What is periodontal disease?
Periodontal disease, also known as gum disease, is a serious infection of the gums and supporting structures of the teeth. It is caused by a buildup of plaque, a sticky film of bacteria, on the teeth. As plaque accumulates, it can harden into tartar that irritates the gums. With mild or moderate periodontal disease, the gums become inflamed and bleed easily when brushing or flossing. In more advanced cases, the gums pull away from the teeth and pockets form, becoming infected. The supporting bone and tissue structures of the teeth are gradually destroyed, leading to loose or lost teeth.
There are two main stages of gum disease: gingivitis and periodontitis. Gingivitis is milder and reversible while periodontitis is more severe, causing permanent damage. Symptoms include red, swollen gums that bleed when brushing, receding gums, bad breath, loose or separating teeth, and painful chewing. Periodontal disease is associated with an increased risk of heart disease, stroke, and diabetes complications. Treatment is essential to prevent tooth loss and stop the infection from worsening.
What causes periodontal disease?
Periodontal disease is caused by the buildup of plaque biofilm on teeth. Within the plaque, bacteria release toxins that trigger inflammation and infection in the gums. As plaque accumulates with poor oral hygiene, the bacteria multiply, eventually damaging the supporting structures around the teeth. There are several risk factors that can increase susceptibility to periodontal disease:
Poor Oral Hygiene
Inadequate brushing and flossing allows plaque to build up and harden into calculus or tartar on teeth. This provides a breeding ground for harmful, infection-causing bacteria. Poor oral hygiene is the primary preventable cause of gum disease.
Smoking and Tobacco Use
Smoking is a major risk factor, with smokers more likely to develop periodontal disease. Tobacco use impairs immune system function and healing, while some of the chemicals in tobacco can increase inflammation and infection. Smokers have more dental plaque and calculus than non-smokers.
Genetics
Research shows that up to 30% of the population may be genetically susceptible to gum disease. Despite good oral care, these individuals still remain at high risk. There appears to be a genetic predisposition making some people more prone to periodontal infection.
Stress
Chronic stress and anxiety can increase the levels of inflammation-promoting hormones like cortisol. This may make gums more vulnerable to bacterial infection, and impair healing. Stress also causes some people to neglect good oral hygiene practices.
Medications
Some medications like oral contraceptives, antidepressants, and certain heart medicines can alter immunity and inflammation, increasing susceptibility to gum disease. Always inform dentists about any medications being taken.
Underlying Health Conditions
Diabetes, cancer, HIV/AIDS, osteoporosis, and other conditions that impair immunity or healing can increase risk of severe periodontitis. Gum disease also exacerbates complications of some medical conditions.
Hormonal Changes
Hormonal changes and fluctuations, especially in girls/women during puberty, pregnancy, and menopause, increase sensitivity to plaque and gum inflammation.
Poor Nutrition
A diet low in important nutrients can impair immunity and wound healing. Deficiencies in vitamin C, calcium, and other nutrients may impact periodontal health.
How are gum grafts used to treat receding gums?
Gum recession occurs when the margin of the gum tissue pulls back from the teeth, exposing vulnerable tooth roots and creating pockets. This allows more bacterial infection and can lead to tooth sensitivity and eventually, tooth loss. Gum recession can result from overly aggressive brushing, gum disease, or simply the aging process.
Gum grafting is a surgical procedure to reinforce gum tissue that has receded. A small amount of tissue is taken from the roof of the mouth or from a tissue bank and stitched to the receded gum line, covering exposed roots. Over time, the grafted tissue integrates with the existing gum. There are several types of gum grafts:
Free Gingival Graft
This takes tissue from the palate to cover the exposed root. It provides thick, durable tissue but requires a donor site.
Connective Tissue Graft
Thinner tissue is taken from the palate or tissue bank. It may integrate with existing tissue better and does not require donor site healing.
Pedicle Graft
Tissue is lifted from next to the receded area and stitched into place. This avoids donor site but graft size is limited by available tissue.
Benefits of gum grafting include reduced sensitivity, improved aesthetics, and reinforced protection from plaque bacteria. Gum grafts can halt recession in one area. However, grafting will not prevent disease progression elsewhere in the mouth.
Can gum grafts stop or cure periodontal disease?
Once periodontal disease causes damage and bone loss, gum grafting alone cannot cure or reverse the disease. However, in combination with plaque removal and antimicrobial treatment, grafts can help control periodontal disease progression in certain cases:
Treatment of Gingival Recession
Grafting receded areas can reduce pockets depth and reinforce thin tissue susceptible to more bacterial invasion. This improved gum protection aids disease management.
