Periodontal Disease

Definition

Periodontal diseases are a group of diseases that affect the tissues that support and anchor the teeth. Left untreated, periodontal disease results in the destruction of the gums, alveolar bone (the part of the jaws where the teeth arise), and the outer layer of the tooth root.

Description

Periodontal disease is usually seen as a chronic inflammatory disease. An acute infection of the periodontal tissue may occur, but is not usually reported to the dentist. The tissues that are involved in periodontal diseases are the gums, which include the gingiva, periodontal ligament, cementum, and alveolar bone. The gingiva is a pink-colored mucus membrane that covers parts of the teeth and the alveolar bone. The periodontal ligament is the main part of the gums. The cementum is a calcified structure that covers the lower parts of the teeth. The alveolar bone is a set of ridges from the jaw bones (maxillary and mandible) in which the teeth are embedded. The main area involved in periodontal disease is the gingival sulcus, a pocket between the teeth and the gums. Several distinct forms of periodontal disease are known. These are gingivitis, acute necrotizing ulcerative gingivitis, adult periodontitis, and localized juvenile periodontitis. Although periodontal disease is thought to be widespread, serious cases of periodontitis are not common. Gingivitis is also one of the early signs of leukemia in some children.

Gingivitis

Gingivitis is an inflammation of the outermost soft tissue of the gums. The gingivae become red and inflamed, loose their normal shape, and bleed easily. Gingivitis may remain a chronic disease for years without affecting other periodontal tissues. Chronic gingivitis may lead to a deepening of the gingival sulcus. Acute necrotizing ulcerative gingivitis is mainly seen in young adults. This form of gingivitis is characterized by painful, bleeding gums, and death (necrosis) and erosion of gingival tissue between the teeth. It is thought that stress, malnutrition, fatigue, and poor oral hygiene are among the causes for acute necrotizing ulcerative gingivitis.

Adult periodontitis

Adult periodontitis is the most serious form of the periodontal diseases. It involves the gingiva, periodontal ligament, and alveolar bone. A deep periodontal pocket forms between the teeth, the cementum, and the gums. Plaque, calculus, and debris from food and other sources collect in the pocket. Without treatment, the periodontal ligament can be destroyed and resorption of the alveolar bone occurs. This allows the teeth to move more freely and eventually results in the loss of teeth. Most cases of adult periodontitis are chronic, but some cases occur in episodes or periods of tissue destruction.

Localized juvenile periodontitis

Localized juvenile periodontitis is a less common form of periodontal disease and is seen mainly in young people. Primarily, localized juvenile periodontitis affects the molars and incisors. Among the distinctions that separate this form of periodontitis are the low incidence of bacteria in the periodontal pocket, minimal plaque formation, and mild inflammation.

Herpetic gingivostomatitis

Herpes infection of the gums and other parts of the mouth is called herpetic gingivostomatitis and is frequently grouped with periodontal diseases. The infected areas of the gums turn red in color and have whitish herpetic lesions. There are two principal differences between this form of periodontal diseases and most other forms. Herpetic gingivostomatitis is caused by a virus, Herpes simplex, not by bacteria, and the viral infection tends to heal by itself in approximately two weeks. Also, herpetic gingivostomatitis is infectious to other people who come in contact with the herpes lesions or saliva that contains virus from the lesion.

Pericoronitis

Pericoronitis is a condition found in children who are in the process of producing molar teeth. The disease is seen more frequently in the lower molar teeth. As the molar emerges, a flap of gum still covers the tooth. The flap of gum traps bacteria and food, leading to a mild irritation. If the upper molar fully emerges before the lower one, it may bite down on the flap during chewing. This can increase the irritation of the flap and lead to an infection. In bad cases, the infection can spread to the neck and cheeks.

Desquamative gingivitis

Desquamative gingivitis occurs mainly in postmenopausal women. The cause of the disease is not understood. The outer layers of the gums slough off, leaving raw tissue and exposed nerves.

