Unlike most regions of the body, the mouth is perpetually populated by harmful microorganisms, and this causes a constant challenge in the form of these microorganisms’ harmful products. The oral cavity contains over 500 different microorganisms and it’s not possible to exactly distinguish the good ones from the harmful pathogenic ones.

Periodontal disease affects one or more of the periodontal tissues:

Alveolar bone
Periodontal ligament
Cementum
Gingivae
Plaque, also known as a biofilm consists of many different bacteria- microorganisms. Bacteria have to eat to survive; they also have to eliminate wastes, and are constantly reproducing and getting bigger in number. Naturally, bacteria are always present in the oral cavity, and when plaque is not removed on a daily basis, trouble begins.

Gingivitis
The first stage of the disease is called gingivitis, or inflammation of the gum tissue.

The symptoms of gingivitis are:

Swollen gums
Red or purple gums
Tender or painful to touch
Bleeding with/without brushing
The gingivitis can be prevented through regular oral hygiene that includes daily brushing and flossing. Anti-bacterial mouth rinse can also be employed.

The focus of treatment for gingivitis is removal of the causative agent, plaque. Therapy is aimed at the reduction of oral bacteria, and may take the form of regular periodic visits to a dental professional together with adequate oral hygiene home care.

Periodontitis
Periodontitis is a set of inflammatory diseases affecting the tissues that surround and support the teeth. It involves progressive loss of the alveolar bone around the teeth, and if left untreated, can lead to the loosening and subsequent loss of teeth.

In the early stages, periodontitis has very few symptoms similar to gingivitis but patients should realize that the gingival inflammation and in advanced cases bone destruction are largely painless.

Hence, people may wrongly assume that painless bleeding after teeth cleaning is insignificant, although this may be a symptom of progressing periodontitis in that patient.

The primary aetiology of gingivitis is poor oral hygiene. Other contributors are poor nutrition, and smoking, and underlying medical issue, such as diabetes.

In some people, gingivitis progresses to periodontitis- with the destruction of the gingival fibres, the gum tissues separate from the teeth and deepened sulcus, called the periodontal pocket. Subgingival micro-organisms colonize the periodontal pockets and cause further inflammation in the gum and progress to bone loss. Examples of secondary aetiology are things that cause micro-organisms accumulation, such as restoration overhang.

Initial Treatment
The cornerstone of successful periodontal treatment starts with establishing excellent oral hygiene, which includes twice daily brushing with daily flossing and or using Interdental brush.

Removal of plaque and calculus is necessary to establish periodontal health.

The first step in the treatment of periodontitis involves non-surgical cleaning below the gum line using manual or ultrasonic scalers. This may require multiple visits. It is also important to correct ill filling restoration and any other plaque retentive restoration.

It is necessary for the dentist or the hygienist to perform a re-evaluation as well as periodontal treatment (if required) after three months, to see if other courses of treatment can be identified.

Surgery
If non-surgical therapy is found to have been unsuccessful, periodontal surgery may be needed to stop progression of the disease.

Maintenance
Once successful periodontal treatment has been completed, an ongoing periodontal maintenance regimen is required. This involves regular check-ups and detailed cleaning every three months to prevent re-population of the pathogenic plaque, and to closely to monitor affected teeth so that early treatment can be rendered if disease recurs.