In the broadest sense, the term gum disease—or periodontal disease—describes bacterial growth and the production of factors that gradually destroy the tissue surrounding and supporting the teeth. Untreated gum disease can become very serious, causing teeth to become loose or fall out.
Gum disease begins with plaque, which is always forming on your teeth, without you even knowing it. When it accumulates to excessive levels, it can harden into a substance called tartar (calculus). Tartar is so tightly bound to teeth that it can only be removed by professional cleaning.
Gingivitis and periodontitis are the two main stages of gum disease. Each stage is characterized by what a dentist sees and feels in your mouth, and by what's happening under your gumline. Although gingivitis usually precedes periodontitis, it's important to know that not all gingivitis progresses to periodontitis.
With periodontitis, gums become weakened and form pockets around the base of the teeth. Bacteria pool in these pockets, causing further destruction of the gums. As periodontitis spreads, it damages deeper gum tissue and can eventually spread to areas of the jawbone that support the teeth. This can cause teeth to become loose and fall out. If it's not treated, it can cause real trouble for your teeth.
Although the symptoms of periodontal disease often are subtle, the condition is not entirely without warning signs. Certain symptoms may point to some form of the disease. They include:
- gums that bleed during and after brushing
- red, swollen or tender gums
- persistent bad breath or bad taste in the mouth
- receding gums
- formation of deep pockets between teeth and gums
- loose or shifting teeth
- changes in the way teeth fit together on biting, or in the fit of partial dentures
Even if you don't notice any symptoms, you may still have some degree of gum disease. Some people have gum disease only around certain teeth, such as those in the back of the mouth, which they cannot see. Only a dentist or a periodontist—a dentist who specializes in gum disease—can recognize and determine the progression of gum disease.
Treatments range from non-surgical therapies that control bacterial growth to surgery to restore supportive tissues:
- Professional dental cleaning. During a typical check-up your dentist or dental hygienist will remove the plaque and tartar (plaque that builds up and hardens on the tooth surface and can only be removed by professional cleaning), from above and below the gumline of all your teeth. If you have signs of gum disease, your dentist may recommend professional dental cleaning more than twice a year.
- Scaling and root planing. This is a deep-cleaning, non-surgical procedure, done under local anesthetic, whereby plaque and tartar from above and below the gumline are scraped away (scaling) and rough spots on the tooth root are made smooth (planing). Smoothing the rough spots removes bacteria and provides a clean surface for the gums to reattach to the teeth. Scaling and root planing is done if your dentist or periodontist determines that you have plaque and calculus (hardened plaque, also called tartar) under the gums that needs to be removed.
- Flap surgery/pocket reduction surgery. During this procedure the gums are lifted back and the tarter is removed. In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. The gums are then placed so that the tissue fits snugly around the tooth. This method reduces the size of the space between the gum and tooth, thereby decreasing the areas where harmful bacteria can grow and decreasing the chance of serious health problems associated with periodontal disease.
- Bone grafts. This involves using fragments of your own bone, synthetic bone or donated bone to replace bone destroyed by periodontal disease. The grafts serve as a platform for the regrowth of bone, which restores stability to teeth. New technology, called tissue engineering, encourages your own body to regenerate bone and tissue at an accelerated rate.
- Soft tissue grafts. This procedure reinforces thin gums or fills in places where gums have receded. Grafted tissue, most often taken from the roof of the mouth, is stitched in place, adding tissue to the affected area.
- Guided tissue regeneration. Performed when the bone supporting your teeth has been destroyed, this procedure stimulates bone and gum tissue growth. Done in combination with flap surgery, a small piece of mesh-like fabric is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow to better support the teeth.
- Bone surgery. Smoothes shallow craters in the bone due to moderate and advanced bone loss. Following flap surgery, the bone around the tooth is reshaped to decrease the craters. This makes it harder for bacteria to collect and grow.
In some patients, the non-surgical procedure of scaling and root planing is all that is needed to treat gum diseases. Surgery is needed when the tissue around your teeth is unhealthy and cannot be repaired using non-surgical options.