Trench mouth

Trench mouth is an acute, necrotizing (causing tissue death), ulcerating (causing open sores) form of gingivitis. It causes pain in the affected gums. Fever and fatigue are usually present also. Trench mouth, also known as Vincent's disease, is a complication of mild cases of gingivitis. Frequently, poor oral hygiene is the main cause. Stress, an unbalanced diet, or lack of sleep are frequent cofactors in the development of trench mouth. This form of periodontal disease is more common in people who smoke. The term "trench mouth" was created in World War I, when the disease was common in soldiers who lived in the trenches. Symptoms of trench mouth appear suddenly. The initial symptoms include painful gums and foul breath. Gum tissue between teeth becomes infected and dies, and starts to disappear. Often, what appears to be remaining gum is dead tissue. Usually, the gums bleed easily, especially when chewing. The pain can increase to the point where eating and swallowing become difficult. Inflammation or infection from trench mouth can spread to nearby tissues of the face and neck.

Periodontitis

Periodontitis is a condition in which gingivitis has extended down around the tooth and into the supporting bone structure. Periodontitis is also called pyorrhea. Plaque and tarter buildup sometimes lead to the formation of large pockets between the gums and teeth. When this happens, anaerobic bacteria grow in the pockets. The pockets eventually extend down around the roots of the teeth where the bacteria cause damage to the bone structure supporting the teeth. The teeth become loose and tooth loss can result. Some medical conditions are associated with an increased likelihood of developing periodontitis. These diseases include diabetes, Down syndrome, Cohn's disease, AIDS, and any disease that reduces the number of white blood cells in the body for extended periods of time.

Causes and symptoms

Several factors play a role in the development of periodontal disease. The most important are age and oral hygiene. The number and type of bacteria present on the gingival tissues also play a role in the development of periodontal diseases. The presence of certain species of bacteria in large enough numbers in the gingival pocket and related areas correlates with the development of periodontal disease. Also, removal of the bacteria correlates with reduction or elimination of disease. In most cases of periodontal disease, the bacteria remain in the periodontal pocket and do not invade surrounding tissue.

The mechanisms by which bacteria in the periodontal pocket cause tissue destruction in the surrounding region are not fully understood. Several bacterial products that diffuse through tissue are thought to play a role in disease formation. Bacterial endotoxin is a toxin produced by some bacteria that can kill cells. Studies show that the amount of endotoxin present correlates with the severity of periodontal disease. Other bacterial products include proteolytic enzymes, molecules that digest protein found in cells, thereby causing cell destruction. The immune response has also been implicated in tissue destruction. As part of the normal immune response, white blood cells enter regions of inflammation to destroy bacteria. In the process of destroying bacteria, periodontal tissue is also destroyed.

Gingivitis usually results from inadequate oral hygiene. Proper brushing of the teeth and flossing decreases plaque buildup. The bacteria responsible for causing gingivitis reside in the plaque. Plaque is a sticky film that is largely made from bacteria. Tartar is plaque that has hardened. Plaque can turn into tartar in as little as three days if not brushed off. Tartar is difficult to remove by brushing. Gingivitis can be aggravated by hormones, and sometimes becomes temporarily worse during pregnancy, puberty, and when the patient is taking birth control pills. Interestingly, some drugs used to treat other conditions can cause an overgrowth of the gingival tissue that can result in gingivitis because plaque builds up more easily. Drugs associated with this condition are phenytoin, used to treat seizures; cyclosporin, given to organ transplant patients to reduce the likelihood of organ rejection; and calcium blockers, used to treat several different heart conditions. Scurvy, a vitamin C deficiency, and pellagra, a niacin deficiency, can also lead to bleeding gums and gingivitis.

