Periodontal (gum) disease, which is also known as periodontitis, is a progressive disease which if left untreated may result in tooth loss.  Gum disease begins with the inflammation and irritation of the gingival tissues which surround and support the teeth.  The cause of this inflammation is the toxins found in plaque which cause an ongoing bacterial infection.

The bacterial infection colonizes in the gingival tissue and deep pockets form between the teeth and the gums.  If treated promptly, the effects of mild inflammation (known as gingivitis) are completely reversible.  However, if the bacterial infection is allowed to progress, periodontal disease begins to destroy the gums and the underlying jawbone; promoting tooth loss.  In some cases, the bacteria from this infection can travel to other areas of the body via the bloodstream and can lead to various forms of systemic disease.

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 ensure and preserve the natural dentition and supporting bony structures.  When bacteria and calculus (tartar) are not removed, the gums and bone around the teeth become affected by bacteria toxins and can cause gingivitis or periodontitis, which can lead to tooth loss.
• Tobacco use – Research has indicated that smoking and tobacco use is one 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. We recommend patients seeing the dentist every 3 months during pregnancy to keep the mouth clean and prevent any spread of bacteria to the placenta.
• Chronic stress and poor diet – Stress lowers the ability of the immune system to fight off disease, which means bacterial infections may possibly 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 treat.
• Grinding teeth – The clenching or grinding of the 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) and stress.  When an individual is suffering from gum disease, the additional destruction of gingival tissue due to grinding can accelerate the progression of the disease. Excessive grinding or clenching of the teeth can lead to "abfractions" (areas of worn away tooth structure usually located at the "gum line") which may need to be restored with fillings.
  
• 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.

Treatment of Gum Disease

Early periodontal disease can usually be controlled by seeing your dentist every 3 months.  From time to time a procedure called "Scaling and Root Planing" will be needed to help remove unwanted plaque and bacteria from your mouth in order to stabilize your periodontal disease.  Antibiotic injections are also a wonderful treatment modality to place in deep pockets in order to attempt to "shrink" the pockets and stabilize the gum disease.  In addition to seeing the dentist every 6 months for routine examination, cleaning and x-rays, patients with gum disease see the dentist for 3 month periodontal maintenance visits.  Sometimes at these maintenance visits, antibiotics are placed in unstable areas by the hygienist.  There has been great success with these antibiotics in controlling gum disease. When the gum disease seems to be unstable and early treatment methods have not worked, a referral to a gum specialist (periodontist) is necessary for further evaluation and treatment.

Periodontists specialize in the treatment of gum disease, and it is this doctor who will perform periodontal surgery when it is needed. 

In the case of tooth loss, the periodontist is able to perform tissue grafts to promote natural tissue regeneration, and can insert dental implants if a tooth or several teeth are missing.  Where gum recession causes a “toothy” looking smile, the periodontist can recontour the gingival tissue to create an even and aesthetically pleasing appearance.

Preventing periodontal disease is critical in preserving the natural dentition.  Addressing the causes of gum disease and discussing them with your dentist will help prevent the onset, progression, and recurrence of periodontal disease.

If you have any questions or concerns about the causes or treatments pertaining to gum disease, please ask your dentist.