DEAR MAYO CLINIC:

I'm 68 years old and I have periodontitis. What causes this? Is there anything I can do to make sure my condition doesn't worsen?

ANSWER:

Periodontitis is a chronic bacterial infection that can destroy the soft tissue and bone supporting your teeth. Infection of the gum tissue (gingivitis) is a mild form of the disease in which only the tissue surrounding the tooth is involved. Periodontitis is more severe because both gum tissue and bone are involved. Periodontitis usually starts as a result of ineffective oral hygiene. Not brushing and flossing on a daily basis allows bacteria to accumulate below the gumline. Periodontitis can be made worse by other diseases, such as uncontrolled diabetes. In addition, smoking can significantly increase your risk of periodontitis.

When you eat, starches and sugar in food combine with the bacteria that are normally in your mouth to form a sticky film (plaque) on your teeth. You can remove this film when you brush and floss. If plaque remains on your teeth for several days, it hardens into tartar. Tartar is more difficult to remove than plaque; a professional dental cleaning is usually required to get tartar off your teeth. Tartar is also a problem because its surface is porous, so it permits more bacterial plaque to collect, further irritating the tooth's supporting gum tissue and bone.

Because both tartar and plaque harbor bacteria, they can trigger inflammation in your gum tissue. If left untreated, ongoing gum tissue inflammation can cause bone loss that allows pockets to form between your gums and teeth. In time, these pockets can become deeper, and even more bacteria build up inside them, eventually undermining your gum tissue and damaging the bone that supports your teeth. If too much bone is damaged or destroyed due to periodontitis, you may lose one or more teeth.

Treatment for periodontitis depends on the severity of the disease and other underlying medical conditions you may have. Treatment is most effective when paired with good daily oral care, including regular brushing and flossing. The first line of treatment for mild to moderate periodontitis usually involves a professional deep cleaning to remove tartar and bacteria from your teeth and beneath your gums.

If your dentist or periodontist (gum specialist) suspects that another medical condition, such as diabetes, may be contributing to periodontitis, effective treatment for that disorder may also help control periodontitis. If nonsurgical approaches aren't enough to remove all the bacteria and prevent further damage, or if periodontitis is severe, your dentist may refer you to a periodontist, a specialist in the treatment of gum disease. More advanced treatment, such as periodontal (gum) surgery to repair or replace damaged tissue and bone, may be necessary.

After active treatment is complete, many people with periodontitis require regular follow-up care, generally including a professional deep cleaning every three to four months and a yearly evaluation with a periodontist to monitor the condition.

In addition to following your dentist's treatment recommendations, you can also help control periodontitis over the long term by taking a number of self-care steps. Brush your teeth at least twice a day, ideally after meals and snacks. Use a soft-bristled toothbrush and toothpaste that contains fluoride. Avoid vigorous or harsh scrubbing, which can irritate your gums. Floss daily, and use a mouth rinse to help reduce plaque buildup on and between your teeth. Finally, if you smoke, quit.

Daniel Assad, D.D.S., Dental Specialties, Mayo Clinic, Rochester, Minn.

Medical Edge from Mayo Clinic is an educational resource and doesn't replace regular medical care.

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