The initial symptoms of periodontitis are bleeding and inflamed gums, and bad breath. Periodontitis follows cases of gingivitis, which may not be severe enough to cause a patient to seek dental help. Although the symptoms of periodontitis are also seen in other forms of periodontal diseases, the key characteristic in periodontitis is a large pocket that forms between the teeth and gums. Another characteristic of periodontitis is that pain usually does not develop until late in the disease, when a tooth loosens or an abscess forms.

Diagnosis

Diagnosis is made by observation of infected gums. Usually, a dentist is the person to diagnose and characterize the various types of periodontal disease. In cases such as acute herpetic gingivostomatitis, there are characteristic herpetic lesions. Many of the periodontal diseases are distinguished based on the severity of the infection and the number and type of tissues involved.

Diagnosis of periodontitis includes measuring the size of the pockets formed between the gums and teeth. Normal gingival pockets are shallow. If periodontal disease is severe, jaw bone loss will be detected in x-ray images of the teeth. If too much bone is lost, the teeth become loose and can change position. This will also be seen in x-ray images.

Treatment

Tartar can only be removed by professional dental treatment. Following treatment, periodontal tissues usually heal quickly. Gingivitis caused by vitamin deficiencies is treated by administering the needed vitamin. There are no useful drugs to treat herpetic gingivostomatitis. Because of the pain associated with the herpes lesions, patients may not brush their teeth while the lesions are present. Herpes lesions heal by themselves without treatment. After the herpetic lesions have disappeared, the gums usually return to normal if good oral hygiene is resumed. Pericoronitis is treated by removing debris under the flap of gum covering the molar. This operation is usually performed by a dentist. Surgery is used to remove molars that are not likely to form properly.

Treatment for trench mouth starts with a complete cleaning of the teeth, removal of all plaque, tartar, and dead tissue on the gums. For the first few days after cleaning, the patient uses hydrogen peroxide mouth washes instead of brushing. After cleaning, the gum tissue will be very raw and rinsing minimizes damage to the gums that might be caused by the toothbrush. For the first few days, the patient should visit the dentist daily for checkups and then every second or third day for the next two weeks. Occasionally, antibiotic treatment is used to supplement dental cleaning of the teeth and gums. Surgery may be needed if the damage to the gums is extensive and they do not heal properly.

KEY TERMS

Anaerobic bacteria— Microorganisms that grow in the absence of oxygen.

Inflammation— A painful redness and swelling of an area of tissue in response to infection or injury.

Treatment of periodontitis requires professional dental care. The pockets around the teeth must be cleaned, and all tartar and plaque removed. In periodontitis, tartar and plaque can extend far down the tooth root. Normal dental hygiene, brushing and flossing, cannot reach deep enough to be effective in treating periodontitis. In cases where pockets are very deep (more than 0.25 in [0.64 cm] deep), surgery is required to clean the pocket. This is performed in a dental office. Sections of gum that are not likely to reattach to the teeth may be removed to promote healing by healthy sections of gum. Abscesses are treated with a combination of antibiotics and surgery. The antibiotics may be delivered directly to the infected gum and bone tissues to ensure that high concentrations of the antibiotic reach the infected area. Abscess infections, especially of bone, are difficult to treat and require long term antibiotic treatments to prevent a reoccurrence of infection.

Prognosis

Periodontal diseases can be easily treated. The gums usually heal and resume their normal shape and function. In cases where they do not, prostheses or surgery can restore most of the support for proper functioning of the teeth.

Prevention

Most forms of periodontal disease can be prevented with good dental hygiene. Daily use of a toothbrush and flossing is sufficient to prevent most cases of periodontal disease. Tartar control toothpastes help prevent tartar formation, but do not remove tartar once it has formed.

Resources

BOOKS

Gorbach, S. L., J. G. Bartlett, and N. R. Blacklow. Infectious Diseases. 2nd ed. Philadelphia: W. B. Saunders Co., 1998.

Periodontal disease

Definition

Periodontal diseases are a group of diseases that affect the tissues that support and anchor the teeth. Left untreated, periodontal disease results in the destruction of the gums, alveolar bone (the part of the jaws where the teeth arise), and the outer layer of the tooth root.

