, smokers, or compromised immune systems, regular dental visits every six months are recommended. These visits not only help in professional cleaning but also in monitoring and managing potential oral health complications effectively.

Comprehensive and Personalized Periodontal Treatment in Montreal, QC

Gum disease can be effectively managed with proper treatment. While the structural support around your teeth may not be fully recoverable once lost, proactive periodontal care can significantly control infection and help rebuild bone and soft tissue to a considerable extent.

Another factor that can make you prone to this disease is genetics. 

Genetics also play a role in predisposing some individuals to gum disease, as certain types of oral bacteria, like porphyromonas gingivalis, can be more prevalent.

Early intervention is crucial for the successful management of periodontitis. At Blanc Dentaire, we are committed to providing tailored periodontal care. Following a thorough examination, our team of dentists and periodontists will devise a personalized treatment plan. Treatment options range from professional dental cleanings and enhanced at-home oral hygiene practices to antibiotic therapy and scaling and root planing (deep cleaning).

Our primary goal is to halt the progression of gum disease and restore oral health. Prompt and efficient treatment not only prevents further damage but also enhances overall treatment outcomes, ensuring you regain and maintain a healthy smile.

Non-surgical Periodontal Treatment

If diagnosed with periodontitis, your dentist will initially discuss nonsurgical treatment options with you. These approaches are highly effective for milder forms of gum disease, aiming to halt its progression before it can cause more severe and lasting damage.

Some common nonsurgical treatment options include:

• Scaling and root planing
• Improved at-home oral hygiene
• Antibiotic treatment

During your initial consultation, your dentist or periodontist will thoroughly discuss and review all your treatment options with you before working out a treatment plan that provides the best results for your specific needs.

Scaling and root planing:

The initial phase of treatment for all forms of periodontitis involves professional dental cleaning, which entails scaling the teeth and root planing to remove dental plaque and calculus from both above and below the gum line.  

Scaling and root planing are done using ultrasonic devices or special handheld instruments and may cause some pain or discomfort, especially if significant tartar has accumulated on your teeth and under your gums. It may also be somewhat time-consuming.

AIRFLOW cleaning treatment:

At Blanc Dentaire, we use an innovative and cutting-edge cleaning technology, AIRFLOW, for painless, swift, comfortable, and convenient cleaning of the teeth and gums. This specialized treatment harnesses a combination of compressed air, water, and special fine powder to effectively target and remove plaque, tartar, and food deposits from the tooth surfaces and hard-to-reach areas, including under the gumline, without irritating or damaging the gums. It has proven to be exceptionally effective at reducing pocket depths and mitigating infection. 

The AIRFLOW treatment is carried out using a handheld device that ejects a stream of pressurized water onto your tooth surfaces and along the gum line to clean these areas effectively without causing any discomfort or pain. 

The powder used in this device inhibits the growth of bad bacteria and promotes bone health, thereby halting the progression of gum disease and preventing its recurrence. This treatment has a vast array of benefits that truly set it apart from conventional cleaning techniques, offering an unparalleled quality of oral hygiene and infection control. 

This treatment is very gentle on the gums and allows the water temperature to be set at the most comfortable level for you, making it a top choice for patients with sensitive gingivae. 

At-home oral care:

A significant aspect of dental cleaning involves the dental professional providing oral hygiene instructions to improve the patient’s at-home oral care routine.

Reevaluation:

Following the completion of the cleaning appointment, the patient should return to the dentist for a reevaluation of the periodontal condition, which involves an examination that observes the state of the periodontium and measures probing depths to see if the disease process was arrested. If the resolution of the condition can be confirmed, the patient should return to the dentist for regularly scheduled cleanings, as periodontitis is a chronic disease that can be reactivated if given the proper environment.

Antibiotic treatment:

More severe and persistent infections may need treatment with oral antibiotics. In some cases, dentists may inject antibiotics directly into the area to help clear out the infection. In cases of persistent periodontal disease that is refractory to non-pharmacologic therapies, antibiotics can be administered both locally and systemically, depending on the severity of the disease.

Local antibiotics:

Your dentist may recommend antibiotics for use alone or in conjunction with other gum disease treatments. Antibiotic therapy is usually begun after gum surgery. Following a deep scaling and root planing procedure, a potent antibiotic is carefully placed inside the infected pockets to reduce the microbial load, effectively clear away the infection, and help heal the pockets. The usual antibiotics used are doxycycline, minocycline, tetracycline, amoxicillin, macrolide, and metronidazole.

Chlorhexidine gluconate is a common antimicrobial compound used in conjunction with mechanical periodontal therapy. It is generally administered as a mouth rinse but can also be used as a gel, varnish, and subgingival chip. Using chlorhexidine, in addition to regular toothbrushing, can reduce dental plaque build-up and thus can be very beneficial in treating chronic periodontitis. A relatively new advancement in pharmacotherapy for periodontal disease is a chlorhexidine gluconate chip. After professional cleaning, this chip is placed into the periodontal pocket and provides a long-term, sustained release of chlorhexidine gluconate into the affected area.

Systemic antibiotics:

You may require systemic antibiotics if you have persistent deep pockets that are not healing. The most common antimicrobial agents prescribed include tetracyclines, penicillins, macrolides, quinolones, cephalosporins, and nitromidazole compounds. 

If you have any questions about nonsurgical gum disease treatment or if you want to schedule an appointment with our gum disease specialist, please contact our office today.

Surgical Periodontal Treatment

Gum Grafting Procedures

Your dentist may recommend a gum graft as a solution to prevent further damage to your gums and provide support to teeth that have been affected by periodontal disease. Although this may sound scary, there’s nothing for you to be apprehensive about. At Blanc Dentaire, we employ special techniques to offer our patients minimally invasive treatments to augment thinning, lost, or compromised gum tissue.

