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Periodontal gum disease--also known as periodontitis--stems from a bacterial infection under the gums. This infection damages the connective tissue (attachment) between the gum tissue and the roots of the teeth. Once the attachment is broken, the bone is no longer sealed and protected. This leads to a deepening area called a "pocket" where bacteria can multiply out of the reach of oral hygiene efforts. The symptoms of the disease include bleeding gums, recession, shifting teeth, bad breath, pain on chewing, swelling, and sensitivity. In time, periodontal disease can lead to the loss of teeth and can contribute to the spread of other diseases. Recent medical data has linked these bacteria to other serious health problems which include: heart disease, stroke, respiratory and sinus infections, digestive problems, osteoporosis, premature birth, and infertility.

What Causes Periodontal Disease?

Periodontal gum disease starts when bacteria, supported by parasites, yeast, or viruses, encounter a weak immune response from an individual. The general state of the immune system is therefore an important factor in the onset of periodontal disease. The immune system's efficiency and susceptibility to infectious disease is linked to a number of factors. These factors include smoking, a person's level of stress and fatigue, and a number of life-style factors such as diet, exercise, and general health habits. Genetics also play a role in making some people more susceptible than others.

The infection itself is caused by bacteria that thrive inside of the plaque that is under the gums. These anaerobic bacteria--living where there is no air--are very mobile and can invade into other tissue. They produce chemical products such enzymes, acids, and toxins, which cause damage to the gum tissue, the bone, and the attachment. Some of the chemicals depress the neutrophil, which is one of our main defensive cells. Others can break the attachment from the gingival tissue over to the root surface, exposing the bone.

As a result, a pocket is formed where bacteria can multiply rapidly out of the reach of hygiene efforts. In this pocket, the roots and surface of the bone are exposed to bacteria and chemicals. Bacteria then dissolve the protective layer of the bone, named the cortical layer, which exposes the internal bone to further attack. Additional damage is caused by the body's immune components, which will often destroy tissue as they fight the infection. As more time passes the pockets deepen, bacteria levels increase, and chemicals contaminate the bone and the root surface.

Traditional Periodontal Treatment

Traditional periodontal treatment begins with non-surgical scaling and root planing (deep cleaning) to remove the plaque and calculus from the teeth. Disinfectants and at-home oral hygiene techniques are then used to control the bacteria.

Some pockets, however, are too deep to resolve with a deep cleaning. When the pockets are deeper than 5-6 millimeters, dentists can choose to perform an invasive surgery. This entails creating a periodontal incisional flap that creates access to the deep pockets. In the case of severe infections, antibiotics are often prescribed.

Due to the nature of the incision and the damaged state of the tissue, the gums, bone, and attachment are left in a very weak state after the surgery. In addition to fighting the infection from the gum disease, the body is now also burdened with trying to repair the damage done from the surgery. Under these conditions, healing deep pockets proves to be very challenging. Abscesses tend to occur with some regularity. While antibiotics are used, they often suppress the immune system and lead to additional health problems. Frequent cleaning routines and rigorous home care are required to keep the disease under control.

Attempts to restore the attachment and cure the disease have been met with mixed results. Locally targeted antibiotics (atridox, actisite, arestin, perio-chip) or disinfectants and lasers can alleviate the symptoms but cannot be considered long-term solutions. Other attempts, including sub-clinical doses of antibiotics, bone grafting, growth factors, and membranes, have all experienced limited success.

While traditional periodontal surgery can still be useful in some cases, new technology allows us to effectively heal a wider range of periodontal cases without invasive surgery. Please visit the BOST section of the site to learn about an alternative to traditional periodontal surgery.