Description

Periodontal (meaning "around the tooth") disease is usually seen as a chronic (long-term) inflammatory disease. An acute (sudden) infection of the tissue surrounding the teeth (periodontal tissue) may occur, but acute inflammation usually resolves on its own and is not treated by a dentist.

Periodontal diseases affect the gums, which consist of the gingiva, periodontal ligament, cementum, and alveolar bone. The gingiva is a pink-colored mucous membrane that covers part of the teeth and the alveolar bone. The periodontal ligament, also called the periodontal membrane, is the tough, fibrous tissue that holds the teeth in the gums. The cementum is a bony layer that covers the lower parts of the teeth. The alveolar bone is a set of ridges along the jaw bones (maxillary and mandible) from which the teeth arise.

Periodontal disease most often develops when a pocket or space is formed between the teeth and the gums. This pocket is called the gingival sulcus. A number of distinct forms of periodontal disease are known, including gingivitis, acute necrotizing ulcerative gingivitis, adult periodontitis, and localized juvenile periodontitis. Although many people have some form of periodontal disease, serious cases are not common.

Gingivitis is an inflammation of the outermost soft tissue of the gums. The gums become red and inflamed, lose their normal shape, and bleed easily. Gingivitis may remain a chronic disease for years without affecting other periodontal tissues. Chronic gingivitis may lead to a deepening of the pockets between the gum and tooth. In some children, gingivitis and bleeding gums are among the early signs of leukemia.

Acute necrotizing ulcerative gingivitis is seen mainly in young adults. This form of gingivitis is characterized by painful, bleeding gums, and death (necrosis) and erosion of gums between the teeth.

Localized juvenile periodontitis is a less common form of periodontal disease and is seen mainly in young people. Localized juvenile periodontitis usually affects the molars (back grinding teeth) and incisors. Among the distinctions that separate this form of periodontitis are the low incidence of bacteria in the periodontal pocket, minimal plaque formation, and mild inflammation.

Pericoronitis is a condition found in children whose molars are in the process of erupting through the gum. The disease is seen more frequently in the lower molar teeth. As the molar emerges, a flap of gum still covers the tooth. The flap of gum traps bacteria and food, leading to mild irritation. If the upper molar fully emerges before the lower one, it may bite down on the flap during chewing and increase the irritation of the flap, leading to infection. In severe cases, the infection can spread to the neck and cheeks.

Periodontitis, also called pyorrhea, is a condition in which gingivitis has extended down around the tooth and into the supporting bone structure. Plaque and tarter build-up lead to the formation of large pockets between the gums and teeth. When this happens, anaerobic bacteria (bacteria that do not need oxygen) grow in the pockets. The pockets eventually extend down around the roots of the teeth where the bacteria cause damage to the bone structure supporting the teeth.

Herpetic gingivostomatitis, which is relatively common in children, is an inflammation of the gums and mouth caused by the herpes simplex virus. This disease is contagious, but tends to heal without medical intervention in about two weeks.

Desquamative gingivitis occurs mainly in postmenopausal women and is not well understood.

Trench mouth, also called Vincent's disease, is a suddenly developing (acute) complication of gingivitis. It causes tissue death and open sores on the gums and is often accompanied by fever , fatigue, and painful bleeding gums. Trench mouth usually develops because of poor oral hygiene , stress, fatigue, and smoking . It requires immediate treatment by a dentist, since pain can increase to the point where eating and swallowing become difficult, and the inflammation can spread to nearby tissues of the face and neck.

Demographics

Periodontal disease is common. It is estimated that 9–17 percent of children between the ages of three and 11 years have gingivitis. The number increases sharply at puberty , with 70–90 percent of teens developing the disease. More boys than girls have gingivitis, probably because girls have better oral hygiene habits than boys, rather than because of any physiological differences.

