What Is Gum Disease?

Periodontal disease (also known as periodontitis and gum disease) is a common inflammatory condition that affects the supporting and surrounding soft tissues of the tooth, eventually affecting the jawbone itself in the disease’s most advanced stages.

It Starts With Gingivitis

Periodontal disease is most often preceded by gingivitis which is a bacterial infection of the gum tissue.  A bacterial infection affects the gums when the toxins contained in plaque begin to irritate and inflame the gum tissues.  Once this bacterial infection colonizes in the gum pockets between the teeth, it becomes much more difficult to remove and treat.  

When left untreated, gingivitis (mild gum inflammation) can spread to below the gum line.  When the gums become irritated by the toxins contained in plaque, a chronic inflammatory response causes the body to break down and destroy its own bone and soft tissue.

Signs & Symptoms of Periodontal Disease To Watch For

Being able to identify common risk factors related to gum disease helps individuals understand the importance of seeking an evaluation by their dental health professional.

Do your teeth and gums bleed during brushing and flossing?

Bleeding is one of the most common general symptoms of periodontal disease. Unexplained bleeding while brushing and flossing teeth is a sure sign something is amiss and needs prompt attention by a health professional.

Do you have loose or wobbly teeth?

Periodontal disease is caused by bacteria that infect soft tissue and damage supporting structures around teeth over time. As bone and soft tissue are compromised due to infection, the teeth become less firmly attached and may wobble, shift or fall out completely.

Are your teeth suddenly looking longer?

Gum recession is a highly visible warning sign of periodontal disease. If teeth appear longer than before, gums may be receding as bacteria and debris deepen periodontal pockets around teeth. While some gum recession is expected as we age, soft tissue problems resulting from periodontal disease cause significant and quick recession.

Do you suffer from other health conditions?

Heart disease, high stress, diabetes, osteoporosis and osteopenia are all linked to periodontal disease. Medications taken for these illnesses can also render the gums more sensitive to bacteria commonly found in the mouth.

Does anyone in your family have periodontal disease?

Despite a rigorous oral hygiene routine, 30% of the population may be genetically predisposed to developing gum disease. Periodontal disease can also be spread through bacteria found in saliva. When saliva is passed through common contact, couples and children are at additional risk for gum disease.

Have you had previous gum problems?

A personal history of gum problems, such as general soft tissue irritation and inflammation, increases the risk of advanced periodontal disease six fold.

Daily brushing and flossing reduces amounts of harmful oral bacteria and keeps calculus formation to a minimum. However, periodontal disease can progress without any noticeable symptoms, so it is essential to get a dental check-up and professional cleaning twice a year. This professional cleaning removes tartar and assists in maintaining better gum health over time.

If you have completed the self-test and found yourself to be at risk or have more questions regarding periodontal disease, please ask your oral health professional about treatment for soft tissue infection and how to prevent additional gum problems.

Diagnosing Gum Disease

During a periodontal examination your dentist will be able to diagnose the presence of gum disease. This exam should always be part of your regular dental check-up.

A small dental instrument is gently used to measure the pocket or space between the tooth and the gums.  The depth of a healthy pocket measures three millimeters or less and does not bleed.  The instrument helps indicate if pockets are deeper than three millimeters.  As periodontal disease progresses, the pockets usually get deeper.

Your dentist or hygienist will use pocket depths, amount of bleeding, inflammation, tooth mobility, etc., to make a diagnosis that will fall into a category below:

Gingivitis

Gingivitis is the mildest and most common form of periodontitis. It is caused by the toxins in plaque and leads to periodontal disease. People at increased risk of developing gingivitis include pregnant women, women taking birth control pills, people with uncontrolled diabetes, steroid users and people who control seizures and blood pressure using medication.

Common Types of Periodontitis

There may be little or no symptoms as periodontal disease causes the teeth to separate from the infected gum tissue.  Deepening pockets between the gums and teeth are generally indicative that soft tissue and bone is being destroyed by periodontal disease.

• Chronic periodontitis – Inflammation within supporting tissues cause deep pockets and gum recession.  It may appear the teeth are lengthening, but in actuality, the gums (gingiva) are receding.  This is the most common form of periodontal disease and is characterized by progressive loss of attachment, interspersed with periods of rapid progression.
• Aggressive periodontitis – This form of gum disease occurs in an otherwise clinically healthy individual.  It is characterized by rapid loss of gum attachment, chronic bone destruction and familial aggregation.
• Necrotizing periodontitis – This form of periodontal disease most often occurs in individuals suffering from systemic conditions such as HIV, immunosuppression and malnutrition.  Necrosis (tissue death) occurs in the periodontal ligament, alveolar bone and gingival tissues.
• Periodontitis caused by systemic disease – This form of gum disease often begins at an early age.  Medical condition such as respiratory disease, diabetes and heart disease are common cofactors.    

