Penam Periodontics - Evidence based Personalized Periodontics

What is Periodontal Disease?

Periodontal diseases are ongoing infections or inflammation of the gums that may gradually destroy the support of your natural teeth. Periodontal disease affects one or more of the periodontal tissues: alveolar bone, periodontal ligament, cementum, or gingiva. While there are many diseases which affect the tooth-supporting structures, plaque-induced inflammatory lesions make up the majority of periodontal issues, and are divided into two categories: 1) Gingivitis; and 2) Periodontitis. While gingivitis, the less serious of the diseases, may never progress into periodontitis, it always precedes periodontitis.


Accumulation of Dental Plaque is the primary cause of gingivitis. The important feature of gingivitis is that there is inflammation, swelling and bleeding of the gums but the underlying bone is rarely affected. All people have potential to develop gingivitis and interestingly there are up to 70% of people that no matter how much they neglect their teeth will probably only ever get a chronic gingivitis and will never develop the more serious Periodontitis (see below).  Plaque is a sticky colourless film, composed primarily of multiple types of bacteria, which adhere to your teeth at and below the gum line. Plaque constantly forms on your teeth, even minutes after cleaning. Bacteria found in plaque produce toxins or poisons that irritate the gums. Some people may have more toxic bacteria in their dental plaque and their gums may become inflamed, red, swollen, and bleed easily.  If daily brushing and flossing is neglected, plaque may also harden into a rough, porous substance known as calculus (or tartar). This can occur both above and below the gum line.

Nonplaque associated gingivitis can also occur. These issues are discussed on a separate section 


Periodontitis is the destructive form of gum inflammation and is related to the presence of certain bacterial species being present in your plaque. The important feature of periodontitis is that the gums are swollen and inflamed (just like gingivitis) but there is also destruction of the underlying bone occurring. It is estimated that about 30% of the population have a significant background susceptibility to potentially developing periodontitis.

Once you have been diagnosed as having a susceptibility to periodontitis, treatment and optimized preventive care will allow you to stabilize the condition and prevent it from causing bone loss and tissue damage in most cases. This is the same as many other medical conditions such as diabetes, high blood pressure and cardiac disease where we know some patients have increased susceptibility to these diseases due to their genetic predisposition however if appropriate treatment and preventive strategies are put in place then the problem can be controlled long term and damage to the body minimized. This is important to understand as this means you will need to follow a professional maintenance program and optimize your home dental care to ideally manage your periodontitis. If untreated there is progressive loss of the soft tissue and bone at a rate of up to 2mm per year, which if allowed to progress may result to loosening and subsequent loss of teeth.

Defined Periodontitis

Periodontitis may be present in up to 80% of the population at some time in their life. However we see the more problematic form of the disease in ~20% of the population.

Your Periodontitis is currently assessed by: 1) the amount of destruction (stages 1 - 4); 2) the rate of progression (Slow, Moderate or Rapid); and 3) the distribution of the disease (Isolated, Generalized or Molar/incisor patterns). The disease is now classified as being associated with certain known systemic diseases, including 1) Diabetes; 2) Osteoporosis; 3) Rheumatoid arthritis, and 4) Thyroid disease. Good control of these conditions by your medical practitioner are required so we will work with them to better control your periodontal disease issues. Studies of these issues are being conducted at the University of Melbourne and Clinical Associate Professor McGregor is one of the lead investigators for this research. We will make these tests available to patients so we can personalize the patients treatment. 

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