Some medical conditions are associated with an increased likelihood of developing periodontitis. These diseases include diabetes, Down syndrome , AIDS , and any disease or condition that compromises the immune system and reduces the number of white blood cells in the body for extended periods.

Causes and symptoms

Bacteria present on the gingival tissues cause periodontal diseases. The mechanisms by which bacteria in the periodontal pocket cause tissue destruction in the surrounding region are not fully understood. However, removal of bacteria through good oral hygiene practices and regular dental care helps reduce or eliminate these diseases. There are indications that a tendency toward developing periodontal disease is genetic, with up to 30 percent of the population being highly susceptible despite aggressive oral hygiene habits.

Other factors that put individuals at higher risk for developing periodontal diseases include smoking, stress, poor diet, and taking certain medications such as antidepressants, some heart medicines, and oral contraceptives . Gingivitis can be aggravated by hormones and may temporarily worsen during puberty and pregnancy. Individuals with diabetes and diseases that depress the immune system are more likely to develop periodontal disease.

The main symptoms of periodontal disease include:

• bleeding gums
• red, sore, or swollen gums
• gums that have receded from the base of the teeth
• chronic bad breath
• loose permanent teeth
• open sores on the gums

When to call the dentist

Beginning as toddlers, all children need regular checks-up by a dentist. Children who have chronically bleeding gums, open sores on the gums, or who complain of gum or tooth pain, should see a dentist promptly. Those with bleeding gums should see their pediatrician urgently, as this is also a symptom of leukemia in some children.

Diagnosis

Diagnosis of periodontal disease is made by observation of infected gums. Usually a dentist diagnoses and characterizes the various types of periodontal disease. Many periodontal diseases are distinguished based on the severity of the infection and the number and type of tissues involved.

Diagnosis of periodontitis includes measuring the size of the pockets formed between the gums and teeth. Normal gingival pockets are shallow. If periodontal disease is severe, jawbone loss will be detected in x rays of the teeth. If too much bone is lost, the teeth become loose and can change position. This will also be seen in x-ray images.

Treatment

Tartar can be removed only by professional dental treatment. Following treatment, periodontal tissues usually heal quickly. Administering the needed vitamins and improving diet treats gingivitis caused by poor nutrition or vitamin deficiencies. Removing debris under the flap of gum covering the molar treats pericoronitis.

Treatment of periodontitis requires professional dental care. The pockets around the teeth are cleaned, and all tartar and plaque removed. In periodontitis, tartar and plaque can extend far down the tooth root. Normal dental hygiene, brushing and flossing, cannot reach deep enough to effectively treat periodontitis. In cases where pockets are very deep (more than 0.25 in, or 0.64 cm, deep), surgery is required to clean the pocket. This is performed in a dental office. Sections of gum that are not likely to reattach to the teeth may be removed to promote healing by healthy sections of gum. Abscesses are treated with a combination of antibiotics and surgery. If antibiotics are needed for gum disease, they are usually given orally. The antibiotics may be delivered directly to the infected gum and bone tissues to ensure that high concentrations reach the infected area. Abscess infections, especially of bone, are difficult to treat and require long term antibiotic therapy to prevent a reoccurrence of infection.

There are no useful drugs to treat herpetic gingivostomatitis, but acyclovir is used in high-risk patients or those with a compromised immune system. Herpes lesions heal by themselves without treatment. After the herpetic lesions have disappeared, the gums usually return to normal if good oral hygiene is resumed.

Prognosis

Most cases of periodontal disease are mild and can be cleared up with improved oral hygiene, as well as tooth and gum cleaning by a trained professional. Serious cases of periodontal disease may be persistent, but they can usually be controlled. Untreated periodontal disease may cause teeth to loosen and fall out, and infection may spread to surrounding tissues.

Prevention

Good oral hygiene, a well-balanced nutritious diet, and regular dental visits for tooth cleaning all help prevent periodontal disease. Prompt attention to gingivitis can prevent it from progressing to more serious periodontal diseases.