Repair Bone Defects
Bone grafts or guided tissue regeneration with membranes can help rebuild bony support destroyed by gum disease. This eliminates deep pockets and stabilizes infection sites.
Improve Tooth Prognosis
Grafts to cover exposed roots and fill in defects can sometimes save severely compromised teeth and avoid extraction.
Enhance Outcomes of Deep Cleanings
Flap surgery to access roots for deep cleanings can leave recession defects. Grafts placed during surgery improve healing and outcomes.
However, grafts alone cannot eliminate or cure periodontal disease. The success of any grafts depends on the ongoing prevention and treatment of bacterial infection with proper homecare and professional maintenance.
What treatments are needed to stop periodontal disease progression?
While localized gum grafting can assist management of gum recession and periodontal defects, there are several essential treatments needed to stop overall disease progression:
Professional Dental Cleaning
Deep cleanings both above and below the gumline are needed to remove hardened calculus deposits full oral plaque biofilm cannot be removed by brushing or flossing alone.
| Type of Cleaning | Description |
|---|---|
| Basic Prophylaxis | Cleans surface of teeth above the gumline |
| Scaling and Root Planing | Deep cleaning below gumline and tooth roots to remove tartar and bacteria |
Professional maintenance cleaning every 3-4 months is typically needed to prevent reaccumulation of harmful plaque.
Antimicrobial Medications
In addition to mechanical cleaning, antiseptic chemical rinses or gels are used to reduce remaining bacteria and infection in pockets. Common examples include chlorhexidine and antibiotics like doxycycline.
LASER Therapy
LASER can target inflammation and kill pathogenic bacteria, aiding the treatment of periodontitis. It reduces pocket depth and can stimulate gum tissue regeneration.
Oral Hygiene Instruction
Improving brushing and flossing technique is critical to removing new plaque accumulation and preventing reinfection between dental visits. Using supplemental aids like antibacterial mouth rinses daily helps control bacteria.
Smoking Cessation
Since smoking severely worsens periodontal disease, quitting tobacco use improves outcomes significantly. Dentists can discuss programs to assist with smoking cessation.
Diabetes Control
Closely monitoring and controlling elevated blood sugar in diabetes reduces the risk of more severe gum disease complications.
With diligent daily oral hygiene and consistent professional maintenance care, periodontal disease can be halted. However, like any chronic inflammatory disease, periodontitis requires lifelong management and monitoring for signs of recurrent infection or tissue breakdown.
What is the long-term outlook with treatment of gum disease?
Periodontal disease is a progressive condition, which means it will continue to worsen without treatment. The goal of therapy is to stop this cycle of inflammation and tissue destruction in its tracks, allowing healing and stability of the remaining support structures. However, some degree of permanent bone loss and tissue damage often occurs from periods of infection before treatment.
The long-term prognosis depends on several factors:
- Severity of disease at time of diagnosis
- How well the patient complies with at-home oral hygiene and maintenance care
- Risk factors like smoking that may impair healing
- Presence of health conditions like diabetes that increase susceptibility
- Genetic predisposition that may make gum tissues more vulnerable
Early detection and treatment of gingivitis provides a very favorable long-term outlook. The inflammation can be fully resolved, and teeth have excellent prognosis. However, with generalized severe chronic periodontitis, there is high likelihood of at least some ongoing tissue breakdown or tooth loss despite treatment. Supportive periodontal maintenance care and monitoring are crucial for the best chances of tooth retention.
With consistent care, most patients achieve reduced inflammation, stabilized bone and attachment levels, minimal bleeding on probing, and excellent control of infection. Gum recession defects may persist requiring grafting or restorations. While some progressive breakdown can occur over time, the destruction is slowed dramatically. Regular dental cleanings every 3 months and daily oral hygiene can manage periodontal disease successfully over the long-term.
Conclusion
Gum grafting can aid periodontal treatment by covering exposed roots and helping fill bony defects in localized recession sites. However, grafts alone cannot stop or cure periodontal infections. Effective treatment requires professional plaque biofilm removal, antimicrobials to resolve the infection fully, and excellent daily homecare to prevent reaccumulation of disease-causing bacteria. While some bone loss from periodontal disease may be irreversible, progression of the condition can be halted with diligent treatment and maintenance care over the long term. Gum grafts can support periodontal stability when combined with ongoing infection control, allowing patients to retain teeth and restore gum health. With early intervention and careful management, most cases of periodontitis can be well controlled.