The Tunneling Technique

Although technically challenging for the dentist, the ‘tunneling’ technique offers you many advantages over conventional gum grafting procedures. Using this technique, your dentist circumvents the need for a vertical incision in the area of gum recession, reducing trauma, eliminating the risk of scarring, accelerating healing after the procedure, and improving treatment outcomes.

This approach also preserves the blood supply to the gum tissue, thus greatly increasing the success rate of the procedure and providing a more aesthetically pleasing result. 

Autogenous gum grafts

These types of connective tissue grafts come from your own body and are typically excised from the roof of your mouth and placed where your gums have receded or been damaged. 

A small incision is made in the palate to harvest the tissue, which is then transplanted into the area undergoing treatment. The incision in the roof of your mouth is closed with minute stitches. 

This approach aims to cover and protect the root surfaces that have become exposed and stimulate new gum growth to repair the damage. As it is your own tissue, there is no risk of tissue rejection or contamination. However, if there isn’t enough healthy tissue available in your mouth, this option is no longer viable for you, and your dentist might suggest an alternate treatment.

Allografting 

Sometimes, it is difficult to extract a sufficient amount of healthy tissue from the patient. In such cases, a soft tissue allograft, such as AlloDerm, is used. AlloDerm is derived from human skin tissue and put through a meticulous cleaning process that removes all the cells that can potentially lead to tissue rejection when placed in the mouth. 

AlloDerm is used for a wide range of purposes, including root coverage, soft tissue augmentation, and guided bone regeneration. It is ideal for treating multiple gum defects in a single procedure. As it is taken from someone else, there is no need to prepare a second surgical site to extract the graft. Consequently, it is less painful than an autograft, and the recovery is significantly faster. 

One significant advantage of allografts is that they eliminate the need for two surgical sites, unlike traditional methods, which involve harvesting tissue from the roof of the mouth. This not only reduces the surgical footprint but also minimizes post-operative complications, leading to a more comfortable recovery phase with fewer visits to the dental practice.

Moreover, a soft tissue allograft offers significant benefits in terms of dental aesthetics and blends seamlessly with the surrounding gums to create a natural appearance. It also provides relief for individuals experiencing sensitivity due to gum recession.

To conclude, gum grafting with soft tissue allografts represents a new era in gum treatments, offering reduced discomfort, shorter recovery times and optimal results. Specializing in treating gum problems like recession, our periodontists and dental team utilize the latest graft materials and advanced state-of-the-art techniques like tunneling to provide the best care to their patients in Montreal.

Pocket reduction surgery (Flap surgery)

If the gum inflammation in deep pockets does not subside after non-surgical treatment, your dentist might recommend surgery. This involves lifting your gums surgically and exposing the sites inaccessible to brushing and flossing, cleaning them thoroughly by removing plaque and calculus deposits, and smoothing out the bone. 

The gums are then reattached to their former position and stitched back together. Flap surgery makes it easier for you to keep your teeth and gums clean.

Bone grafting

If the infection in your gums has started to erode the bone, causing the teeth to become loose or wobbly, your dentist might recommend getting a bone graft. A bone graft will function to provide support to the teeth in the affected area and save you from losing those teeth to periodontal disease. 

To place a bone graft, your periodontist or gum specialist begins by numbing the area using a local anesthetic so you don’t feel any pain during the procedure. Next, they move the gum tissue slightly back to expose the jawbone underneath by making a small, clean incision (cut) in your gum. After disinfecting and cleaning the area, they carefully place the bone grafting material to cover the defect. In most cases, an additional membrane is placed over the bone graft to allow for better bone regeneration. Finally, the gum is positioned back and closed with sutures to allow complete healing and recovery. 

Guided Tissue Regeneration (GTR)

In contrast to conventional techniques that focus only on reducing inflammation and halting gum disease, guided tissue regeneration is a comprehensive approach to tackling this issue from a regenerative perspective. 

GTR actively promotes regrowth and regeneration of the supporting structures of teeth that have been compromised or lost due to periodontal disease. It restores both the aesthetics and the functionality of the teeth, providing promising results for patients suffering from the debilitating effects of severe gum disease. 

This procedure involves strategically placing a barrier membrane between the soft tissue and the root surface of the affected tooth. This membrane serves as a physical obstacle, preventing the movement of undesirable cells and creating a conducive environment for the regeneration of periodontal ligaments and bone. GTR can also integrate with bone grafts or other biocompatible materials to provide a scaffold for tissue growth.

One of the most distinguished qualities of the GTR procedure lies in its capacity to facilitate the regeneration of tissues that were previously lost due to periodontal disease. This creates an opportunity for and encourages the reattachment of the gums to the teeth and the reconstruction of the bone holding the teeth in place. That said, GTR not only treats existing damage but also plays a major role in preventing further deterioration, contributing significantly to the enduring stability of the teeth in question.

The success and prognosis of GTR hinge upon various factors, including the patient’s overall health, the extent of periodontal disease, and the proficiency of the dental professional. If you decide to undergo GTR treatment at Blanc Dentaire, you can rest assured that the procedure will be comfortable and the healing swift, thanks to the latest dental technology available at the practice and the adeptness of our dental team at performing the procedure. 

For those seeking an effective approach to treating periodontal disease, Blanc Dentaire’s innovative guided tissue regeneration in Montreal, Canada, is the answer. Make your oral health a top priority today, and allow us to assist you in achieving your oral health goals. Click here to schedule a consultation with our periodontists at Blanc Dentaire.