Parental concerns

Sometimes parents are less concerned about their child's first (baby) teeth than their permanent teeth. However, poor oral hygiene and lack of care of the first set of teeth are apt to be reflected in problems with the gums and the permanent teeth.

KEY TERMS

Alveolar bone —A set of ridges from the jawbones.

Cementum —A bony substance that covers the root of the tooth.

Gingiva —The gum tissue surrounding the teeth.

Gingival sulcus —The space between the tooth and the gum that often traps food and bacteria, leading to periodontal disease.

Periodontal ligament —Also called the periodontal membrane, this tough fibrous tissue holds the teeth in place in the gums.

Plaque —A deposit, usually of fatty material, on the inside wall of a blood vessel. Also refers to a small, round demyelinated area that develops in the brain and spinal cord of an individual with multiple sclerosis.

Tartar —A hardened yellow or brown mineral deposit from unremoved plaque. Also called calculus.

Resources

BOOKS

Berkow, Robert, ed. Merck Manual of Medical Information. Whitehouse Station, NJ: Merck Research Laboratories, 2003.

Gorbach, S. L., et al. Infectious Diseases. 2nd ed. Philadelphia: W. B. Saunders Co., 1998.

PERIODICALS

Academy of Periodontology. "Position Paper: Guidelines for Periodontal Therapy." Journal of Periodontology 72 (2001): 1624–28.

American Dental Association. "Preventing Periodontal Disease." Journal of the American Dental Association 132 (Sept. 2001): 1339.

American Dental Association. "Treating Periodontal Disease." Journal of the American Dental Association 134 (Feb. 2003): 259.

WEB SITES

"Periodontal (Gun) Diseases." American Academy of Periodontology. [cited June 11, 2004]. <www.perio.org>

Stephen, James. "Gingivitis." eMedicine.com [cited August 11, 2004]. <www.emedicine.com/emerg/topic217.htm>.

Tish Davidson, A.M. John T. Lohr, Ph.D.

PERIODONTAL DISEASE

DEFINITION

Periodontal disease affects the tissues that support and anchor the teeth. Left untreated, periodontal disease results in destruction of the gums, parts of the jawbone, and portions of the tooth root.

DESCRIPTION

In a healthy person, teeth are held in place by a combination of soft tissue and bone. The soft tissue is known as the gums. Periodontal disease can attack any part of the gums or bone. The most common forms of periodontal disease are gingivitis, periodontitis, and trench mouth.

Gingivitis

The gingiva is the outermost part of the gums. Gingivitis is an inflammation of the gingiva. The gingiva becomes red and loses its normal shape. Bleeding occurs easily, during toothbrushing, for example. Gingivitis may be present for many years without becoming a serious medical problem. In some cases, however, it may become more severe. It may become very painful and lead to loss of tissue between the teeth. Poor oral (mouth) hygiene, fatigue, a poor diet, and stress may all lead to gingivitis.

Periodontitis

Periodontitis is a more serious form of gingivitis. Periodontitis is also called pyorrhea. Plaque and tartar sometimes form on the outer surfaces of teeth. Plaque and tartar are thin films of food particles and saliva. They provide a home for bacteria that cause tooth decay.

The decay caused by these bacteria sometimes extends down into the gums. There may be damage to the bone structure that holds teeth in place. The teeth become loose and may fall out. Periodontitis in adults is the most serious form of periodontal disease. It is the main cause of tooth loss in adults.

Periodontal Disease: Words to Know

Gingiva:

The outer layer of the gums.

Plaque:

A thin layer of food and saliva that forms on the surface of teeth.

Tartar:

Plaque that has become hardened and attached to the tooth surface.

Periodontitis also occurs in children, but it is much less common than in adults. If not treated, periodontitis in children can become chronic. That is, it does not get better but is always present as a health problem. In some cases, it may become much worse in adulthood, leading to tooth loss.

