Periodontal diseases are infections of the structures around the teeth. These include the gums, the cementum that covers the root, the periodontal ligament and the alveolar bone. In the earliest stage of periodontal disease, gingivitis, the infection affects only the gums. In more severe forms of the disease, all of the supporting tissues are involved.
What Causes Periodontal Disease?
Periodontal disease is caused by bacteria in dental plaque. Plaque is the sticky substance that forms on your teeth soon after you have brushed. In an effort to get rid of the bacteria, the cells of your immune system release substances that inflame and damage the gums, periodontal ligament or alveolar bone. This leads to swollen, bleeding gums, a sign of gingivitis (the earliest stage of periodontal disease). Damage from periodontal disease also can cause teeth to become loose. This is a sign of severe periodontitis (the advanced stage of the disease).
You can prevent periodontal disease by practicing good oral hygiene and visiting your dentist regularly. Most people should see the dentist about once every six months. But if you already have gum disease you may need to visit more often.
Daily brushing and flossing, when done correctly, can help to remove most of the plaque from your teeth. Professional cleanings by your dentist or dental hygienist will keep plaque under control in places that are harder for a toothbrush or floss to reach.
Risks and Prevention
The bacteria in plaque are the main cause of periodontal disease. But several other factors also can contribute.
- Genes – Some people are more likely than others to get periodontal disease because of their genes. But your genes do not make gum disease inevitable. Even people who are highly prone to periodontal disease can prevent or control the disease with good oral care.
- Smoking and tobacco use – Smoking increases the risk of periodontal disease. The longer you smoke, and the more you smoke, the higher the risk. If you have periodontal disease, smoking makes it more severe. Smoking is a major reason that some cases of periodontal disease are resistant to treatment. Smokers tend to collect more tartar on their teeth. They often develop deeper periodontal pockets once they have gum disease. They also are likely to lose more bone as the disease gets worse. Unlike many other factors that affect the health of your gums, the decision to smoke or not is under your control. Quitting smoking can play a major role in bringing periodontal disease under control.
- Misaligned or crowded teeth, braces or bridgework – Anything that makes it more difficult to brush or floss your teeth is likely to enhance plaque and tartar formation. The more plaque and tartar you have, the greater your chance of developing gum disease. Dentists and periodontitis can show you the best ways to clean your teeth, even if they are hard to clean. For example, you can use special tools and ways of threading floss to clean around bridgework or slide under braces. If overcrowded or crooked teeth are a problem, your dentist might recommend orthodontics. This could straighten out your smile and give you a better chance of preventing disease.
- Grinding, gritting or clenching of teeth – These habits won’t cause periodontal disease. However, they can lead to more severe disease if your gums are already inflamed. These habits exert excess force on the teeth. This pressure appears to speed up the breakdown of the periodontal ligament and bone. In many cases, people can learn to stop this habit simply by recognising when it is happening and then relaxing. If these efforts don’t work, your dentist or periodontist can create a custom guard appliance to help reduce the pressure of clenching or grinding on the teeth. This device is sometimes called an occlusal guard, night guard, mouth guard or bite guard.
- Stress – Stress can make periodontal disease worse and harder to treat. Stress weakens your body’s immune system. This makes it harder for your body to fight off infection, including periodontal disease.
- Fluctuating hormones – Whenever hormone levels go up and down in the body, changes can occur in the mouth. Puberty and pregnancy can temporarily increase the risk and severity of gum disease. So can menopause.
- Medicines – Several types of medicines can cause dry mouth, or xerostomia. Examples include certain drugs for depression and high blood pressure. If you don’t have enough saliva, plaque is more likely to form. This may lead to tooth decay (cavities). Other medicines may cause the gums to enlarge. This makes them more likely to trap plaque. These medicines include:
- Phenytoin (Dilantin and other brand names), used to control seizures
- Cyclosporine (Neoral, Sandimmune), used to suppress the immune system in people who have had organ transplants
- Nifedipine (Adalat, Cardizem and others) and other calcium channel blockers, used to treat high blood pressure, chest pain (angina) or heart arrhythmias.
- Diseases – People with certain diseases have a higher risk of developing periodontal disease. For example, people with diabetes are more likely to get periodontitis than people without diabetes. Their gum disease is also likely to be more severe. Other diseases that increase periodontal disease risk include inflammatory conditions such as rheumatoid arthritis and HIV infection. Having one of these diseases can make the control of your periodontal disease more difficult. But a good periodontist or dentist who is aware of these problems can give you guidance on how to maintain your periodontal health.
- Poor nutrition – Nutrition is important for overall good health, including a working immune system and healthy gums and mouth. Severe vitamin C deficiency (scurvy) can cause bleeding gums.