A Slow but Destructive Disease: Periodontitis

Periodontitis is an irreversible bacterial disease of the structures surrounding the teeth, namely the gingiva (the gums), periodontal ligament, and bone. It is a bacterial-driven disease, caused by inadequate home care, in-office care, genetic factors, vitamin D levels, and habits like smoking that predispose a person to this disease.

Most of the bacteria causing the severe form of the disease fall into the red complex and have the following scientific names.

The disease is easily treatable, and relapse can be prevented when identified and managed early. Patient education and compliance play a key role.

As doctors, dentists also have a public health responsibility in educating patients about this disease so patients can maintain a healthy dentition for good oral health, nutrition, and well-being.

Periodontitis treatment involves two phases:

Disease Control Phase: During this stage, calculus (tartar) is removed from teeth, gums, and underneath the gum line (a process sometimes misnamed deep cleaning). Antibacterial therapy may be provided locally using rinses or systemically using medications like capsules and pills. Laser therapy helps completely eliminate bacteria, promote cell regeneration, encourage bone formation, and prevent relapse. Advanced periodontal disease may need prompt surgical therapy after completion of scaling and root planing.
Maintenance Phase: In this phase, patients come in for routine maintenance and practice good home care habits to prevent recurrence or relapse. Periodontitis is an irreversible disease—once it sets in, it can return. The bone loss it causes is nearly impossible to reverse, so the goal is to prevent further bone loss that could lead to tooth mobility, bone defects, and tooth loss. It also affects blood sugar levels and can worsen diabetes control. Scientific studies have shown that periodontitis is an independent factor causing heart disease. Dr. Bradley Bale, a cardiologist from the Cleveland Clinic, has several videos discussing this connection. Additionally, periodontal bacteria have been found in the brains of Alzheimer’s patients. Periodontitis is a slow, destructive, and chronic disease. Therefore, it is essential not to ignore the diagnosis and to avoid performing preventative maintenance or prophylaxis on patients who have gum disease. Many patients wonder why a “regular cleaning” cannot be done, but in truth, “regular cleaning” and “deep cleaning” are misleading terms. A healthy patient receives routine preventative therapy, while a patient with periodontal disease must be educated, treated, and maintained in a timely manner to prevent disease progression and re-establish oral health.