If Left Untreated

Periodontal disease is a progressive condition that eventually leads to the destruction of the connective tissue and jawbone.  If left untreated, it can cause shifting teeth, loose teeth, and eventually tooth loss. 

Periodontal disease is the leading cause of tooth loss among adults in the developed world and should always be promptly treated.

Treating Gum Disease

Periodontal treatment methods depend upon the type and severity of the disease. Your dentist and dental hygienist will evaluate for periodontal disease and recommend the appropriate treatment.

Periodontal disease progresses as the sulcus (pocket or space) between the tooth and gums gets filled with bacteria, plaque, and tartar, causing irritation to the surrounding tissues.  When these irritants remain in the pocket space, they can cause damage to the gums and eventually, the bone that supports the teeth!

If the disease is caught in the early stages of gingivitis, and no damage has been done, one to two regular cleanings will be recommended.  You will also be given instructions on improving your daily oral hygiene habits and having regular dental cleanings.

If the disease has progressed to more advanced stages, a special periodontal cleaning called scaling and root planing (deep cleaning) will be recommended.  It is usually done one quadrant of the mouth at a time while the area is numb.  In this procedure, tartar, plaque, and toxins are removed from above and below the gum line (scaling) and rough spots on root surfaces are made smooth (planing).  This procedure helps gum tissue to heal and pockets to shrink.  Medications, special medicated mouth rinses, and an electric tooth brush may be recommended to help control infection and healing.

If the pockets do not heal after scaling and root planing, periodontal surgery may be needed to reduce pocket depths, making teeth easier to clean.  Your dentist may also recommend that you see a periodontist (specialist of the gums and supporting bone).

Common Causes of Gum Disease

There are genetic and environmental factors involved in the onset of gum disease, and in many cases, the risk of developing periodontitis can be significantly lowered by taking preventative measures. 

Here are some of the most common causes of gum disease:

• Poor dental hygiene - Preventing dental disease starts at home with good oral hygiene and a balanced diet.  Prevention also includes regular dental visits which include exams, cleanings, and x-rays.  A combination of excellent home care and professional dental care will preserve the natural dentition and support of bony structures.  When bacteria and calculus (tartar) are not removed, the gums and bone around the teeth become affected by bacterial toxins and can cause gingivitis or periodontitis, which ultimately lead to tooth loss.
• Tobacco use – Research has indicated that smoking and tobacco use are some of the most significant factors in the development and progression of gum disease.  In addition to smokers experiencing a slower recovery and healing rate, smokers are far more likely to suffer from calculus (tartar) build-up on teeth, deep pockets in the gingival tissue, and significant bone loss. 
• Genetic predisposition – Despite practicing rigorous oral hygiene routines, as much as 30% of the population may have a strong genetic predisposition to gum disease.  These individuals are six times more likely to develop periodontal disease than individuals with no genetic predisposition.  Genetic tests can be used to determine susceptibility and early intervention can be performed to keep the oral cavity healthy.
• Pregnancy and menopause – During pregnancy, regular brushing and flossing is critical. Hormonal changes experienced by the body can cause the gum tissue to become more sensitive, rendering them more susceptible to gum disease.
• Chronic stress and poor diet – Stress lowers the ability of the immune system to fight off disease which means bacterial infection can beat the body’s defense system.  Poor diet or malnutrition can also lower the body’s ability to fight periodontal infections, as well as negatively affecting the health of the gums.
• Diabetes and underlying medical issues – Many medical conditions can intensify or accelerate the onset and progression of gum disease including respiratory disease, heart disease, arthritis and osteoporosis.  Diabetes hinders the body’s ability to utilize insulin which makes the bacterial infection in the gums more difficult to control and cure.
• Grinding teeth – The clenching or grinding of teeth can significantly damage the supporting tissue surrounding the teeth.  Grinding one’s teeth is usually associated with a “bad bite” or the misalignment of the teeth.  When an individual is suffering from gum disease, the additional destruction of gingival tissue due to grinding can accelerate the progression of the disease.
• Medication – Many drugs including oral contraceptive pills, heart medicines, anti-depressants, and steroids affect the overall condition of teeth and gums, making them more susceptible to gum disease.  Steroid use promotes gingival overgrowth, which makes swelling more commonplace and allows bacteria to colonize more readily in the gum tissue.

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