Periodontal Disease

Periodontal diseases are bacterial infections of the tissues and structures that support your teeth. These include the gums, the cementum that covers the root, the periodontal ligament and the alveolar bone.

The earliest stage of periodontal disease is called gingivitis, this infection affects only the gums. The gum tissue is not attached to the teeth as high as it may seem - there is a very shallow v-shaped crevice called a sulcus between the tooth and gums. This is where gingivitis attacks - just below the gum line in the sulcus. You can tell if you have gingivitis if your gums are swollen and bleed when you brush or floss. If nothing is done the bacteria can spread and destroy the structures that support your teeth in your jawbone. As the tissues are damaged, the sulcus develops into a pocket. Generally, the more severe the disease, the greater the depth of the pocket. Eventually, your teeth can become so loose that they have to be extracted.

What causes periodontial disease and what health problems are linked to it?

After years of research scientists have come to the conclusion that bacteria in dental plaque is the major cause of periodontial disease. Plaque is the sticky substance that forms on your teeth soon after you have brushed. In an effort to get rid of the bacteria, the cells of your immune system release substances that inflame and damage the gums, periodontal ligament or alveolar bone. This leads to swollen, bleeding gums and, as mention previously, gingivitis.

Other factors can also contribute to the main cause of periodontal disease and make things worse once the infection has set in:

GenesSome people are more likely than others to get periodontal disease because of their genes. But your genes do not make gum disease inevitable. Even people who are highly prone to periodontal disease can prevent or control the disease with good oral care.

Smoking and tobacco useSmoking increases the risk of periodontal disease. The longer you smoke, and the more you smoke, the higher the risk. If you have periodontal disease, smoking makes it more severe. Smoking is a major reason that some cases of periodontal disease are resistant to treatment. Smokers tend to collect more tartar on their teeth. They often develop deeper periodontal pockets once they have gum disease. They also are likely to lose more bone as the disease gets worse. Unlike many other factors that affect the health of your gums, the decision to smoke or not is under your control. Quitting smoking can play a major role in bringing periodontal disease under control.

Misaligned or crowded teeth, braces or bridgeworkAnything that makes it more difficult to brush or floss your teeth is likely to enhance plaque and tartar formation. The more plaque and tartar you have, the greater your chance of developing gum disease. Dr. Wokuluk can show you the best ways to clean your teeth, even if they are hard to clean. For example, you can use special tools and ways of threading floss to clean around bridgework or slide under braces. If overcrowded or crooked teeth are a problem, your Dr. Wokuluk might recommend Invisalign®. This could straighten out your smile and give you a better chance of preventing disease.

Grinding, gritting or clenching of teethThese habits won't cause periodontal disease. However, they can lead to more severe disease if your gums are already inflamed. These habits exert excess force on the teeth. This pressure appears to speed up the breakdown of the periodontal ligament and bone. In many cases, people can learn to stop this habit simply by recognizing when it is happening and then relaxing. If these efforts don't work, Dr. Wokuluk can create a custom Nightguard appliance to help reduce the pressure of clenching or grinding on the teeth.

StressStress can make periodontal disease worse and harder to treat. Stress weakens your body's immune system. This makes it harder for your body to fight off infection, including periodontal disease.

Fluctuating hormonesWhenever hormone levels go up and down in the body, changes can occur in the mouth. Puberty and pregnancy can temporarily increase the risk and severity of gum disease. So can menopause.

MedicinesSeveral types of medicines can cause dry mouth, or xerostomia. Examples include certain drugs for depression and high blood pressure. If you don't have enough saliva, plaque is more likely to form. This may lead to tooth decay (cavities). Other medicines may cause the gums to enlarge. This makes them more likely to trap plaque. These medicines include:

Phenytoin (Dilantin and other brand names), used to control seizures.
Cyclosporine (Neoral, Sandimmune), used to suppress the immune system in people who have had organ transplants
Nifedipine (Adalat, Cardizem and others) and other calcium channel blockers, used to treat high blood pressure, chest pain (angina) or heart arrhythmias.

Diseases — People with certain diseases have a higher risk of developing periodontal disease. For example, people with diabetes are more likely to get periodontitis than people without diabetes. Their gum disease is also likely to be more severe. Other diseases that increase periodontal disease risk include inflammatory conditions such as rheumatoid arthritis and HIV infection. Having one of these diseases can make the control of your periodontal disease more difficult. Dr. Wokuluk is aware of these problems and can give you guidance on how to maintain your periodontal health.

Poor nutrition — Nutrition is important for overall good health, including a working immune system and healthy gums and mouth. Severe vitamin C deficiency (scurvy) can cause bleeding gums.

Continuing research has also linked possible connections to periodontial disease and other health problems in the body. More research is needed but positive studies have linked periodontial disease to:
Atherosclerosis and heart disease — Gum disease may increase the risk of clogged arteries and heart disease. It also is believed to worsen existing heart disease. >
Stroke — Gum disease may increase the risk of the type of stroke that is caused by blocked arteries.
Premature births — A woman who has gum disease during pregnancy may be more likely to deliver her baby too early. The infant may be more likely to be of low birth weight.
Diabetes — Diabetic patients with periodontal disease may have more trouble controlling their blood sugar than diabetic patients with healthy gums.
Respiratory disease — Bacteria involved in gum disease may cause lung infections or worsen existing lung conditions. This is particularly important for elderly adults in institutions such as nursing homes. In this group, bacteria from the mouth may reach the lungs and may cause severe pneumonia.

