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Periodontal Disease

At first, it’s silent, practically invisible and sometimes even painless. But once periodontal disease strikes, it’s only a matter of time until it makes its presence known with uncomfortable, unsightly and quite possibly irreparable side effects. There are financial reasons to consider, when deciding how often to floss… Researchers said severe gum disease is associated with increased health care costs, for not only dental care, but also inpatient hospital care. Periodontal disease is one of the most common chronic diseases, yet researchers had not previously determined whether it is also associated with increased inpatient, outpatient and other health care costs. The investigators found that overall costs were 21 percent higher for men and women with severe gum disease than for those with no gum disease (Published Jul 23, 2006 by JoDee Kenney ) Periodontal disease, also know as gum disease, is the major cause of tooth loss in adults. There are several types and stages of the disease, all of which start with an infection of the gums that can move into the bones and ligaments that support the teeth. In the beginning stages, it can only be detected by a dentist during regular checkups. If left untreated, gums and bone can become so seriously damaged that teeth can fall out or have to be removed. More than half of all adults, and three quarters of adults over 35, have some form of periodontal disease. Even young children can exhibit signs. If you plan to make your teeth last a lifetime, it’s important to understand the causes, symptoms and best methods for treating and preventing periodontal disease.

What causes Periodontal Disease?

The major cause of periodontal disease is the bacteria found in plaque—the sticky, virtually invisible film that collects on teeth every day. These bacteria create toxins that irritate the gums and cause them to separate from the teeth. The toxins can eventually destroy the gum tissues and move on to infect the underlying bone. When plaque is not removed from the teeth regularly, it forms a hard, porous substance called calculus, or tartar. If calculus forms on the roots of the teeth below the gum line, it allows even more plaque to collect. Only a dentist or dental hygienist can remove plaque and calculus from the roots of your teeth. Once the bacteria in plaque have started to damage the gum tissues, a number of other factors can contribute to the severity of periodontal disease and the rate at which it progresses. Among them are:

  • Food or chemical irritants impacted between teeth
  • Smoking or chewing tobacco
  • Poorly fitting bridges
  • Badly aligned teeth
  • Defective fillings clenching or grinding teeth
  • Poor diet
  • Pregnancy or oral contraceptives
  • Systemic diseases such as AIDS or diabetes
  • Certain medications

But these are only contributing factors. They don’t cause periodontal disease. Plaque does.

What are the stages of Periodontal Disease?

  • Healthy gums are firm, pink and don’t bleed. In the earliest stage of periodontal disease, a stage called gingivitis, the gums begin to get red and puffy and may bleed during brushing or flossing. Plaque and tartar start to build up at the gum line, but the gum tissues and bone that hold the teeth are healthy.
  • The next stage of periodontal disease is called periodontitis. At this stage, the gums are separating from the teeth and starting to recede. Pockets form below the gum line that trap plaque and food. Bacteria-laden plaque spreads to the roots and infects the supporting tissues and bone. In cases of advanced periodontitis, infection further destroys the supporting tissues and bone.
  • In cases of advanced periodontitis, infection further destroys the supporting tissues and bone. The gums recede more and teeth may shift, become loose or even fall out.

What are the symptoms of Periodontal Disease?

While the early symptoms of periodontal disease can only be detected by a dentist, there are other indicators that start to appear as the disease progresses. Symptoms like:

  • Gums that bleed during brushing or flossing
  • Teeth that have shifted or loosened
  • Pus between teeth and gums
  • Red, swollen gums
  • Painful or tender gums
  • Persistent bad breath
  • Teeth that look longer because gums have receded
  • Gums that have pulled away from the teeth
  • Changes in the way teeth fit together when biting
  • Changes in the way partial dentures fit

If you have any of these symptoms, you may have some form of periodontal disease and should consult your dentist. He or she will then measure the depth of the pockets between your teeth and gums and take X-rays to see if any of the supporting bone has been destroyed. If, after this evaluation, your dentist determines that you do have periodontal disease, there are a number of treatments he or she will suggest depending on the severity of your situation.

How can Periodontal Disease be treated?

If periodontal disease is diagnosed in the early stage of gingivitis, it can be treated with a thorough professional cleaning. If the disease has progressed beyond gingivitis to periodontitis, the cleaning may involve a process called scaling, the scraping of the surface of the teeth to remove calculus deposits both above and below the gum line. Scaling is often performed along with root planing. Root planing is a process whereby the roots are smoothed and cleaned so that the gums can heal around them. This procedure may require several appointments, depending on the extent of your periodontal disease. In cases of advanced periodontitis, when deep pockets have formed between the teeth and gums, surgery may be required to allow the dentist to remove calculus from the roots of the teeth. One type of surgery, known as flap surgery, involves lifting a portion of the gum away, cleaning the roots, then suturing the gum back into a position that will be easier to keep clean. When there’s not enough existing gum, a gum graft might be performed. Osseous (bone) surgery is performed when the bone around the tooth has been damaged. The bone is reshaped, or a bone graft is performed to replace lost bone. In some cases of periodontal disease, gum tissue that has been destroyed can be partially regenerated by inserting special membranes that stimulate new tissue growth.

How can Periodontal Disease be prevented?

The best way to prevent periodontal disease is to practice good oral hygiene. Brushing and flossing every day, eating a balanced diet and scheduling regular checkups with your dentist are essential to keeping periodontal disease at bay. And by doing so, you’ll increase your chances of keeping your teeth for a lifetime. Copyright 2001, California Dental Association, All Rights Reserved

headshot of dr eric vanek d.d.s

Dr. Eric Vanek, d.d.s

Eric has been a practicing dental surgeon for over 20 years and is the owner of Vanek Dentistry, a family dental practice in Costa Mesa, CA.

Published September 11, 2014. Updated August 17, 2021