Gum Disease

The two most common forms of dental disease, caries (tooth decay) and periodontal disease (gum disease) are caused by the presence of  bacterial communities in dental plaque, which is a sticky film that is  constantly accumulating in the mouth. While in the case of tooth decay  the acidic products of the plaque bacteria progressively erode tooth  structure, in gum disease an inflammatory response is provoked in the  periodontal tissues that surround and support the teeth. If left  untreated, periodontal disease can lead to gingival pocket formation,  gum recession and diminishing alveolar bone with the eventual loosening  and loss of teeth.

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According to  the Centers for Disease Control and Prevention (CDC), one out of every  two adults aged 30 and over in the United States is affected by  periodontal disease. Furthermore, that number increases to over 70% for  individuals 65 and older. Since gum disease is the main cause of tooth  loss in adults and there is an increasing association with systemic  diseases such as heart disease, stroke, diabetes, respiratory problems  and adverse pregnancy outcomes, periodontal disease represents a serious  public health concern.

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Although inadequate oral hygiene practices, infrequent dental checkups and few if any professional teeth cleanings are the main reasons for the development of gum disease, there are  other factors that can contribute to the risk. An individual may be  predisposed to periodontal disease because of genetic factors, smoking  and tobacco use, harmful oral habits, misaligned teeth, poor nutrition,  and stress as well as the fluctuating hormones in pregnancy. Diseases  such as diabetes, rheumatoid arthritis and HIV infection can also  increase the risk and severity of periodontal disease. Additionally,  certain medications for the therapeutic treatment of systemic disease  can lay the groundwork for periodontal problems by producing side  effects such as dry mouth (xerostomia) or causing the gums to enlarge.

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What are the signs and symptoms of gum disease?

Since much of  the course of periodontal disease is not painful, there may be little  awareness by an affected individual that a condition, which is harmful  to oral health as well as one that is linked to larger systemic  problems, is present.

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Some of the signs and symptoms of gum disease to be aware of include the following:

• Inflamed and red gums

• Bleeding when brushing or flossing

• Receding gums and exposed root surfaces of the teeth

• Sensitivity to hot or cold temperatures

• Bad breath or a bad taste in the mouth

• Teeth that feel loose

• The development of new spaces between the teeth or a change in the bite

• Change in the fit of existing partial dentures

• Discharge around the teeth and gums

• Sharp or dull pain when biting down or chewing food

While gum  disease is a progressive condition, if treated early in its onset it can  be reversed to restore oral health. At more advanced stages, the  disease can be managed to halt its progression and prevent the most  severe consequences.

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The earliest stage of gum disease is known as gingivitis,  which is caused by the buildup of dental plaque at the gumline.  Gingivitis is extremely common and is typically associated with bleeding  when brushing or flossing. With gingivitis there is no evidence of bone  loss or significant periodontal pockets between the teeth and gums. Gingivitis can be successfully treated and reversed with a series of professional dental cleanings and an improved regimen of oral hygiene at home.

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If gingivitis is allowed to progress, it can advance to the next stage, which is known as periodontitis.  When periodontitis is present, the tissue damage extends beyond the  gums to include the loss of the collagen attachment of the tooth to the  surrounding bone, the development of deep periodontal pockets and the  loss of supporting alveolar bone. In this stage the connective tissue  and bone that hold the teeth in place begin to break down. Without proper treatment,  periodontitis will progress from a mild to moderate loss of supporting  tissue to the complete destruction of the alveolar bone around the  teeth. As periodontal disease advances, more extensive procedures are  required to halt its progression. The dentist may recommend a series of deeper cleanings involving root planing and scaling, surgical procedures to reduce pocket depth, bone or tissue grafts, laser dentistry procedures, or antimicrobial medications.

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By far, the  best approach to care is the prevention of periodontal disease. By  maintaining an effective regimen of brushing and flossing at home,  following a healthy lifestyle and seeing the dentist for routine checkups and professional dental cleanings, gum disease and its consequences are largely preventable.