April 27, 2017
Periodontal (gum) disease is an infection of the tissues that surround and support your teeth, and is a major cause of tooth loss in adults. A study by the Centers for Disease Control and Prevention (CDC) showed that about half of American adults have some form of periodontal disease. The disease is usually painless, yet, if left untreated can lead to major tissue damage, or even tooth and bone loss.
Periodontal diseases range from mild forms such as gingivitis - inflammation of gums caused by bacterial infection leading to plaque and tartar buildup – to more advanced and chronic forms that can result in major damage to the soft tissue and even tooth loss. Early detection is key to controlling and treating periodontal disease before it becomes worse.
Genetics, un-healthy habits such as smoking, and poor oral hygiene all play a part in increasing the risk of periodontal disease. While some of the damage done cannot be reversed, periodontal disease can be managed and treated, along with restorative procedures to regain lost teeth and bone.
While some of the damage caused by periodontal disease may not be reversible, there are a number of actions that you and your dental professional can take to manage and treat it. These include proper oral hygiene, non-surgical therapies as well as surgical and restorative procedures to regain lost teeth and bone.
Periodontal disease is treatable and manageable with expert care from a periodontist, especially when caught early. If you suspect that you are at risk due to the visual symptoms, see your dentist or periodontist right away.
Periodontists at University of Illinois at Chicago College of Dentistry are experts in treating periodontal disease.
UIC periodontists have specialized training to perform non-surgical treatments and advanced periodontal surgery procedures to treat periodontal disease and replace missing teeth in the management of implant diseases. We provide a full range of periodontics care. Services include periodontal non-surgical treatments as well as advanced surgery and gum / bone grafting, regenerative procedures, dental implants, dental crown lengthening, and pocket reduction. We are also dedicated to educating our patients about the scientific link between periodontal disease and systemic disorders such diabetes, cardiovascular disease and complication during pregnancy.
What is periodontal disease?
Periodontal diseases range in severity and type. A mild form is gingivitis, or inflammation of gums caused by bacterial infection. Every day, food can get trapped in the space between where our teeth and gums attach below the gum line. Without regular brushing and flossing to remove it, bacteria can build up as plaque on the surface of your teeth. As plaque advances, it hardens and becomes tartar. The gums may get infected when the plaque extends below the gum line. Once this happens, the gums become red, swollen and can bleed easily. Gingivitis can usually be reversed with a good brushing and flossing routine, and regular cleaning by a dentist or dental hygienist.
Un-treated gingivitis may advance to periodontitis, where the gums pull away from the teeth and form bigger spaces (called “pockets”) that become infected. As the bacterial infection increases, the plaque continues to spread below the gum line. While your body’s immune system fights the bacteria, it may also start to break down the bone and connective tissue that hold teeth in place. If left un-treated, the bones, and soft tissue that support the teeth are eventually destroyed and the teeth may eventually become loose and have to be removed.
Periodontal disease is a silent infection, usually not causing any pain, yet if left un-diagnosed and un-treated, can chronically affect oral and overall health. With regular dental exams, the infection can be caught early and treated to avoid tooth loss.
Did you know?
Half of American adults suffer from periodontal (gum) disease.
Data from the Centers for Disease Control and Prevention show high prevalence of periodontal disease in the U.S. population. Read more
According to the American Academy of Periodontology, there are several forms of periodontitis:
- Aggressive periodontitis tends to affect younger people, teens into the early thirties who are otherwise generally healthy, usually with a rapid rate of loss of attachment between tooth and gum, and bone destruction.
- Chronic periodontitis is a more common form occurring in a wide range of ages. It usually progresses more slowly and leads to more generalized, widespread damage including loss of attachment between tooth and gum and loss of the adjacent supporting bone.
- Periodontitis as a manifestation of systemic diseases often begins at a young age. Systemic conditions such as heart disease, respiratory disease, and diabetes are associated with this form of periodontitis.
