What is periodontal (gum) disease?

Periodontal disease is the major cause of tooth loss in adults world-wide. The word periodontal can be broken down to "perio " from the Greek word for "around " and "dontal " referring, of course, to the tooth itself. So, just what IS around the tooth? The first thing we can see is the gums. Underlying this is bone -- which acts to support and stabilize the teeth. There are actually two types of gum tissue: attached and unattached (dentists often refer to the latter as free or marginal tissue). Attached gingiva is, as the name implies, firmly attached to the underlying bone (Gingiva is what dentists call gums). Marginal tissue is not attached.  If you can recall having a dentist probe your gums and take gum readings, he is actually measuring the distance from the crest of the free-standing or unattached marginal tissue to the point where it is attached to the bone. If plaque becomes trapped in this narrow space or "pocket " the marginal gingiva (or gums) become inflamed. This first stage of gum disease is referred to as gingivitis.

Symptoms of gingivitis can include red gums and bleeding -- most often noticed when brushing or flossing -- but very often patients are entirely unaware of any symptoms at all. If allowed to go unchecked, gingivitis can lead to to more swelling and a deeper gum pocket. The attachment mechanism (called periodontal ligament) generally responds to this inflammation by breaking down and migrating further along the root. This, in turn, stimulates bone loss and deeper pockets that are even harder to clean. Because of this added challenge, the plaque remains trapped in the pockets and hardens into calculus (also called "tartar "). Calculus is quite irritating, which leads to still more inflammation and bone loss. At this point, we have a condition called periodontitis.

In a technical sense, this is really what periodontal disease is about -- bone loss. When a patient loses enough bone they can lose the tooth. Periodontal disease can be limited to small areas or it can occur throughout the mouth. Once lost, the bone does not grow back.Often, it is the lack of perceptible symptoms that gets people into trouble. This is just one reason why dentists recommend a dental examination which includes a periodontal screening every six months. In my Philadelphia dental office, many patients will maintain their periodontal condition with cleanings as often as every three months, finding that doing so keeps their problems in check while also helping them to avoid more painful, and expensive, surgeries.