The periodontium is comprised of the gums, bones, cementum and the periodontal fibers. The health of the periodontium is as important as the health of the teeth. We can compare the relationship of the teeth, bone and gums to that of a tree in a soil. The tree will survive as long as the soil is good, just as the teeth will survive as long as the periodontium is healthy. Often we erroneously relate good oral health to the absence of caries and ignore periodontal care. Since caries and periodontitis are caused by different strains of bacteria, both the diseases can occur separately or together.
You can recognize the presence of periodontal disease if you notice the following symptoms.
- Change in the texture of the gums: The normal texture of our gums is stippled, or of an orange peel consistency. When there is inflammation of the gums due to the bacteria in the dental plaque (a microfilm full of bacteria on the teeth and the gums), the stippling is lost and the gums look plain and shiny.
- Change of color of the gums: The normal color of the gum or gingiva is coral pink or darker pink, depending on the ethnicity of the individual. The gums become red when inflamed.
- The papillary inflammation: The papilla is the gum in-between the two teeth. It is knife-edged and attached like a cuff to the underlying bone around the tooth. In disease, the papilla becomes swollen like a balloon, evident more so in mouth-breathers.
- Irritation or itching in-between the teeth: Normally, there should be no itching but when there is papillary gingivitis, your gums become itchy, and you feel like probing them with a pin or toothpick to give them relief.
- Tender gums: As the disease advances, the gums become painful. Hot fluids can give relief.
- Bleeding gums: Untreated gum disease makes the epithelium vulnerable due to inflammation. Brushing or biting into coarse or fibrous food leads to bleeding of the gums. Even slight probing by yourself or your dentist leads to obvious bleeding.
- Halitosis: The inflamed bleeding gums break the cuff-like attachment of the gingiva to the underlying bone. Plaque accumulates as calculus or tartar, bacteria proliferate and sometimes, depending on the strain of the bacteria and the individual's immunity status, there is suppuration or pus formation. All of this causes foul smell or halitosis, as the anaerobic bacteria release sulphur compounds.
- Loose teeth: All this inflammation leads to increased volume of the gingiva on the underlying bone in-between the teeth. Due to pressure, suppuration and demineralization, the bone gets resorbed, leading to loss of support of the teeth, making them mobile. Another reason is the dissolution of the periodontal fibers that hold the teeth in the dental socket and act as shock absorbers.
- Sensitive teeth: All the above factors make the teeth hypersensitive.
Periodontitis is the major cause of loss of teeth. The primary reason for this is simply a low level of awareness of its importance, poor brushing habits, not getting teeth professionally cleaned by a dentist, and poor oral hygiene. People suffering from chronic systemic diseases and those with mental and physical challenges are particularly vulnerable to periodontitis.
When left unchecked, periodontal disease can contribute to infective endocarditis (damaged heart valves), cardiovascular diseases (arteriosclerosis, coronary thrombosis, ischemic heart disease, stroke), diabetes, respiratory disease, and low birth weight infants. Behavioral and psychosocial status is also affected due to low self-esteem from halitosis.
Bleeding gums should not be taken lightly. Bleeding gums can also be due to trauma by a toothbrush or other means, Vitamin C deficiency, platelet disorders, Vitamin K deficiency, hemophilia, blood cancers, uremia, viral disease, salicylates like aspirin, anti-coagulants, female hormonal changes, and pregnancy gingivitis. So get a proper medical investigation done if symptoms persist despite dental intervention.