- Necrotizing periodontal disease is an infection characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions such as HIV infection, malnutrition and immunosuppression.
Chronic periodontitis was traditionally was more prevalent in older populations, but we’re now seeing it with younger patients too, as a result of years of poor oral hygiene, and lack of professional care. The prevalence is especially high in under-served communities who lack access to regular dental care and education.
Video: What is Periodontal Disease?
Watch this video to learn what causes periodontal disease, and how it can affect the body.
How do I know if I have periodontal disease? (the symptoms)
Symptoms pointing to periodontal disease commonly don’t include pain, especially early on. As with other chronic conditions such as diabetes or heart disease, you may be affected, yet feel okay. Symptoms that you can look for include bleeding, inflamed or swollen gums, and loose teeth. In extreme cases, the teeth may look ‘long’ because the gums have receded from the teeth, leaving an appearance of longer teeth due to more of the tooth being visible. Upon regular dental examinations, other symptoms such as bone deterioration can be found in x-rays. If you have a loose tooth, or gum areas that have become soft, red and swollen (or ‘puffy’), or even somewhat detached from teeth – consult a dentist right away.
Are there other factors that increase my risk of periodontal disease?
There are many factors that lead to or increase the risk of periodontal disease. Genetics, unhealthy diet, unhealthy habits such as smoking, and poor oral hygiene all play a part in creating the conditions that may lead to periodontal disease. These are also risk factors for the four leading chronic diseases – cardiovascular diseases, cancer, chronic respiratory diseases and diabetes – and oral diseases are often linked to chronic disease.
Genetics, and other health related factors also play a part in influencing how our bodies respond to the disease and treatment methods. For instance, research studies have identified an association between periodontitis, obesity and type 2 diabetes. And, we know that obesity is a risk factor for several chronic diseases, most notably hypertension, type 2 diabetes, dyslipidemia and coronary heart disease. While the causal relationship between diabetes, obesity and periodontitis is less clear, it is still important for you to understand how these conditions increase your risk - especially if either are present at the same time.
Here are some of the biggest associated risk factors:
- Smoking. Smoking is one of the most significant risk factors associated with the development of periodontal disease. Additionally, smoking can lower the chances for successful treatment.
- Diabetes. People with diabetes are at higher risk for developing infections for many diseases.
- Hormonal changes in girls/women. These changes can make gums more sensitive and make it easier for gingivitis to develop.
- Other illnesses and their treatments. Diseases such as AIDS and its treatments can also negatively affect the health of gums, as can treatments for cancer.
- Medications. There are hundreds of prescription and over the counter medications that can reduce the flow of saliva, which has a protective effect on the mouth. Without enough saliva, the mouth is vulnerable to infections such as gum disease. And some medicines can cause abnormal overgrowth of the gum tissue; this can make it difficult to keep teeth and gums clean.
Can I get periodontal disease, even at a young age?
Many people may believe periodontal disease only affects older people with longer histories of poor oral hygiene, or other unhealthy habits such as smoking. Recently, we’re seeing more cases of even young adults suffering from periodontal disease either due to poor oral hygiene, sugar heavy diets, or even genetic traits passed on to them. The key is knowing you can be at risk at any age, and following healthy oral health habits to reduce your risk.
Is periodontal disease associated with other health conditions?
Our mouths are more than literal pathways inside our bodies – they are also good microscopes for better understanding various conditions that impact our overall health. There is a significant body of literature that we at the college follow, that has established several connections between mouth (oral) health and the health throughout the rest of our body. This means that other diseases may present themselves as early symptoms in the mouth. For instance, we know there are associations between periodontal disease and diabetes and cardiovascular disease. Signs of leukemia and AIDS can be present in the mouth and throat.
We are dedicated to educating our patients on the connections between oral and systemic health.