How do you know if you have periodontal disease?

It is possible to have periodontial disease and have no warning signs. This is one reason why regular checkups and periodontial examinations by Dr. Wokuluk are very important.

However, there are a number of warning signs that can signal you have a problem with perodontal disease. If you notice any of the following, see Dr. Wokuluk.

  1. - Gums that bleed easily;
  2. - Red, swollen, or tender gums;
  3. - Gums that have pulled away from teeth;
  4. - Puss between the teeth when the gums are pressed;
  5. - Persistent bad breath or bad taste in your mouth;
  6. - Permanent teeth that are loose or separating;
  7. - Any change in the way your teeth fit together when you bite;
  8. - Any change in the fit of partial dentures.

Types of periodontal diseases:

Periodontal diseases are classified according to the severity of the disease. The two major stages of the disease are gingivitis (as mentioned previously) and periodontitis.

Gingivitis - This is a milder and reversible form of periodontal disease that only affects the gums. It develops as toxins in plaque irritate the gums, making them red, tender, swollen and likely to bleed easily. It can usually be eliminated by daily brushing, cleaning between your teeth and regular dental cleanings at Dr. Wokuluk's office.

Periodontitis - Gingivitis may lead to more serious, destructive forms of periodontal disease called periodontitis. There are several forms of periodontisis, with the most common being chronic adult periodontitis.

Periodontitis occurs when toxins, enzymes and other plaque byproducts destroy the tissues that anchor the teeth into the bone. The gum line recedes, which can expose the tooth's root. Exposed roots can become susceptible to decay and sensitive to cold and touch.

As mentioned earlier, the sulcus deepens into a pocket in the early stage of periodontal disease. Plaque that collects in these pockets can be difficult to remove during regular brushing and interdental cleaning. Byproducts from the plaque can continue to damage the gums, periodontal ligament and bone. In some cases, so much ligament and bone are destroyed that the tooth becomes loose. And again, as mentioned previously, in the worst of cases a loose tooth may need to be extracted or may just fall out on its own.

How can you prevent periodontal diseases?

Daily good oral hygiene can help reduce your risk of developing periodontial diseases along with controlling or eliminating the causes mentioned earlier.

Brush your teeth twice a day. With proper brushing, you can remove plaque from theinner, outer and chewing surfaces of each tooth. Dr. Wokuluk can show you a proper brushing technique.

Carefully clean between your teeth once a day with dental floss or another interdental cleaner to remove plaque from areas your toothbrush can't reach. It only takes a few minutes each day and it is just as important as brushing your teeth.

If you need extra help controlling gingivitis and plaque that forms above the gum line, Dr. Wokuluk may recommend using an ADA-accepted antimicrobial mouthrinse or other oral hygiene aids as an effective addition to your daily oral hygiene routine.

Eat a balanced diet for good general health.

Visit Dr. Wokuluk regularly.

Checking for periodontal diseases.

During you checkup, Dr. Wokuluk will examine your gums. This is called a periodontal examination. Dr. Wokuluk will use an instrument called a periodontal probe to gently measure the depth of the sulcus surrounding each tooth. The healthy sulcus is usually three millimeters or less.

As mentioned before, periodontal diseases cause the sulcus to deepen into a pocket. Generally, the more severe the disease the deeper the pocket. The periodontal probe can determine whether you have developed any pockets and the depth of those pockets. Dental X-rays also may be taken to evaluate the amount of bone supporting the teeth and detect other problems not visible during the clinical examination.


Treatment methods depend upon the type of disease and how far the condition has progressed. Dr. Wokuluk treats Gingivitis, early, moderate and some advanced stages of Periodontitis. If the periodontal disease has progressed beyond a moderate or some advanced periodonitis Dr. Wokuluk will refer you to a Periodontist for treatment.

The first step in the treatment is usually a thorough cleaning that includes scaling to remove plaque and tartar deposits. The tooth roots may also be planed to smooth the root surface, allowing the gum tissue to heal and reattach to the tooth. In some cases, the occlusion, or bite, may require adjustment.

Dr. Wokuluk also may recommend medications to help control infection, pain or to encourage healing. These medications can be given in the various forms: a pill that you would swallow, a liquid mouthrinse or in a form that Dr. Wokuluk could place directly in the periodontal pocket after scaling and root planing.

Surgery may sometimes be needed.

When deep pockets between teeth and gums (4 to 6 millimeters or deeper) are present, it is difficult for Dr. Wokuluk to thoroughly remove the plaque and tartar. Likewise, you may have trouble keeping thses pockets clean and free of plaque. If the pockets do not heal after scaling and root planing, periodontal surgery may be needed. One of the goals of periodontal surgery is to reduce the depth of the periodontal pockets to make it easier to keep clean.

With surgery, Dr. Wokuluk can access hard to reach areas that require the removal of tartar and plaque. The tooth root is cleaned and smoothed. Sometime the bone around the tooth is also smoothed to help remove the pockets that have formed. The gums are sutured back into place or into a new position that will be easier to keep clean at home.

Bone surgery, bone grafts, gum grafts and other highly specialized procedures that could be necessary will be referred to a Periodontist by Dr. Wokuluk.

For more detailed information click on Specialized Dentistry under Services on this page.