If you have been told you have periodontal (gum) disease, you're not alone. An estimated 80 percent of American adults currently have some form of the disease.

The word periodontal literally means "around the tooth." Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth.

Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) causes the gums to become inflamed.

Periodontal diseases are classified according to the severity of the disease.

The two major stages are gingivitis and periodontitis.

Gingivitis is a milder and reversible form of periodontal disease that only affects the gums which usually become red, swollen, and bleed easily. There is usually little or no discomfort. Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with professional treatment and good oral home care.

Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.

If you have been told you have periodontal (gum) disease, you're not alone. An estimated 80 percent of American adults currently have some form of the disease.

The word periodontal literally means "around the tooth." Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth.

Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) causes the gums to become inflamed.

Periodontal diseases are classified according to the severity of the disease.

The two major stages are gingivitis and periodontitis.

Gingivitis is a milder and reversible form of periodontal disease that only affects the gums which usually become red, swollen, and bleed easily. There is usually little or no discomfort. Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with professional treatment and good oral home care.

Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.

Although the primary cause of both gingivitis and periodontitis is the bacterial plaque that adheres to the tooth surface, a variety of factors affect the severity of the disease:

• Tobacco smoking or chewing - recent studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease.

• Systemic diseases such as diabetes- if you are diabetic, you are at higher risk for developing infections, including periodontal diseases.

• Some types of medication such as steroids, some types of anti-epilepsy drugs, cancer therapy drugs, some calcium channel blockers and oral contraceptives - just as you notify your pharmacist and other health care providers of all medicines you are taking and any changes in your overall health, you should also inform your dental care provider.

• Bridges that no longer fit properly, fillings that have become defective and crooked teeth

• Pregnancy – pregnancy can worsen mild gingivitis, primarily because of hormonal changes. Some pregnant women may unknowingly contribute to the problem by neglecting oral hygiene because they feel nauseated in the morning (morning sickness). Also, during pregnancy, a minor irritation, often a buildup of tartar, may cause a lump-like overgrowth of gum tissue, called a pregnancy tumor. The bloated tissue bleeds easily if injured and may interfere with eating.

• Stress- as you probably already know, stress is linked to many serious conditions such as hypertension, cancer, and numerous other health problems. What you may not know is that stress also is a risk factor for periodontal disease. Research demonstrates that stress can make it more difficult for the body to fight off infection, including periodontal diseases.

• Clenching- clenching or grinding your teeth can put excess force on the supporting tissues of the teeth and could speed up the rate at which these periodontal tissues are destroyed.

• Poor Nutrition- as you may already know, a diet low in important nutrients can compromise the body's immune system and make it harder for the body to fight off infection. Because periodontal disease is a serious infection, poor nutrition can worsen the condition of your gums

If left untreated, periodontitis causes progressive bone loss around teeth, looseness of the teeth and eventual tooth loss.

Research is also pointing to possible health effects of periodontal diseases that go well beyond your mouth. Studies are ongoing to try to determine whether there is a cause-and-effect relationship between periodontal disease and:

• an increased risk of heart attack or stroke,
• an increased risk of delivering preterm, low birth weight babies,
• difficulty controlling blood sugar levels in people with diabetes.

In the meantime, it's a fact that controlling periodontal disease can save your teeth -- a very good reason to take care of your teeth and gums.

People usually don't show signs of gum disease until they are in their 30s or 40s.  Men are more likely to have periodontal disease than women.  Although teenagers rarely develop periodontitis, they can develop gingivitis, the milder form of gum disease.  Most commonly, gum disease develops when plaque is allowed to build up along and under the gum line.

Dentists or dental hygienists "measure" periodontal disease using a device called a periodontal probe. This is a thin "measuring stick" that is gently placed into the space between the gums and the teeth, and slipped below the gum-line. If the probe can slip more than 3 millimeters length below the gum-line, the patient is said to have a "gingival pocket" around that tooth. It is generally accepted that pockets are self-cleansable (at home, by the patient, with a toothbrush) if they are 3 mm or less in depth. This is important because if there is a pocket which is deeper than 3 mm around the tooth, at-home care will not be sufficient to cleanse the pocket, and professional care should be sought. When the pocket depths reach 5, 6 and 7 mm in depth, even the hand instruments and cavitrons used by the dental professionals cannot reach deeply enough into the pocket to clean out the bacterial plaque that cause gingival inflammation. In such a situation the pocket or the gums around that tooth will always have inflammation which will likely result in bone loss around that tooth. The only way to stop the inflammation would be for the patient to undergo some form of gingival surgery to access the depths of the pockets and perhaps even change the pocket depths so that they become 3 or less mm in depth and can once again be properly cleaned by the patient at home with his or her toothbrush.

If a patient has 5 mm or deeper pockets around their teeth, then they would risk eventual tooth loss over the years. If this periodontal condition is not identified and the patient remains unaware of the progressive nature of the disease then, years later, they may be surprised that some teeth will gradually become loose and may need to be extracted, sometimes due to a severe infection or even pain.

The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home.

Additionally, modifying certain behaviors, such as quitting tobacco use, might also be suggested as a way to improve treatment outcome.
Deep Cleaning (Scaling and Root Planing)

The dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. Anesthetic is usually required so we can get below the gum line without the patient experiencing root sensitivity. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the patient cannot reach, and helps remove bacteria that contribute to the disease.
Medications

Medications may be used with treatment that includes scaling and root planing, but they cannot always take the place of surgery. Depending on the severity of gum disease, the dentist or periodontist may still suggest surgical treatment. Long-term studies will be needed to determine whether using medications reduces the need for surgery and whether they are effective over a long period of time. Here are some medications that are currently used: