What is periodontal disease?

So Dr. B, my mom went to the dentist the other day because she’s complaining of her teeth hurting and feeling like they’re loose and when she went they told her that she had periodontal disease, what in the world is that.

Periodontal disease first of all is gum disease, that’s what most people call it.  Most people don’t understand or realize that gum disease is the number one cause of the loss of teeth in adults.  The bad thing about gum disease is that it doesn’t hurt.  If gum disease hurt, we would be seeing people all the time complaining.  About 75% of the adults in the United States have some form of gum disease in their mouth and it’s been my experience that about 90% of those people don’t even know about gum disease or the fact that it’s in their mouth.  So if you’d like you could have your mom come over and we could do a consultation with her.  We have several non-surgical approaches to treating gum disease.  I can tell her the whole story of gum disease.

Is that something that I should be concerned about since she has it?

That’s one of the myths in dentistry, my mom lost all of her teeth at 20 because of gum disease so I’m doomed to lose my teeth, when in fact gum disease is caused by bacteria that live in our mouths naturally.  There is a mild genetic component to it, but almost all gum disease is caused by poor oral hygiene or not going to the dentist and getting your teeth cleaned regularly.

Would you like to know more?  I have a visual I can show you.

Sure.

So Amelia, these are photographs that explain gum disease.

Let’s start at the top. This first row is normal health gums and bone.  The gums are nice and pink, they are a coral pink.  We don’t see any puffiness or bleeding.  If you look at the x-ray over here, this gray stuff around here, this is the bone that actually holds your teeth in place. You can see the bones right up around the necks of the teeth. That’s all normal. So this is normal and healthy, when this patient brushes and flosses, they see no blood on their floss or tooth brush.

The first step of gum disease then is caused by bacteria building up on our teeth and that’s called plaque.  Those bugs make a sticky gooey substance that allows them to stick to our teeth and our gums.  So that’s the first stage of gum disease.  You can see the gums are bit swollen, they look a little red and the gums will readily bleed when you brush or floss.  So if your gums bleed when you brush or floss, you have gum disease.  More than likely it’s gingivitis.  That’s what we call gum disease when it’s just in the gums.  If we look at an x-ray of a person with gingivitis, you can see the bone is still normal, so the bone has not been infected.

Periodontal disease goes in stages.  It starts with gingivitis, that’s just in the gums and then left untreated will move to the bone that holds the teeth in. That’s what’s going on with your mom. If her teeth are getting loose, that means that she’s loosing bone around her teeth.  It’s just a matter of how much bone has she lost.

So that’s what these lower photographs are showing.  This is when the gum disease is starting to move from the gum tissue itself into the bone that holds the teeth in.  You can see here you start to see little pits in the bone.  You see the gums starting to recede a little bit, it’s kind of puffy looking. So that’s type 2 gum disease.  Left untreated it moves on.  The sad thing is, it never hurts until it’s too late.

So left untreated for a few years, you can see now on this ray the bone has really started to disappear around the teeth.  About half of the bone is gone and generally when you start to get a half or more the bone, that’s when the teeth start to get loose.  If you look right here on this picture, you’ll see a white chalky substance.  That’s what most people call tarter or calculus.  Tarter and calculus are actually colonies of bacteria.  Those bugs have been living on that tooth so long that they’ve picked up calcium from the saliva and now they’re calcified onto the tooth and they’re kind of like barnacles.  So once this stuff forms on your teeth, you could brush your teeth 100 times a day and floss your teeth 50 times a day, it’s not coming off.

So those bacteria are living there 24 hours a day, 7 days a week.  So every time that you eat, they take the food that you eat and they turn that food into acids and toxins.  It’s those acids and toxins that cause the bone to slowly disappear.  In fact if you look at this x-ray right here, you’ll see these little bumps on the root, those are actually colonies of bacteria, they picked up calcium, they calcified onto the root now, and they’re what’s causing all of this bone to be lost around this tooth.  And that’s the end result of gum disease, is the bone is all gone and now the tooth has to be removed.

People talk about the domino effect of gum disease and that’s what’s going on here, this root of this tooth has lost so much bone, now it’s caused bone loss on the tooth in front of it. So this tooth needs to be removed.

So gum disease is very treatable.  It can be controlled but not cured, because it’s the bacteria that live in our mouths naturally that cause gum disease, so the whole idea is keep the bacteria off of your teeth.  You do that with routine teeth cleaning.  So in order to treat gum disease, what we do is we want to get rid of the cause, and that’s these bugs that are living on the roots of the teeth, we want to get all of them off, nice an clean.  Then your body will have a chance to heal itself.

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