In the case of diabetes, we explain that there is a two-way association, and one affects the other. We emphasize the importance of keeping blood sugar under control in order for the body to fend off infection. When diabetes is under control, periodontal disease is also more easily controlled. Likewise, people who have severe periodontal disease find it harder to control blood sugar levels.
Smoking and Periodontal Disease
According to the Centers for Disease Control and Prevention (CDC), smokers are twice as likely to have periodontal disease as non-smokers, and the longer you smoke, the higher the risk becomes. Smoking (and tobacco use of any kind) weakens the immune system, which makes it harder to fight off infection and treat periodontal disease. We counsel patients on approaches they can take to stop smoking, or at least start the process, and we provide information they can use at home, and with their physician.
Here are the facts:
- If you are a smoker, you have twice the risk for periodontal disease compared with a nonsmoker.
- The more cigarettes you smoke – and the longer you smoke - the greater your risk becomes.
- Tobacco use in any form—cigarettes, pipes, and smokeless (spit) tobacco—raises your risk for periodontal disease.
How do we treat periodontal (gum) disease at UIC?
The main goal of treatment is to control the infection and the types of treatment vary depend on the severity of the disease and medical history. Additionally, treatment can improve overall oral function and smile esthetics, in addition to improved periodontal health. All treatment requires that the patient keep up good daily care at home, so education is a big component of the treatment plan as well.
Our treatment approach is based on first gaining a good understanding of the specific circumstances of bacteria present in each patient’s condition. This can then inform the most effective treatments that allow each patient to best respond to the bacteria, arrest and minimize tissue damage in the mouth, and ultimately heal and strengthen teeth, gums and bone. With a thorough evaluation, our patients will be fully aware of the current state of their overall oral health, and how this may relate to a periodontal condition.
A big part of treating periodontal disease is through patient education – and we excel at this!
We take the time to educate our patients about what periodontal disease is, what causes it, and how it is treated by our efforts – and theirs. In consultations and follow-ups, we explain the conditions, and use x-rays, models and take-home pamphlets as visual aids to show each patient what we see in as much detail as they want. For instance, we will compare a healthy x-ray to theirs because visuals really help our patients understand the extent of their condition. We also dedicate time to oral hygiene instruction, and having the patient demonstrate while in the chair. Our patients appreciate this interactive feedback style of instruction.
We also are always striving to be understanding of our patients’ need for comfort and their level of anxiety. Comfort is built into treatment planning, in addition to our clinic spaces. Each patient’s treatment plan is individually suited to their specific situation. We discuss the recommended options with them, the procedures involved, and the cost/insurance coverage considerations. Ultimately, our patients are well-informed to make the best decision about their care.
All treatments begin with a comprehensive examination that includes a discussion of potentially genetic or other health related causes – such as personal or family history of periodontal disease, and/or risk factors connected to it, such as smoking or diabetes. If you have advanced periodontal disease, you will likely be referred to periodontist, who can perform the following advanced phases of treatment.
Phase 1 is about controlling the disease. This phase usually involves non-surgical deep-cleaning procedures such as scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease. This procedure can result in less bleeding, swelling, and discomfort compared to traditional deep cleaning methods. Time in-between treatments is built-in to allow the patient time to apply what they’ve learned during our oral hygiene instruction, as well as allow the body to respond.
Phase 2 is correcting any defects resulting from periodontal disease, and is the first surgical phase necessary if non-surgical therapy isn’t enough. Patients who have deep pockets (gaps between gum and teeth) or have need for crown lengthening are good candidates for this first phase of surgical treatment. Specific procedures may include:
- Gum grafting. Gum graft surgery can be used to cover roots or develop gum tissue where absent due to excessive gingival recession. Gum tissue is taken from your palate or another donor source to cover the exposed root. A gum graft can reduce further recession and bone loss. In some cases, it can cover exposed roots to protect them from decay.
- Crown lengthening. Excess gum and bone tissue is reshaped to expose more of the natural tooth to remove a ‘gummy’ smile.
