What causes Gum Disease (Periodontal Disease)?

The mouth contains a large number and variety of bacteria that form a sticky film called plaque.

In this film, the bacteria that cause periodontal diseases create toxins (poison), which irritate the gums and bone. Even if you brush and clean between your teeth every day, you may not completely remove plaque, especially around the gumline.

Plaque that is not removed can harden into a rough, porous deposit called calculus, or tartar. The tartar can only be removed when your teeth are cleaned in the dental office.

Although tartar that forms above the gumline has not been shown to cause periodontal disease, tartar on teeth below (under) the gumline makes it more difficult to remove plaque. This can create conditions that lead to chronic inflammation and infection.

The Progress of Periodontal Disease

1. Healthy gingiva (gum tissue) and bone anchor teeth firmly in place.
2. Gingivitis develops as toxins in plaque irritate the gums, making them red, tender, swollen and likely to bleed easily.
3. Periodontitis occurs when toxins destroy the tissues that anchor teeth in the bone. As gums detach from teeth, pockets form and fill with plaque. Tooth roots are exposed and become susceptible to decay and sensitive to cold and touch.
4. Advanced periodontitis is present when the teeth continue to lose their attachment and the supporting bone is destroyed. Unless treated, the affected teeth frequently become loose and may fall out or require removal by a dentist.

The Warning Signs

• Gums that bleed easily.
• Red, swollen or tender gums.
• Gums that pulled away from the teeth.
• Pus between the teeth and gums when the gums are pressed.
• Persistent bad breath or bad taste.
• Permanent teeth that are loose or separating.
• Any change in the way your teeth fit together when you bite.
• Any changes in the fit of partial dentures.

It's possible to have periodontal disease and not have warning signs. That's why regular dental checkups and periodontal examinations are important.

Types of Periodontal Diseases

At the very edge of the gumline, gum tissue is not attached to each tooth. Instead, there is a very shallow, v-shaped groove called the sulcus between the tooth and gums. The normal space between teeth and healthy gums should be 3 mm or less. With periodontal disease this tiny space develops into a pocket. Generally, the more severe the disease, the greater the depth of the pockets.

Gingivitis is a mild, often reversible form of periodontal disease. It develops as toxins in plaque irritate the gums, making them red, tender, swollen and likely to bleed easily. It can usually be eliminated by daily brushing, cleaning between teeth, regular dental cleanings and checkups.

Gingivitis may lead to more serious, destructive forms of periodontal disease, called Periodontitis. This occurs when toxins destroy the tissues that anchor teeth into bone. The gums detach from teeth and form pockets. Exposed tooth roots become susceptible to decay and sensitive to cold and touch. The tartar that forms below the gums inhibits the reattachment gum tissue to the teeth. It creates conditions that contribute to delayed healing and inflammation.

In some cases, so much ligament and bone are destroyed that the tooth, no longer stable, becomes loose in its socket. It may eventually fall out, or require extraction.

Factors That Can Increase Your Risk

Other factors can increase the risk, severity and speed at which periodontal diseases develop. If one or more of these applies to you, you may still have good oral health by following your dentist's advice and practicing good oral hygiene.

People who smoke or chew tobacco are more likely to have periodontal disease. And, it's likely to be more severe than those who do not use any tobacco.

Bridges that no longer fit properly ,malocclusion (misaligned teeth) or fillings that have become defective can contribute to plaque retention and increase your risk of developing periodontal disease.

Clinching or grinding your teeth may also contribute to the rate at which supporting bone is lost.

Poor diet may cause periodontal disease to progress more rapidly or increase the severity of the condition, according to some research. There is some evidence that an adequate diet makes mouth tissues less resistant to infection.

Pregnancy or use of oral contraceptives increases hormone levels which can cause gum tissue to be more sensitive to the toxins and plaque and accelerate growth of some bacteria. The gums are more likely to become red, tender and swollen, and bleed easily.

Systemic diseases, such as AIDS or diabetes, can lower resistance to infection, making periodontal disease more severe.

Many medications, such as steroids, some types of antiepilepsy drugs, cancer therapy drugs, some calcium channel blockers, and oral contraceptives can affect the gums. Let your dentist know about your medications and update your medical history files at the dental office when any changes occur.