Why should I care about gum disease?

While oral hygiene habits can play a vital role in increasing your risk of gum disease, the CDC explains that other factors — like genetics, lifestyle and preexisting conditions — can also contribute to your risk. These include:

• Smoking.
• Diabetes.
• Stress.
• Heredity.
• Crooked teeth.
• Defective fillings or bridges that no longer fit.
• Underlying immune deficiencies.
• Certain medications that cause dry mouth.
• Factors that cause hormonal changes, such as pregnancy or oral contraceptives.

Did you know your mouth is full of bacteria? Some of these bacteria are healthy, while others are harmful and contribute to decay. When bacteria accumulate on your teeth, they form a layer, or biofilm, commonly referred to as plaque. This biofilm likes to make its home around your gum line and, left untreated, can cause your gums to pull away from your teeth, where more bacteria can accumulate. Eventually, deep pockets can form between your gums and teeth, leading to bone loss and inflammation throughout your body. It’s important to understand that gum disease is an active infection. You must appropriately treat gum disease just like you would if you had an infection in any other part of your body.

Gum disease is usually painless in the early stages, so many are not aware they have a problem until it becomes much more advanced. Some of the warning signs may include:

• Gums that bleed easily.
• Gums that are red, swollen or tender.
• Gums that have pulled away from the teeth.
• Persistent bad breath or bad taste.
• Permanent teeth that are loose.
• Changes in bite.
• Changes in how partial dentures fit in your mouth.

Gum disease begins with a milder form called gingivitis. Gingivitis is marked by red, swollen gums with bleeding. At this stage, the disease is still reversible. Committing to twice-daily brushing and flossing, along with twice-yearly professional dental cleanings, can nip the problem in the bud. Your hygienist may recommend specific items you can use at home, such as electric toothbrushes, water flossers and mouth rinses.

If gum disease progresses beyond gingivitis to the more severe form of periodontitis, it is no longer reversible. Periodontitis means that deep pockets have formed at your gum line where thick plaque deposits and bacteria are accumulating, causing bone loss and inflammation throughout your body. Regular brushing and flossing cannot reach into the depths of these pockets. Depending on the severity of your periodontitis, you may have receding gums and loose or missing teeth. While periodontitis cannot be reversed, proper treatment can help get the infection under control to prevent it from progressing even further.

Your dental team will diagnose gum disease based on a combination of X-rays, disease history, the existence of any missing teeth, and gum measurements. You may have felt your hygienist poke at your gums and calling out a series of numbers. What they are doing is measuring the space between the gum and tooth (called the pocket depth) with a dental probe that looks like a ruler. 

In addition to pocket depths, your hygienist will check for the levels of bleeding and plaque, as well as whether the gums are receding from the teeth and whether the teeth are moving. Each of these markers contributes to a diagnosis of gum disease.

When you are diagnosed with gum disease, your hygienist will also determine a stage and grade level based on a system developed by the American Academy of Periodontology. The stage determines how severe and extensive your gum disease is based on the amount of damaged gum tissue. The grade tells you how quickly the disease will progress and how well it will respond to therapy based on lifestyle factors like smoking and medical conditions like diabetes.

Stage 1

Stage 2

Stage 3

Stage 4

Grades

Grade A

Slow rate of progression

Grade B

Moderate rate of progression

Grade C

Rapid rate of progression

Depending on your specific case, your treatment plan may include multiple methods for controlling gum disease. These can include:

Preventative cleaning and fluoride every six months. If your gums are generally healthy, your hygienist will recommend a regular cleaning every six months. “Regular” cleanings are preventative. You can compare your six-month dental cleaning to visiting your medical doctor for a preventative wellness checkup — you and your doctor check to make sure there are no major issues that need attention, and catch minor issues before they become bigger problems. During a regular dental cleaning, we’re doing the same thing for your teeth and gums. The goal of these visits is to keep teeth and gums healthy to prevent gum disease from happening in the first place.

Gingivitis therapy. This is a specialized cleaning performed when gingivitis, the milder form of gum disease, is present. Generally, this cleaning is given when there is more than 30% bleeding present to reduce inflammation and promote healing.

Gum therapy. Also known as scaling and root planing, gum therapy is a specialized cleaning performed when infection is present and has reached the supporting bone. An ultrasonic instrument is used to gently remove deposits and bacteria under the gums and at the base of the deep pockets that have formed. Removing deposits and bacteria is necessary to control the infection and prevent further bone loss around the teeth. This treatment helps to decrease inflammation throughout the body. Local anesthesia is sometimes given for comfort.

Periodontal maintenance treatment. When you have periodontitis, preventative cleanings every six months are no longer appropriate. Because the aggressive bacteria involved in periodontitis colonize quickly, ongoing maintenance therapy every three months is needed to help stop the progression of the disease. Periodontal treatment includes many of the same aspects of a regular cleaning, like plaque removal and polishing. An ultrasonic instrument is used to gently remove deposits and bacteria under the gums and at the base of the deep pockets that have formed.

Localized antimicrobial placement. This is a time-released antibiotic that fights infection-causing bacteria. The antibiotic is in the form of a gel and is placed on the infected area. Over time, the gel will aid in healing.

Laser therapy. Laser therapy involves using a targeted heat and light wavelength that kills harmful bacteria to reduce disease and promote healing. It safely removes damaged tissues and gets rid of plaque deposits, encouraging reattachment of the gums to the teeth.