Vanessa Chamberlin

Periodontology Research Paper

Periodontal Disease

Periodontal disease, otherwise known as periodontitis, is a disease of

the gum tissue and alveolar bone surrounding the teeth. Most people don’t

know what it is or even that it exists. In this paper I will talk about where it

comes from, treatments, conditions caused or worsened by it and how to

avoid it if possible.

Where does periodontal disease come from? Periodontal disease starts

off as gingivitis, which is something most people have heard of, regardless if

they fully understand what it is or not. Gingivitis is inflammation of the gum

tissue due to a buildup of plaque, bacteria and debris on and around the

teeth. Simple things such as a lack of brushing, flossing, or consuming water

after eating or drinking can cause plaque and debris to build up on our teeth

and gum tissues. When our gum tissues constantly have plaque and debris

sitting on them it causes inflammation. Essentially the tissue gets angry and

you’ve landed yourself with a diagnosis of gingivitis. Another cause of

gingivitis and periodontal disease are systemic conditions and medications.

Most medications, especially antidepressants, as well as some oral

contraceptives, steroids and anti-epilepsy drugs cause dry mouth or

xerostomia which affect our gum tissues. Saliva plays a very important role in

our oral health. It carries vitamins and minerals to our teeth and their
surrounding tissues, and acts as a buffering agent against an acidic

environment. Therefore, a decrease in saliva gravely impacts our oral cavities

and leaves them without their natural protectant. Systemic conditions, such

as diabetes and cardiovascular disease also relate to periodontal disease as

well as a generalized lack of nutrition. Pregnancy, crooked teeth, genetics and

tobacco are also contributors to periodontal disease due to hormonal

changes, the inability to maintain good oral hygiene leaving behind excess

plaque, bacteria and calculus, predisposing factors and the introduction of

harmful chemicals into our oral cavities.

So what specifically happens when you’ve been diagnosed with

periodontal disease? We all have bacteria in our mouths, and more

specifically, in our gingival crevicular fluid. That’s the fluid that surrounds our

teeth and alveolar bone within our gum tissue. If the bacteria isn’t cleaned

out properly by brushing, flossing and rinsing, it starts changing into more

aggressive bacteria. Actinobacillus actinomycetemcomitans and

Porphyromonas gingivalis are the two main, bad bacteria that cause

periodontitis. The reason for this is because bacteria go through stages. They

change from gram-positive to mixed gram-positive and gram-negative, then

to gram-negative which are the most destructive. Both Aa and Pg are

gram-negative bacteria and when they have formed inside the GCF the

incidence of periodontitis becomes heightened. These bacteria are

destructive not only to the gingival tissues but also the hard tissues, our
alveolar bone. The bacteria essentially eat away at the bone that is supporting

our teeth, causing it to be disease ridden and unhealthy. Once bone starts

dissipating so does the support for our teeth. Once in a severe state of

periodontitis teeth can be lost, malocclusion can occur and eating becomes

much more difficult.

Though periodontitis usually takes years of neglect to the oral cavity to

progress to a severe state it doesn’t mean it can’t happen quickly to start.

Most people who are diagnosed with periodontitis didn’t even know they had

gingivitis, or did and didn’t understand the severity of it. Gingivitis can be

reversed, however, periodontitis cannot. It can be maintained, though. Once

you are diagnosed with periodontitis you are placed into a category, whether

it be slight, moderate or severe as well as chronic or aggressive. Typically you

are first learning about this disease from your dental hygienist who will be the

main practitioner focused on treating and maintaining your diseased state.

That is where we move into treatment.

Once a diagnosis has been made a treatment plan is established. This

treatment plan includes both you and your dental hygienist. Your dental

hygienist will assess your diseased state and decide whether a debridement,

scaling and root planing (SRP), a referral to your local Periodontist, and/or

antibiotic treatment is needed. More often than not SRP is the first line of

defense in tackling periodontal disease. Scaling and root planing is the

removal of debris, plaque, bacteria and calculus from on top of and

often an uncomfortable process in which your hygienist will discuss the

possibility of local anesthesia with you in order to keep you more comfortable.