- Regenerative procedures. These are procedures that regenerate lost bone and tissue supporting your teeth. In some cases, regeneration can reverse some of the damage caused by periodontal disease. During this procedure, your periodontist folds back the gum tissue and removes the disease-causing bacteria. Membranes (filters), bone grafts or tissue-stimulating proteins can be used to encourage your body's natural ability to regenerate bone and tissue.
As with phase 1, we will do another complete re-evaluation after phase 2 to determine where each patient stands, and if further surgical treatment is needed.
Phase 3 is permanent restoration of teeth, such as implants, crowns or bridges, as needed.
Phase 4 is disease prevention on a 3 month interval of re-evaluations, to keep the disease from re-forming.
With all treatment phases, it is important that the patient continues the healthy habits at home to take control of their oral health.
Periodontal Disease Treatment
Watch these videos to learn more about how we treat periodontal disease.
What if I have dental implants?
Similar to a natural tooth, bacteria can build up on the base of dental implants, below the gum line. This condition is called peri-implant disease and causes inflammation affecting the soft and hard gum tissues around dental implants. Without good oral hygiene and regular check-ups, even artificially implanted teeth (dental implants) can become affected by periodontal disease.
In general, dental implants are susceptible to oral diseases just like natural teeth, and in some cases maybe even more so. Nationally, periodontal disease affects about 12% of dental implants. The risk of disease associated with dental implants is even higher if the replaced teeth were lost due to periodontal disease. So, implant teeth need regular care and maintenance just as much as natural teeth do.
Peri-implant disease conditions may take several years to take hold, and detecting it may require advanced techniques only available from specialists such as periodontist or prosthodontist. And as with our natural teeth, dental implants require good at-home oral care and regular dental visits to maintain good healthy condition.
Why is UIC a great choice for periodontal therapy?
World-Class Expertise. As an educational and research institution based here in Chicago, UIC is uniquely positioned to lead the way in periodontal disease care and research. Our periodontics team has an average tenor of 15+ years, and many of our periodontists are board certified. We are actively involved in innovating the understanding of periodontal disease, as well as the treatment and management of the disease over the course of patients’ lives. For instance, our faculty specialists read and evaluate hundreds of scientific journals every year to stay abreast of the latest knowledge in each respective practice area. Additionally, our faculty attend, and speak at leading clinical and scientific conferences on the latest trends and topics shaping oral health care – not just in the U.S. – but globally.
Team of Specialists in One Location. The great thing about getting your dental care at UIC is that we have all the dental specialties – including periodontists – working closely together to coordinate dental care when needed. Our general dentists can refer you to our internal specialists as with general dentists anywhere in Chicago.
Highest Standards of Care. Our general dentists and specialists are familiar with and apply the latest approaches based on scientific evidence that gives the highest levels of confidence in what is the best ways to deliver care. Patients get the advantage of being able to get consultation from a number of experts for the most optimal overall care plan. We provide a continuity of care and compassionate dialog that so many of our patients appreciate. This, in addition to the expertise and affordability we offer, makes UIC a great choice for specialty dental care. And as teachers and students ourselves, we are very good at educating our patients in ways that really make sense to them.
Care Options to Fit Your Budget. We offer three care options to fit different budgets and time commitments. Our student dentistry is great for patients on a budget (or without insurance) and have some extra time for general dental care. Our advanced specialty residents, who are training to become specialists (such as periodontists), are another option to get more specialized and advanced care, like treatment for advanced periodontitis. And, our faculty see patients. Either way, you get a team of dental professionals dedicated to our mission of changing the future of oral health in Chicago, and around the world.
Video: Research at UIC to Fight Periodontal Disease
How do I get referred to a UIC periodontist?
If your symptoms indicate advanced periodontal disease, your general dentist may refer you to a periodontist for advanced treatments. Ask for a referral to UIC College of Dentistry, using our online referral form, or your dentist can call our periodontal clinic directly at (312) 996-7374.