Periodontal diseases, including gingivitis and periodontitis, are inflammatory diseases affecting the supporting structures that anchor teeth in place (periodontium). Gingivitis and periodontitis are related conditions; if left untreated, gingivitis (inflammation of the gingival tissue [gums]) can progress to periodontitis, a more serious condition. Gingivitis is treatable and reversible, while periodontitis is irreversible and can lead to tooth loss.
Risk factors for periodontitis include smoking, stress, depression (Grossi 2000), and alcohol consumption (Tezal 2004). Tobacco use is an important risk factor for periodontitis (Albandar 2000; Bergstrom 2000a,b; Tomar 2000). For more specific information on risk factors for gingivitis, the most common form of gum disease, see Life Extension’s Gingivitis protocol.
During periodontitis, healthy gum tissue is transformed from pink and firm, with knife-edge margins between the soft tissue and the tooth, to inflamed and red. Eventually, tissue pulls away from the tooth, allowing pockets to form. These pockets can be measured with a special probe during a standard dental check-up. Any pocket over 3 millimeters (mm) in depth signifies gingivitis; a pocket over 5 mm usually signifies periodontitis.
Periodontal infections frequently involve bacteria that discharge hydrogen sulfide, ammonia, amines, toxins, and inflammatory-causing enzymes that can cause tissue and tooth loss (Haffajee 2000). Bleeding gums, bad breath, and pain also occur (Haffajee 2000). Clinically, periodontitis is characterized by inflamed, red gums and deepening pockets between the tooth root and gum tissue, as well as loss of bone in the jaw. Advanced periodontal disease can be diagnosed by changes in appearance of the teeth and gums, including:
- noticeable loosening of teeth
- gum recession with tooth root exposed
- new spaces forming between teeth
- food being trapped between teeth and where gums have receded
- constant bad taste in the mouth
Periodontal disease is usually painless until late in the disease process, when teeth are so loose that pain occurs while chewing. Retention of food in a pocket site may provoke a sudden burst of bacterial growth, resulting in a painful abscess (Loesche 2001). At other times, front teeth may become so loose that they separate.
Conventional therapy for periodontal disease consists of mechanical scaling and root planing, surgical treatment, and use of various antimicrobial regimens (Loesche 2001). The goal is to reduce the number of bacteria on the surface of teeth by reducing the amount of plaque. If pocket depths in the gums are 5 mm or greater, large numbers of bacteria can accumulate that cannot be reached by normal oral hygiene. Periodontal surgery may then be recommended to reduce the pocket depths to 1 to 2 mm (Loesche 2001).
Antibiotic therapy is sometimes needed when bacterial count continues to climb. In open clinical trials, tetracycline has been used successfully to treat aggressive periodontitis, either as an oral tetracycline/surgery combination (Lindhe 1984; Mandell 1986, 1988) or alone for 3 to 8 weeks (Christersson 1993; Slots 1983). Tetracycline can deplete calcium, magnesium, and iron; therefore, people on tetracycline should take a multivitamin (Pelton 2001).
There are several ways to release medications directly into the periodontal pocket, including the use of long-lasting gels. These methods reduce the dose of medicine needed and deliver the antibiotic in a highly targeted fashion (Loesche 2001). Devices that deliver localized antibiotics are about as effective as systemic agents in their ability to target harmful bacteria; also, people do not have to remember to take medicine, thus improving patient adherence (Loesche 1993, 1999). These devices include Atridox®, PerioChip®, and Arestin® (Paper 2004).