Gingivitis is the initial stage of gum disease. Affected gum areas become increasingly red. They may appear swollen and may bleed easily, especially when you brush or floss your teeth. The condition is reversible at this stage with regular brushing, flossing and visits to the dentist. If it is not treated, however, gingivitis may lead to a more serious condition called periodontitis or periodontal disease.

Periodontal disease of some degree affects about 75% of the adult population. It is an infection of the gums and bone that hold your teeth in place. It causes irreversible damage to the bone and tissue structures that support the teeth and can lead to bad breath and tooth loss. Periodontal disease is most often painless, and you may not be aware that you have a problem until your gums and the supporting bone are seriously damaged. This is why regular dental visits and periodontal examinations are very important.

Without good periodontal health, there cannot be good general health. Research suggests that periodontal disease can affect the state of your whole body. Over the past few years, studies have shown a definitive link between your oral health and your general health. The following are a few of the many health problems that can be aggravated by poor oral hygiene: stroke, heart disease (including heart attack), respiratory infections, severe osteopenia (reduction in bone mass), uncontrolled diabetes, and preterm and low birthweight babies. In fact, one study showed that periodontal disease was a stronger risk factor for heart disease than any of the other conditions usually linked to it, including hypertension, high cholesterol, age, and gender!

Periodontal disease is caused by the natural bacteria in your own mouth. Bacteria constantly forms on the teeth and between the teeth and gums. This causes inflammation and damage to the attachment of the gums and bone to the teeth. Healthy gum tissue fits like a cuff around each tooth. Where the gum line meets the tooth, it forms a slight v-shaped crevice called a sulcus. In healthy teeth, this sulcus depth is usually three millimeters (mm) or less. When periodontal disease is present, this normally shallow sulcus develops into a deeper pocket that bleeds, collects more plaque bacteria, and is difficult to keep clean.

The goal of treating periodontal disease is to establish healthy gums and prevent any further bone loss. The easiest way to control periodontal disease and restore oral health is to begin treatment at its earliest stage, before the pockets get too deep. The deeper the pockets, the harder it is to clean, and the more easily it can progress. The first step involves a special cleaning called scaling and root planing which carefully removes plaque and tartar from beneath the gum line down to the bottom of each periodontal pocket. This treatment is usually done by the hygienist and is most often provided comfortably without the need for anesthetic. Occasionally, antibiotics are prescribed. This procedure helps gum tissue to heal and pockets to shrink; however, the bone around the teeth will never grow back to its original level. Therefore, you most likely will always have periodontal pockets deeper than 3mm around the affected teeth. A toothbrush and floss cannot clean deeper than 3mm below the gums; therefore, even with proper brushing and flossing, plaque bacteria will repopulate the base of the pocket and begin to do more damage to the tissue and bone. Studies have shown that this reaccumulation of the pocket with bacteria enough to reactivate periodontal disease only takes about 90 days. This is why it is so very important for patients who have undergone treatment to continue to have these pockets cleaned by a dental professional every three to four months for the rest of their lives. Since you are unable to clean these deeper areas effectively at home, waiting longer than three to four months may allow the bacteria time to cause more tissue and bone damage. There is no endpoint for periodontal therapy as long as you have teeth.

At more advanced stages, the disease may require more complex treatment such as gum surgery and bone and/or soft tissue grafting. Usually, this is carried out by a dental specialist called a Periodontist. In the worst case scenario, teeth can become loose and need to be removed.

You don’t have to lose teeth to periodontal disease. Brush, clean between your teeth, eat a balanced diet, and schedule regular dental visits for a lifetime of healthy smiles.


Dr. Jack M. Hosner, D.D.S. (2012)

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