Periodontitis Is the inflammation of the periodontium (the tissues surrounding the teeth). There are two types: periapical and marginal.
Periapical periodontitis results from neglected tooth decay. If dental caries is left untreated, areas of enamel and the dentine (softer tissue) beneath them are eventually destroyed, allowing bacteria to enter the tooth pulp. From there, the bacteria spread to the root tip and into the surrounding tissues, sometimes causing the formation of an abscess, granuloma, or cyst.
Marginal periodontitis is the major cause of tooth loss in adults. It is a result of untreated gingivitis (gum disease), which in turn is usually due to poor oral hygiene. In this condition, neglected, inflamed gum tissue at the base of the teeth becomes damaged, and pockets form between the gums and the teeth. A sticky deposit of mucus, food particles, and bacteria and a hard, mineralized coating formed from plaque and saliva then collect in these pockets. The bacteria in the plaque and calculus attack the periodontal tissues, causing them to become inflamed and then detached from the teeth. The bacteria also eventually erode the bones surrounding the teeth. As a result, the teeth become loose in their sockets and fall out.
Periapical periodontitis may cause localized toothache, especially on biting. An abscess may damage bone and periodontal ligaments, causing the tooth to become loose; a large dental cyst may cause swelling of the jaw.
In marginal periodontitis there are signs of gingivitis, such as red, soft, shiny tender gums that bleed easily. There is also an unpleasant taste in the mouth and bad breath. The deepening pockets in the gums gradually expose the sensitive dentine in the roots of the teeth, causing the teeth to ache when hot, cold, or sweet foods or liquids are consumed. Occasionally, there is a discharge of pus from the gums, or a periodontal abscess develops.
Diagnosis and treatment
The diagnosis of periodontitis disease is by a dental examination to find any pockets and assess their size and depth, and dental x-rays to check for bone loss.
Periapical periodontitis is treated by draining the pus and filling the tooth or alternatively by root-canal treatment, in which decayed pulp is removed from a tooth and its root and the cavity is then filled. If the tooth cannot be saved, however, extraction is performed.
In the early stages of marginal periodontal disease, regular, scrupulous teeth cleaning can prevent further plaque and calculus formation and thus halt destruction of the tissues surrounding the teeth. For more severe periodontitis, the dentist will remove existing plaque (smoothing the surface of an exposed root). In some cases, gingivectomy (surgical trimming of the gums) may be performed to reduce the size of gum pockets. Surgery may also be carried out in order to remove the diseased lining from the pocket, so that healthy underlying tissue will reattach itself to the tooth; and the damaged, irregular bone is smoothed. Loose teeth can sometimes be anchored to firmed ones by a method called splinting.