Periodontal disease, or gum disease, is a serious infection caused by harmful bacteria in the plaque that forms on teeth. In the United States, approximately 35% of adults have some form of gum disease involving bone loss, while 13% of adults have a moderate-to-severe level of gum disease.

When gum disease occurs, supporting tissue and bone around the teeth are destroyed, forming “pockets” around the teeth. This can result in tooth loss if left untreated. It may also lead to acute (sudden) infections and tooth decay.

Diagrams of gingivitis, mild periodontitis, and advanced periodontitis

What are the symptoms of gum disease?

Gum disease is normally a “silent” disease, not causing any pain. Warning signs of gum disease can include persistent red, bleeding, and swollen gums. Other symptoms include:

1. Bleeding of the gums during brushing or flossing
2. Occasional swelling or tenderness of the gum, although frequently with no accompanying pain
3. Drainage (pus) between teeth and gums
4. Persistent bad breath
5. Receding gums, making the teeth appear longer than before
6. Development of spaces between the teeth
7. Changes in the way teeth fit together when biting

Many scientific studies have found that gum disease may also affect overall health due to the passing of harmful bacteria and bacterial toxins into the bloodstream. Research indicates that gum disease may increase the risk for heart attack and stroke. For individuals with diabetes, periodontal disease may have a negative effect on glycemic control (control of blood sugar). For pregnant women, periodontal disease may increase the likelihood of premature and low birth weight. It is important to take action quickly to protect your gums, teeth, and health.

How is gum disease treated?

The treatment of advanced periodontal (gum) diseases usually involves three phases of treatment:

1. Initial periodontal therapy (non-surgical scaling and root planing) to remove the cause of gum disease
2. Periodontal corrective procedures (periodontal surgery and regeneration) to correct the damaged bone and gum tissues
3. Periodontal maintenance (specialized cleanings, usually every three months) to help prevent re-infection of the gums

Initial periodontal therapy

Scaling and root planing is the thorough cleaning of the root surfaces to remove plaque, calculus (tartar), and bacteria. It also involves the smoothing of root surfaces to retard recurring build-up and allow for reattachment of the gingiva (gum tissues). Scaling and root planing is performed under local anesthesia (numbing) using ultrasonic and hand scaling instruments. Antibiotics (locally applied or oral medication) are also used in certain situations to assist in the healing process. Initial therapy is performed in the general dentist’s or the periodontist’s office. Following initial periodontal therapy, a follow-up with the doctor will occur after approximately one month’s time to check the progress of initial treatment.

Periodontal corrective procedures

In areas of severe periodontal (gum) disease, “pockets” will still exist following initial therapy. These pockets are too deep to clean with daily home care and a professional care routine. They will continue to collect bacteria and result in further bone and tissue loss.

We may recommend a pocket reduction procedure (periodontal surgery). During this procedure, the gum tissue is moved back and the disease-causing bacteria is removed. Irregular surfaces of the damaged bone are also smoothed to limit areas where disease-causing plaque can hide, allowing the gum tissue to better attach to healthy bone. Sutures are placed at the end of the procedure. Reducing pocket depth and eliminating harmful bacteria are necessary to prevent further damage to the bone and loss of the teeth.

In areas of severe gum disease, it may be possible to regenerate or re-grow the bone supporting teeth. This is done during periodontal surgery with the use of membranes (filters), bone grafts, or growth factors to encourage your body’s natural ability to regenerate bone and supporting tissues.

Periodontal maintenance

While there have been significant advancements in periodontal therapy, there is no cure for gum disease. Even after successful, corrective therapy and surgical intervention, your gum disease can recur. For the majority of patients with periodontal disease (~90%), regular periodontal maintenance cleanings have proven to be effective in preventing the recurrence of gum disease. This phase is an essential part of treatment. Often, this can be the most important part of your therapy.

At each periodontal maintenance visit, we will review your medical history, noting any compromised health conditions (i.e. diabetes, cardiovascular disease, pregnancy, or immunosuppressive disorders) that can affect the stability of your periodontal condition. We will also perform an oral cancer exam, measure your pocket depths and note any bleeding sites, and review your plaque control effectiveness. We will also thoroughly scale and remove plaque and tarter buildup, accessing those areas where you can’t reach just by brushing and flossing.

At the end of your maintenance appointment, we will customize a “plan of attack” based on your needs to aid you in preserving your healthy, natural smile.