In the broadest sense, the term gum disease — or periodontal disease — describes bacterial growth and production of factors that gradually destroy the tissue surrounding and supporting the teeth. “Periodontal” means “around the tooth.”
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) in as little as 24 hours. Tartar is so tightly bound to teeth that it can be removed only during a 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.
In the early stage of gingivitis, the gums can become red and swollen and bleed easily, often during toothbrushing. Bleeding, although not always a symptom of gingivitis, is a signal that your mouth is unhealthy and needs attention. The gums may be irritated, but the teeth are still firmly planted in their sockets. No bone or other tissue damage has occurred at this stage. Although dental disease in America remains a serious public health concern, recent developments indicate that the situation is far from hopeless.
Frederick N. Hyman, D.D.S., a dental officer in the FDA’s dermatologic and dental drug products division, says that because people seem to be paying more attention to oral hygiene as part of personal grooming, the payoff is “a decline in gingivitis over recent years.” Hyman adds that “gingivitis can be reversed in nearly all cases when proper plaque control is practiced,” consisting, in part, of daily brushing and flossing.
When gingivitis is left untreated, it can advance to periodontitis. At this point, the inner layer of the gum and bone pull away from the teeth (recede) and form pockets. These small spaces between teeth and gums may collect debris and can become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gumline. Bacterial toxins and the body’s enzymes fighting the infection actually start to break down the bone and connective tissue that hold teeth in place. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed.
At this point, because there is no longer an anchor for the teeth, they become progressively looser, and the ultimate outcome is tooth loss.