How gum disease starts

Plaque is a soft film of bacteria that forms on teeth constantly. If it is not removed, it begins taking up minerals from saliva and hardening into calculus, also called tartar. That hardening usually starts within one to three days and continues over the days and weeks that follow. Calculus bonds to the tooth, brushing does not remove it, and its rough surface holds still more bacteria against the gum.

The gum responds with inflammation. It reddens, swells and bleeds when it is disturbed. At this stage the changes are confined to soft tissue and the bone is still intact, which is gingivitis. Remove the deposits, keep the area clean daily, and the tissue can return to health. That stage is generally reversible.

If deposits remain below the gum margin, inflammation can continue for months. The fibers holding gum to root break down, the bone anchoring the tooth resorbs, and the groove around it deepens into a pocket that no brush or floss can reach. That stage is periodontitis.

Much of the destruction comes from the body's own immune response rather than from the bacteria alone, which is part of why two people with similar plaque can have very different outcomes. Bone that has been lost usually does not rebuild on its own, though regenerative procedures and grafting can restore some of it in selected defects. The main aim of treatment is to stop the process and keep the teeth.

Gingivitis and periodontitis

The two words are often used interchangeably. The difference determines what treatment is needed and what to expect from it.

Consideration Gingivitis Periodontitis
What is involved The gum tissue only. The fibers and bone holding the tooth are intact. The attachment fibers and the bone that hold the tooth in the jaw.
What you notice Redness, puffiness, bleeding when you brush or floss, often bad breath. The same, plus receding gums, teeth that look longer, root sensitivity, teeth that drift or loosen.
Can it be reversed Usually yes. With the deposits removed and daily cleaning, the tissue can return to health. Not in the same way. Lost bone does not generally rebuild on its own, though grafting and regenerative procedures can restore some of it in selected sites. The disease can usually be arrested and the teeth kept.
What treatment involves A thorough cleaning and a genuine change in daily home care. Scaling and root planing, a re-evaluation, then maintenance at a shorter interval.

Risk factors for gum disease

Plaque is necessary for gum disease, but it is not the only factor. Whether inflammation progresses to bone loss depends on the rest of the picture, including diet, saliva, medications and genetics as well as how you clean.

  • Smoking and other tobacco use. This is one of the largest modifiable risks. It can make the disease worse and healing slower, and nicotine constricts the vessels in the gum so it bleeds less. Gums can look healthier at the margin while more is happening underneath.
  • Diabetes. The relationship runs both ways. High blood sugar can make gum infection more likely and more severe, and active gum infection can make blood sugar harder to control.
  • Family history. Some people mount a more destructive response to the same amount of plaque. If a parent lost teeth to gum disease rather than to decay, that history is relevant and should be mentioned.
  • Medications. Some blood pressure, anti-seizure and immune-suppressing drugs can cause gum overgrowth that traps plaque. Many more cause dry mouth, and saliva is one of the mouth's main defenses. Your pharmacist or physician is the right person to ask about anything you are taking.
  • Stress and broken sleep. Both can alter the immune response, and daily routines often lapse during difficult periods.
  • Hormonal change. Puberty, pregnancy and menopause can all make gum tissue react more strongly to the same plaque.
  • Crowded or overlapping teeth. Some areas are genuinely difficult to clean regardless of technique, and old fillings with overhanging edges create the same problem.
  • A previous history of periodontitis. Past breakdown is one of the better predictors of future breakdown, which is why earlier charts are valuable.

No single factor settles anything on its own. Together they help determine how often we measure and how actively we treat, which is the purpose of charting.

Gum disease and adult tooth loss

Gum disease is a leading cause of adult tooth loss. A tooth can be free of decay and perfectly comfortable and still be at risk, because the bone holding it has gradually been lost. Decay is also a major cause of tooth loss in adults, and the two often appear in the same mouth, which is one reason routine examinations look at both.

The early changes are easy to overlook. Bleeding while cleaning, a tooth that looks slightly longer than it used to, or gums that feel a little tender can all seem minor at the time, and by the point a tooth feels loose a good deal of its support has usually gone. Having the gums measured is what turns those small signs into information that can be acted on.

When a tooth cannot be kept, it can often be replaced. Dental implants and dentures and partials both restore function and appearance, and each suits different situations. Neither is identical to a natural tooth, and an implant sits in the same mouth with the same bacteria, so gum health still matters afterward.

How periodontal care is provided here

Dr. Robert J. Brosi, DDS provides non-surgical periodontal treatment as a general dentist. Treatment and maintenance are provided here, and cases that need surgical or specialist care are referred to a periodontist. More about Dr. Brosi and our team.

Understanding it
What gum disease is, the signs that tend to appear first, why it often remains painless for so long, and what the research does and does not say about the links to general health.
Diagnosis
Measured charting rather than visual inspection alone. Six readings around every tooth, bleeding points, recession, mobility, and bone levels compared against your earlier x-rays.
Treatment
Scaling and root planing under local anesthetic, usually a quadrant at a time, followed by a re-evaluation about four to six weeks later.
Maintenance
Periodontal maintenance, often every three or four months rather than every six, because treated pockets can rebuild bacteria well before six months have passed. The interval is reviewed as your readings change.

Common questions about gum disease

How do I know if I have gum disease?

Watch for bleeding when you brush or floss, breath that does not improve after cleaning, gums that look puffy or have pulled back, and teeth that look longer or have moved. Symptoms alone do not provide an answer. The condition is diagnosed by measuring the pockets around every tooth.

Can gum disease be cured?

Gingivitis can usually be reversed, because nothing structural has been lost. Periodontitis is generally managed rather than cured, since bone that has been lost does not usually rebuild on its own, although grafting and regenerative procedures can restore some of it in selected sites. Treatment aims to stop the process and maintain that state, which for many people means keeping their teeth.

Is gum disease linked to heart disease and diabetes?

Research has repeatedly found associations between periodontitis and cardiovascular disease, poorly controlled diabetes and adverse pregnancy outcomes. Those associations merit attention. They are not proof that treating your gums prevents those conditions, and the evidence on that question is still developing. The link with diabetes is better understood than the others, and it appears to run both ways.

Do I have to see a periodontist?

Often not. Much non-surgical gum treatment is done in a general dental office. When pockets stay deep after thorough treatment, or when surgery is the answer, we refer you to a periodontist and stay involved in your general care.

In this area of treatment

Each of these has its own page with the detail that does not fit here.

  • What Is Periodontal (Gum) Disease?

    A bacterial infection of the gums and bone that supports the teeth, usually painless in its early stages.

  • Periodontal Diagnosis

    Measured pocket depths, bleeding points and bone levels that support a specific periodontal diagnosis.

  • Periodontal Treatment

    Deep cleaning below the gumline to remove the bacterial deposits that sustain the infection.

  • Periodontal Maintenance

    The ongoing three to four month recall that helps keep treated gum disease from returning.