Good oral care at home is important for everyone. Brushing twice a day and flossing helps remove bacteria and food particles from the teeth and gums. When you think about bettering your health, exercising regularly and eating more vegetables probably come to mind. But taking better care of your teeth and gums should also be on the list. A good brushing and flossing routine coupled with regular dental cleanings and visits can help prevent or treat periodontal disease, which is a progressive condition that affects the teeth and jawbone.

Untreated periodontitis can cause serious health problems, such as heart disease, stroke, respiratory diseases and diabetes. It can also increase the risk of preterm birth and low birth weight babies.

Causes

Bacteria found in plaque irritate and inflame the gum tissue, causing gingivitis. Untreated gingivitis progresses to periodontitis, wherein the gum tissues separate from the teeth and form pockets that harbor harmful bacteria. Toxins produced by these bacteria irritate the tissues and trigger a chronic inflammatory response in which the tissues and bone are broken down and destroyed.

Other risk factors for periodontitis include smoking, certain health conditions such as diabetes or a weakened immune system, and physical irregularities such as crooked teeth, poorly fitted restorations (dentures, crowns, bridges), or tooth roots that extend beyond the gum line. Genetics and hormone changes — especially during pregnancy and menopause — can also increase a person’s susceptibility to periodontitis.

Symptoms

In the beginning, gum disease presents as gingivitis. This is a mild inflammation of the gums caused by an increase in bacteria and a shift from harmless to harmful types. The bacteria irritate the gum tissue and create a sticky film on the teeth called plaque. Over time, plaque grows and hardens into tartar. When this occurs, pockets develop between the teeth and gums. These pockets fill with bacteria and trigger an immune response that destroys bone and connective tissue around the teeth.

Symptoms of gum disease include bright red or dark purple gums that bleed easily, bad breath that won’t go away, loose teeth and changes in the way your teeth fit together when you bite. In advanced gum disease, the teeth become loose and eventually fall out. In addition, the bacteria can spread to other parts of the body, triggering a chronic inflammatory response that can damage internal organs such as the heart and liver.

Diagnosis

A periodontal disease diagnosis begins with your dentist examining your teeth and gums. During this examination, the dentist will look for signs of gingivitis or chronic periodontitis.

Bacteria from plaque build up in your mouth over time, forming a sticky substance called tartar that covers the teeth. The toxins in this bacteria cause irritation to your gums and over time break down your tissue and bone. This loss of tissue and bone around your teeth creates pockets that become infected and deepen over time. These pockets can trap food and allow harmful anaerobic (non-oxygenating) bacteria to grow in the space. The bacterial growth destroys the tooth, and eventually the gum, causing it to pull away from the root.

During your exam, the dentist will use a tiny ruler called a probe to measure the depth of these pockets. They may also take X-rays of your mouth to observe the degree of bone loss due to periodontitis. They will ask you about your medical history, and whether there are any conditions or medications that increase your risk for gum disease.

Treatment

If you have gingivitis — the first stage of periodontal disease, which causes your gums to become red and swollen and may bleed when you brush or floss — nonsurgical treatments are available. These include a deep cleaning technique called scaling and root planing that removes tartar both above and below the gum line, along with rough spots on the tooth roots where bacteria collect. This allows your gum tissue to heal.

If left untreated, gingivitis can progress to periodontitis, which destroys the bone and tissue that support your teeth. In this stage, your gum pockets may get deeper, and your teeth may become loose or fall out.

If you have advanced gum disease, your dentist may recommend more invasive treatment options such as bone or tissue grafts. You will also need to commit to consistent, diligent oral hygiene practices at home, including daily brushing and flossing, and regular visits to the dentist or dental hygienist for professional cleanings.