Trench Mouth

Gingivitis can also lead to a condition known as trench mouth. The most common cause of trench mouth is poor oral hygiene. Stress, a poor diet, and lack of sleep may also be factors.

CAUSES

How bacteria in the periodontal pocket cause tissue destruction is not fully understood. Researchers to know that bacteria that live in plaque and tartar produce acids when they digest foods. These acids can destroy tooth enamel and bone. The bacteria also produce toxins (poisons) that can kill cells in gum tissue. Finally, when the body's immune system attacks the bacteria, some gum tissue is destroyed at the same time.

The most basic cause of periodontal disease is poor oral hygiene. Regular toothbrushing and flossing remove most of the plaque and tartar on which bacteria live. They can greatly reduce the risk for any form of periodontal disease. Regular dental checkups are also important. Dental hygienists can remove any of the plaque and tartar that may still remain.

Gingivitis is usually the first stage in all other periodontal diseases. If it can be prevented or controlled, the more serious forms of the disease are unlikely to occur.

SYMPTOMS

The initial symptoms of periodontal disease are bleeding and inflamed gums and bad breath. Periodontitis follows cases of gingivitis. The key characteristic of periodontitis is a large pocket that forms between the teeth and gums. Pain is often absent until late in the disease. It occurs then when a tooth becomes loose or infected.

The symptoms of trench mouth often appear suddenly. They include pain, fever, fatigue, and foul breath. Trench mouth results in the formation of open sores on the gums and death of tissues surrounding the teeth. The gums may bleed easily, especially when chewing. The pain may become so bad that the patient cannot eat or swallow. The inflammation may spread to nearby tissues of the face and neck.

DIAGNOSIS

Dentists can usually diagnose a periodontal disease quite easily. The most important clues are inflamed gums and the presence of an opening between gums and teeth. The specific form of periodontal disease usually depends on the nature of the opening. In gingivitis, the pocket tends to be small and shallow. As the disease progresses, the pocket becomes larger and deeper. Bone loss can be detected on an x-ray photograph.

TREATMENT

Gingivitis can usually be treated simply. Plaque and tartar are removed from teeth, depriving bacteria of their home. The inflamed tissues around a tooth usually heal quickly and completely.

More serious cases of periodontitis cannot be treated by routine dental procedures. Dental surgery may be necessary to remove plaque, tartar, and infected gum tissue. Treatment with antibiotics may be necessary if infection is present.

Treatment for trench mouth starts with a complete cleaning of the teeth. All plaque, tartar, and dead gum tissue are removed. Regular visits to the dentist and use of mouthwash containing hydrogen peroxide may be needed to ensure that the gums heal completely. Surgery may be needed if damage to the gums is extensive and they do not heal properly.

PROGNOSIS

Periodontal disease is easily treated. The gums usually heal quickly and resume their normal shape and function. In more difficult cases, surgery may be necessary. But the surgery is relatively simple and usually successful.

PREVENTION

Most forms of periodontal disease can be prevented with good dental hygiene. Daily brushing and flossing are sufficient to prevent most cases of periodontal disease. Tartar-control toothpastes help prevent the formation of tartar. But they do not remove tartar once it has formed.

FOR MORE INFORMATION

Books

Berns, Joel M. Understanding Periodontal Diseases, 2nd edition. Carol Stream, IL: Quintessence Publishing Company, 1993.

Sheldon, Sydney. Ignore Your Teeth and They'll Go Away : The Complete Guide to Gum Disease, 3rd edition. Pikesville, MD: Devida Publications, 1998.

Organizations

The American Academy of Periodontology. 737 N. Michigan Avenue, Suite 800, Chicago, IL 60611–2690. (312) 787–5518. http://www.perio.org.

Web sites

"Dental Health: Periodontal Disease." Dental Review Online. [Online] http://www.dentalreview.com/tooth_periodontitis.htm (accessed on October 28, 1999).

"What Are Periodontal Diseases?" [Online] http://www.perio.org/consumer/2a.html (accessed October 28, 1999).