Anatomy of the tooth supporting structures

To better understand periodontal diseases and treatment you need to know the anatomy of the tooth supporting structures. They include the periodontal ligament which attaches the tooth roots to the interdental bone (socket) and the gum tissue which attaches to the bone and surround the tooth neck like a collar. The word periodontal literally means "around the tooth". Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth.

Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) releases toxins causing gum inflammation.

This causes the gums to swell, appear puffy and bleed easily. This early stage of gum inflammation is called gingivitis. There is usually little or no discomfort. Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with regular professional treatment and good oral home care.

Untreated gingivitis can advance to periodontitis. With time, plaque hardens to form tartar and begins to grow below the gum line detaching the gums from tooth. Toxins produced by the bacteria in plaque stimulate a chronic inflammatory response causing bone resorption. Gums separate from teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Symptoms include bleeding gums, bad taste in the mouth, halitosis (bad mouth odor) and in severe cases abcesses. Eventually, teeth can become loose and may have to be removed.

The first step towards gum health is regular professional cleaning and good home care. Gingivitis and early periodontitis can be easily be treated by scaling and root planing .Scaling and root planing is careful cleaning of the root surfaces to remove plaque and calculus [tartar] from deep periodontal pockets using hand instruments and ultrasonics and simultaneously smooth the root surfaces. This may be accompanied with local delivery of anti-microbial agents to aid healing.

After scaling and root planing, many patients do not require any further active treatment, including surgical therapy. However, majority of the patients will require ongoing maintenance therapy to sustain health. Non-surgical therapy does have its limitations, and when it does not achieve periodontal health, surgery may be indicated to restore periodontal health.