| Periodontitis is a progressive periodontal disease that affects the gums, ligaments, and bones supporting the teeth.
The disease is a complication of untreated gingivitis, a mild form of gum disease or inflammation of the gums. The inflammation results from the accumulation of bacterial plaque on the teeth, which are sticky deposits containing mucus, food particles, and bacteria. Daily brushing and flossing of the teeth can minimize the build up of bacterial plaque, but lack of regular care along with smoking, sugar consumption, or generally poor nutrition, poor health, or aging can contribute to its formation.
As periodontitis progresses, the gums recede and small ulcerous pockets form between the tooth and the gum line where plaque deposits continue to accumulate. Further recession of the gum line and deepening of the pockets will continue until these pockets ultimately penetrate to the roots of the teeth where supporting tissues are slowly destroyed. The teeth may become loose and eventually may need to be removed (extracted).
Individuals who have diabetes mellitus, thyroid conditions, and nutritional deficiencies have a greater tendency to develop gum disease. Hormonal effects such as those found in puberty, menstruation, and pregnancy have also been associated with the disorder, as have various genetic disorders such as Down syndrome and agranulocytosis.Risk: Two major predisposing factors for the development of periodontitis are poor care of the mouth and teeth (poor oral hygiene) and increasing age. Most cases of the disease are diagnosed after age 35. In rare cases, periodontitis may be associated with defective dental fillings or structural defects in the mouth. Individuals on medications that cause dry mouth, those who smoke, and those with immunosuppression (caused by either HIV or chemotherapy) may also be at higher risk for accelerated formation of bacterial plaque and eventual periodontitis. Incidence and Prevalence: Periodontal disease is second in prevalence to the common cold among adults in the US. The American Dental Association estimates that gingival bleeding occurs in nearly 45% of working age adults, gingival recession in over 50%, and severe destruction due to periodontal disease in almost 25%. The rate increases with age and ranges from 15% in young teens to more than 50% over age fifty (Balch 425). |
Source: Medical Disability Advisor
| History: Because little pain occurs with periodontitis unless there is an accompanying abscess, the usual symptoms of the disorder are bleeding of the gums during tooth brushing and bad breath (halitosis). Bad breath is caused by food particles being trapped in the pockets and microbial waste products from bacteria in the periodontal pocket. The individual may also notice a gradual receding of the gum line. Physical exam: Upon examination, the dentist may find soft, swollen, red-purple gums that bleed easily on irritation. 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 receded. Periodontal pocket measurements (usually greater than 3 mm in depth) provide information about the extent of the disease. Tests: Periodontitis is usually identified on physical examination and no test is needed to confirm diagnosis. X-rays may help determine the extent of any periodontal destruction. |
Source: Medical Disability Advisor
| Treatment for individuals in the early stages of the disease consists of regular, thorough, professional cleaning to remove plaque from the tooth surfaces. The disease tissue may be cut away from the pockets around the teeth (subgingival curettage). Treatment for individuals in advanced stages of the disease may include a correction or reshaping of soft tissue (gingiva) around the teeth (gingivectomy or gingivoplasty). Flap surgery may be necessary. This involves lifting away the gums from the teeth, recontouring the damaged bone, and replacing the gum in its proper position so as to eliminate the deep pockets and improve access for home care.
In cases where periodontitis is due to structural problems of the mouth or has progressed to the point where it has significantly damaged the underlying structure, extensive bone surgery may be required. When the problem is due to uneven tooth surfaces, the individual's bite may need to be adjusted (occlusal adjustment) to reshape the chewing and biting surfaces of the teeth.
Other treatment options include using antibiotics or chemical irrigation to control bacterial growth. Some dentists have reported favorable results after putting antibiotic fibers into the space between the teeth and gums to control infection, prevent or reduce pocket formation, and encourage healing.
Following treatment, individuals who smoke are usually urged to quit. All individuals are encouraged to practice good dental hygiene by brushing and flossing regularly and having teeth cleaned professionally several times each year to keep the teeth free of plaque build up. Some individuals may be advised to use special dental cleaning tools as well. |
Source: Medical Disability Advisor
| In general, the earlier in life that periodontitis develops or the more advanced it is when diagnosed, the more chronic the condition is likely to be. Gingivitis is usually reversible after cleaning the teeth and removing diseased tissue. The problem may not recur provided that the individual practices good oral hygiene thereafter. If the gingivitis progresses to a serious case of periodontitis, however, the condition is more likely to recur and the individual may require extensive treatment for the remainder of his or her life. |
Source: Medical Disability Advisor
| Certain medications for high blood pressure (hypertension) and epilepsy can cause gums to swell. If periodontal disease has progressed to the point where it damages the underlying support structure of the teeth, extensive reconstructive surgery and/or prosthetics may be recommended. |
Source: Medical Disability Advisor
| The individual with chronic periodontitis may benefit from having access to a lavatory for brushing and flossing teeth after lunch and snacks. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Has diagnosis of periodontitis been confirmed by dental examination?
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Have x-rays been done to determine the extent of periodontal destruction?
Regarding treatment:
- Has conservative treatment with thorough cleaning been effective in resolving the periodontitis?
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Are more aggressive interventions, such as gingivectomy or gingivoplasty, being considered?
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Is structural repair or correction indicated?
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Is individual compliant with dental hygiene regimen?
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What can be done to enhance compliance?
Regarding prognosis:
- If symptoms persist despite treatment, are other treatment options being considered (i.e., gingivectomy, gingivoplast, or pocket elimination surgery)?
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Does individual understand the importance of diligent oral hygiene and frequent dental follow-up?
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Does individual have an underlying condition (such as immune suppression or bleeding disorder) that may impact recovery?
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Source: Medical Disability Advisor
| Balch, J. F., and P. A. Balch. "Periodontal Disease." Prescription for Nutritional Healing. 2nd ed. 425-428. |
Source: Medical Disability Advisor