Frequently Asked Questions
What is periodontal disease?
Periodontal disease, also called gum disease, periodontitis, or pyorrhea,
is a complex disease which can be acute or chronic with flare-ups and quiet
periods, like any chronic disease. Periodontal disease involves the inflammation
of the gum tissue, and the resulting destruction of the bone that holds
the teeth in the jaw by the inflammatory process. It is the number one
cause of tooth loss in adults. Periodontal disease also has implications
for increased risk for other health problems, click here.
What causes periodontal disease?
In its most basic form, the answer to this question is bacteria. There
are over 450 different species of bacteria that can live in our mouths,
some of which cause periodontal disease. The current understanding of periodontal
disease attributes 50% of the destruction directly to the bacterial toxins
and 50% to the inflammatory process that they trigger in our own immune
Are there contributing factors in periodontal disease?
Yes: how effectively you clean your teeth, the type(s) of bacteria present,
tooth position and alignment, your general health and resistance, saliva
(amount, pH, viscosity), medications you may be taking, cigarettes and
tobacco products are some of the most significant factors.
The importance of gum tissue.
The gum tissue around the teeth overlies the bone that holds our teeth
in place. The top of the gum that is visible is approximately 2-3 millimeters
(one millimeter is about the thickness of a dime) higher than the actual
attachment of the gum to the tooth in health, making a space similar to
a turtleneck collar. Within this space, bacteria live and multiply. These
bacteria produce toxins that cause our bodies to respond in a localized
reaction called inflammation. In periodontal disease, the fibers that attach
the gum to the tooth are destroyed by the process of inflammation. Once
these fibers are damaged, the bacterial infiltration can continue to deeper
levels of the gum and bone typifying the advancing nature of periodontal
What is gingivitis?
Gingivitis is inflammation of the gums and is apparent with red gums that
can bleed upon touching (brushing and/or flossing). Because inflammation
of the gums must occur before the bone is destroyed, gingivitis, or inflammation
of the gums is the precursor to periodontal disease. Gingivitis may persist
for years before the inflammatory process allows destruction of the bone
to occur. The important thing to note about gingivitis is that it cannot
be distinguished from periodontal disease simply by observation. To determine
if someone has gingivitis or periodontal disease, a periodontal examination
must be performed.
What is a periodontal examination?
A number of components contribute to a thorough periodontal examination:
How do I know if I have periodontal disease?
- visual evaluation of the teeth and gums, including measuring the
crevice depth around each tooth (periodontal probing)
- x-ray evaluation of supporting bone
- review and evaluation of health and dental history (habits, medications)
- evaluation of bite and tooth position (including models of teeth)
- microscopic examination of plaque
- other appropriate diagnostic aids as indicated
While there are a number of signs and even some symptoms of periodontal
disease, the only true way to determine if periodontal disease is present
is by having a periodontal exam. Even x-rays do not show many areas where
the bone may have been destroyed. However, here are some signs to look
Are there different types of periodontal disease?
- Gums that bleed when you brush your teeth. (This may appear as a "pink
- Gums that are red, swollen or tender.
- Gums that have pulled away from the teeth.
- Pus between the teeth and gums when pressed.
- 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 your partial denture.
- Bad breath or bad taste.
By far the most prevalent form of periodontal disease is adult periodontitis.
This is classified into mild, moderate and severe types, depending on the
amount of bone loss. Mild periodontitis occurs when the probing depths
of the gum crevice range from 4-5 millimeters. Moderate periodontitis is
designated for probing depths between 6-7 millimeters, while severe periodontitis
occurs when depths of 8 millimeters or above are observed. Since tooth
roots average between 10-12 millimeters long, the deeper the pocket (higher
the measurement) the more severe the disease and the greater chance for
tooth loss. Different readings can occur around different sides on the
Is periodontal disease transmissible?
What are the treatments for periodontal disease?
Treatment for periodontal disease depends on the severity of the problem.
What all types of treatment do is to reestablish healthy gums that can
be maintained and act as a barrier to future disease. Bacteria must be
effectively and thoroughly removed on a daily basis for permanent success
The first type of treatment involves what is called deep scaling or root
planing. It is the most conservative treatment available and is commonly
called the Non-Surgical approach. This is almost always done with local
anesthetic and rarely causes residual discomfort. In many cases it is best
to do each pocket more than once as it is impossible to remove all deposits
and debris in the deeper pockets on the first treatment. When successful,
the gum will reattach at a higher level than before thus reestablishing
a better barrier to the bacteria and the disease process will be eliminated.
There are many ways to enhance these results, including first among these
improved homecare techniques. Other treatment options include antibiotics
and advanced therapy such as Periostat.
The second major treatment is surgery. Surgery is not a cure for the disease.
Surgery helps create a more maintainable periodontal situation. The simplest
type of surgery is called a gingivectomy. A gingivectomy is the surgical
removal of the diseased gum tissue with the healing of the gum at a lower
level. Depending on the pocket depth, this may involve massive tissue loss.
More common are "flap" procedures. While there are different types of "flaps" and
different techniques, the goal is to temporarily move the gum back during
the surgery, remove the underlying disease process and if necessary, change
the contour of the bone. The gum tissue is then sutured back in place.
With successful healing, the gum will reattach at a higher level than it
was when the disease process was present, although never back to where
it was originally. Other surgical techniques include the implantation of
new bone and the use of a synthetic bone matrix that stimulates bone growth.
The last treatment is the use of extractions, or removal of the teeth.
Certainly, the goal of any treatment is to save the teeth, however there
are times when the bone destruction is so great around one or more teeth
that it threatens to infect the tooth next to it. If the adjacent tooth
has a level of bone that can successfully be treated by one of the methods
mentioned above, yet its next door neighbor cannot, then removal of the
hopeless tooth can only help the long term prognosis.
It is not uncommon to find periodontally involved teeth often respond positively
to root canal treatment. Many studies have shown periodontal disease causing
bacteria within the tooth. Even with antibiotic treatment these bacteria
are not eliminated.
Some upper molars, which usually have three roots, often respond positively
to the removal of one of the smaller roots - this is referred to as a root
Tooth position and bite are very significant factors. When the forces on
teeth are more than the supporting bone and gum can withstand the underlying
periodontal disease can be aggravated. The ultimate successful treatment
of periodontal disease usually involves some sort bite adjustment and/or
orthodontic treatment (braces).
It cannot be emphasized enough that while treatment may re-establish a
healthy gum condition, if the bacteria are not regularly and effectively
removed, the disease will reappear.
What is gum recession?
Gum recession occurs when the gum and supporting bone are destroyed so
that the top of the gum recedes away from the biting edge or chewing surface.
This is the origin of the expression "long in the tooth". Gum recession
is most often caused by too much force on teeth; however, it can be also
be caused by periodontal disease (NOTE: it is not caused by toothbrushing
). Gum recession caused by periodontal disease most commonly occurs where
the inflammation caused by the disease process destroys the attachment
of the gum progressively down the root.
What can be done about gum recession?
Treatment options depend on the nature of the problem and the cause. If
root surface sensitivity occurs, early treatment may simply involve desensitizing
the root surface. Sometimes a bonded filling can serve as a barrier to
temperature. Grafting of gum tissue is very common and successful for noticeable
cases of recession. If the bite is the significant underlying cause, then
a bite adjustment and/or orthodontic treatment (braces) is indicated.