Periodontal (Gum) Disease

The term “periodontal” means “around the tooth.” Periodontal disease (also known as periodontitis or gum disease) is a common inflammatory condition affecting the supporting soft tissues and, in advanced stages, the jawbone itself.

It is the leading cause of tooth loss among adults in the developed world. Four out of five people have periodontal disease and may not know it, as it is usually painless in its early stages.

Causes & Disease Progression

1. Plaque Formation: Plaque is a sticky film made of food debris, bacteria, and saliva. It takes as little as 24 hours for unremoved plaque to harden into calculus (tartar).

2. Gingivitis: Toxins in plaque irritate and inflame the gum tissue, leading to a localized bacterial infection.

3. Pocket Formation: As toxins and tartar build up, bacteria colonizes in the pockets between the gums and teeth.

4. Bone & Tissue Destruction: The body's chronic inflammatory response to the infection begins breaking down its own connective tissue and jawbone.

5. Tooth Loss: If left untreated, the loss of support leads to shifting teeth, loose teeth, and eventual tooth loss.

Systemic Health Links: Research suggests potential links between periodontal disease and systemic conditions such as stroke, cardiovascular disease, diabetes, bacterial pneumonia, and pregnancy complications. Smoking also significantly increases the risk of developing the disease.

Signs & Symptoms

• Bleeding Gums: Gums should never bleed during normal brushing or flossing.

• Red, Puffy, or Swollen Gums: Indicates active inflammation or infection.

• Tenderness or Discomfort: Caused by plaque and tartar irritating the gum tissue.

• Receding Gums: Loss of gum tissue around the tooth, making teeth appear longer.

• Persistent Bad Breath: Caused by bacteria residing in the mouth and gum pockets.

• Pus Around Teeth & Gums: A clear indicator of active bacterial infection.

• New Spacing Between Teeth: Shifts caused by underlying bone loss.

• Loose Teeth: Caused by bone destruction or weakened periodontal support fibers.

Classification & Types of Periodontal Disease

By Diagnostic Stage

• Gingivitis: The initial, mild stage. Plaque and toxins cause tender, inflamed gums that bleed easily. No permanent bone damage has occurred yet.

• Periodontitis: Plaque hardens into calculus. Gums recede, deeper pockets form and fill with bacteria and pus, and slight-to-moderate bone loss occurs.

• Advanced Periodontitis: Tissue, bone, and periodontal ligaments are destroyed. Teeth become loose and generalized moderate-to-severe bone loss is present.

By Specific Condition Type

• Chronic Periodontitis: The most common form; characterized by progressive loss of attachment and deepening pockets, interspersed with rapid progression phases.

• Aggressive Periodontitis: Occurs in otherwise clinically healthy individuals. Features rapid loss of gum attachment, severe bone destruction, and a tendency to run in families.

• Necrotizing Periodontitis: Involves tissue necrosis (death) of the periodontal ligament, bone, and gums. Most common in individuals with systemic conditions like HIV, immunosuppression, or malnutrition.

• Periodontitis Caused by Systemic Disease: Often begins at an early age in connection with medical conditions like respiratory disease, heart disease, or diabetes.

Diagnosis & Examination

Periodontal disease is diagnosed by a dentist or hygienist during a routine examination using a periodontal probe to measure the sulcus (the pocket between the tooth and gum).

• Healthy Sulcus: Measures 3 mm or less with no bleeding.

• Diseased Sulcus: Pockets deeper than 3 mm with bleeding, inflammation, or pus present.

Treatment Options

Treatment varies based on the type and severity of the disease.

Non-Surgical Treatments

• Regular Cleanings: Used for early-stage gingivitis (1–2 standard cleanings paired with improved home hygiene routines).

• Scaling and Root Planing (Deep Cleaning): Done in quadrants while the mouth is numbed. Tartar and toxins are scraped from above and below the gum line (scaling), and rough root surfaces are smoothed out (planing) to allow the gums to reattach.

• Medications: Antibiotic gels placed in pockets, medicated prescription mouthwashes, or specialized electric toothbrushes may be prescribed.

Surgical Treatments

• Pocket Elimination (Flap Surgery): Reduces the pocket depth between teeth and gums, making them easier to keep clean.

• Tissue Regeneration & Grafting: Uses membranes or tissue grafts to encourage the regrowth of destroyed bone and soft tissue.

• Dental Implants: Prosthetic teeth inserted into the jawbone to replace lost teeth (may require bone grafting prior to placement).

Maintenance & Prevention

Because periodontal disease is a chronic condition, ongoing maintenance is essential once treatment is complete.

• Periodontal Maintenance Cleanings: Recommended four times a year to clean hard-to-reach pockets above and below the gum line and check pocket depths.

• Routine Examination Services:

  • Diagnostic X-rays (evaluates bone loss, roots, decay, cysts, or tumors)

  • Oral cancer screening

  • Review of existing restorations (fillings, crowns)

  • Teeth polishing to remove surface stains and remaining plaque

• Home Care Practices: Daily brushing, flossing, balanced nutrition, and avoiding tobacco products are critical to keep periodontal disease under control.