The long-term and short-term goals of nonsurgical periodontal therapy

is plaque and bacteria control along with calculus, plaque and bacteria

removal. Our goals as hygienists are to clean and smooth the root surfaces

and restore the health of the tissues. Unfortunately once diagnosed with

periodontal disease regular recalls aren’t usually an option. Typically your

hygienist would want to see you back around 4-6 weeks after your cleaning in

order to check the health of your tissues and decide the next step in your

treatment plan. Sometimes an antibiotic, either localized or oral, is necessary

to support the hard and soft tissues after a deep cleaning is done. An oral

antibiotic is typically better for a patient who has generalized chronic

periodontal disease due to its ability to be dispersed systematically

throughout the body. One medication for this in specific is called Periostat,

which can be taken twice daily for a total of 40 mg, for 90 days up to 9

months. Sometimes a patient will only have localized areas of deep pockets of

5+ mm, which are considered moderate to severe periodontal pockets

depending on the depth. Those pockets, which are sites where the bone has

been more affected by disease around a tooth, are able to be treated by

localized agents such as Arestin, Atridox and something called a Periochip.

generate healthier tissues and decrease bleeding on probing.

As I mentioned earlier there is the potential that a referral to a

periodontist is needed. This is in the case that a patient is at such a severe

state of disease that a debridement, srp and/or antibiotics simply won’t just

do the trick. At that point there is most likely an excessive loss of gum tissue

and structure surrounding the teeth, at which a periodontist may need to

perform other treatments such as surgical periodontal therapy.

If your local dental hygienist is able to perform nonsurgical periodontal

therapy and treat you accordingly most likely you will have a recall that is half

the time as a normal recall. Typically patients who don’t have periodontal

disease visit their dental hygienist for a cleaning once every 6 months.

Periodontal patients, however, typically visit their dental hygienist every 3

months for care. This is because periodontally affected patient’s hard and soft

tissue health is in a much more fragile and susceptible state. Periodontal

disease needs increased attention from your provider in order to maintain the

disease and make sure progression doesn’t occur.

Along with professional dental care the patient needs to consider their

own responsibility when it comes to their oral health. A deep cleaning every 3

months will not alone take care of or maintain a diseased oral cavity. If a

patient doesn’t follow instruction and guidance set by their oral healthcare

provider most likely there will be no benefit to their oral health. It is imperative
for a patient to perform oral hygiene at home. Brushing and flossing properly

along with using the correct dentifrice and auxiliary aids 2+ times daily plays a

huge role in oral health. Changing your diet also plays a big role in overall

health, which benefits the oral cavity. Eating less acidic and sugary and more

nutritious foods decreases your risk of acquiring cavitated lesions.

There are many drawbacks of nonsurgical periodontal therapy. Besides

potential patient non-compliance is the post-operative pain, discomfort and

sensitivity a patient might experience after nonsurgical periodontal therapy.

Most patients are able to take either an NSAID or another analgesic of which

can help control the discomfort, however, it will not fully get rid of it. Local

anesthesia is also a potential drawback. Most patients don’t like to receive

local anesthesia due to the amount of needle sticks needed to completely

keep them comfortable. On top of that, most patients don’t like the idea that

they will most likely need multiple appointments in the beginning in order to

have their entire mouth cleaned. Most nonsurgical periodontal therapies

need anywhere from 2-4 initial appointments just for the cleaning portion,

with the hygienist focusing on one to two quadrants at a time, depending on

the treatment. Then the 4-6 week follow-up tissue check along with 3 month

periodontal maintenance recalls. It can be overwhelming to patients who are

not focused on oral health or have minimal to no education on dental health.

Another factor is finances. Nonsurgical periodontal therapy isn’t cheap.

SRP treatment can run as high as $300+ per quadrant before insurance.
When you add in any potential medications such as Arestin, Atridox, the

Periochip or Periostat, as well as a fluoride treatment and potentially a

prescribed fluoride toothpaste, the cost can be extremely daunting. This is

why it’s extremely important for the dental hygienist and periodontist to

reinforce potential negative effects of noncompliance to ensure the patient

understands.

At the end of the day knowing the state of your oral health, becoming

or remaining compliant in your home care, attending your dental

appointments and following the instructions given to you by your dental

provider are all major contributors to your oral health outcome.

American Academy of Periodontology. (2023). Gum disease information.

https://www.perio.org/for-patients/gum-disease-information/

American Dental Association. (2023). Gum disease-periodontal disease.

Mouthhealthy.

https://www.mouthhealthy.org/all-topics-a-z/gum-disease

Perry, D. A., Beemsterboer, P., & Essex, G. (2014). Periodontology for the Dental

Hygienist (D. A. Perry, P. Beemsterboer, & G. Essex, Eds.).

Elsevier/Saunders.

Boyd, L., Mallonee, L. F., & Wyche, C. J. (2020). Wilkins' Clinical Practice of the

Dental Hygienist. Jones & Bartlett Learning, LLC.

Haveles, E. B. (2023). Applied Pharmacology for the Dental Hygienist. Elsevier

- Health Sciences Division.