PERIODONTAL DISEASE

Peri means “surrounding” or “encircling” and “odonsos” is a Greek term for “tooth”. This is how the term “Periodontal” is derived. Therefore, periodontal disease means disease of the gums and other structures surrounding the tooth.
The incidence and prevalence of periodontal disease or gum disease are very high in India. This is because of lack of professional help. Gum disease is the main cause of dental morbidity in India. Therefore in this and following articles I will try and explain the cause and progression of gum disease. To understand gum disease it would be pertinent to understand the normal healthy tooth structure and environment.

Normal Tooth Structure and Environment

A single dental unit consists of:
Enamel
Dentin
Cementum
Periodontal fibres
Bone surrounding teeth
Gums surrounding bone
Structure of Teeth

The tooth can be divided into two parts:

Crown: It is the upper 1/3rd of the tooth structure and is visible from outside.
Root: It is the lower 2/3rd of the tooth structure and is not visible from outside. It is embedded in the gums. It takes the chewing load.

Enamel is the outermost covering of the tooth and is the hardest substance of the human body. Because of it we can chew tough and fibrous foods. It is a non-living tissue.

Inside the dentin is the pulp or what is known as the nerve of the tooth. It is a fibrous tissue and it contains nerves, blood vessels and nerve ending.

The tooth is not directly attached to the jawbone. In fact it is suspended in the jawbone by fibres, which are known as periodontal fibres. Periodontal fibres are very thin fibers, which support the tooth.
The periodontal fibres are attached to the cementum of the tooth. The cementum is that part of the tooth is visible. This is how the tooth is supported.

Environment of Teeth
The tooth is continuously bathed in oral fluid that is called saliva. Saliva is necessary for proper health of the teeth. It prevent the tooth surface from being dried up and desiccated. Diseases that alter the flow or the composition of saliva may contribute to faster progression of gum disease. If the environment of the tooth is changed as in the case of pan chewer’s etc., it contributes to the progression of gum disease.
Beginning and progression of Gum Disease

The main cause of gum disease is plaque or tartar. Plaque is sticky white film that continuously forms on everybody tooth. It is whitish in colour and therefore not easily visible no naked eye.

It hardens to form tartar. Once tartar is formed only a dental professional can remove it. Enamel is very smooth but tartar is rough. Therefore, once tartar is formed it attracts more plaque. This leads to more tartar build-up. Thus a vicious circle is set in motion. Tartar formation leads to inflammation in the gums. Inflamed gums are tender. They bleed on tooth brushing.
Therefore, some people avoid brushing and clean their teeth with their fingers. However, that is not a very efficient method of cleaning teeth. Thus plaque formed is not removed and more plaque accumulation and subsequently more tartar formation take place. This contributes to the vicious circle of periodontal disease.

From a technical viewpoint, is of two types:
Supragingival and Subgingival i.e. tartar above the gums line and tartar below the gum line. Subgingival plaque is flint-like in consistency and is difficult to remove; furthermore, it is not easily visible.

When gums have been inflamed for a long times it causes destruction in the underlying bone. Subsequently the gum migrates down. This exposes the gaps in between the teeth. Once there are gaps in between the teeth they attact more food particles and plaque. This is because a toothbrush does not clean the gaps in between the teeth. Thus a vicious circle is formed which ultimately leads to a lot of mobility in the teeth and subsequently tooth loss.

Therefore, it is essential that gum disease be identified and treated in the initial stage only, to save the teeth from the ravages of periodontal disease.

In subsequent articles I would like to elaborate on early identification of gum disease and method of preventing it.