What Is Periodontal Disease?

If your hands bled when you washed them, you would be concerned. Yet, many people think it’s normal if their gums bleed when they brush or floss. In a 1999 study, researchers at the U.S. National Institutes of Health (NIH) found that half of Americans over 30 had bleeding gums.

Swollen and bleeding gums are early signs that your gums are infected with bacteria. If nothing is done, the infection can spread. It can destroy the structures that support your teeth in your jawbone. Eventually, your teeth can become so loose that they have to be extracted.

“Peri” means around, and “odontal” refers to teeth. Periodontal diseases are infections of the structures around the teeth. These include the gums, the cementum that covers the root, the periodontal ligament and the alveolar bone. In the earliest stage of periodontal disease, gingivitis, the infection affects only the gums. In more severe forms of the disease, all of the supporting tissues are involved.

For many years scientists have been trying to figure out what causes periodontal disease. It is now well accepted that bacteria in dental plaque are the major villains. Researchers also are learning more about how an infection in your gums can affect your overall health.

In recent years, gum disease has been linked to other health problems. This is a new and exciting area of research. Many questions remain. Studies have produced varying answers about how much of a connection exists between gum disease and other medical problems. More research is needed.

Researchers are studying possible connections between gum disease and:

• Atherosclerosis and heart disease — Gum disease may increase the risk of clogged arteries and heart disease. It also is believed to worsen existing heart disease.
• Stroke — Gum disease may increase the risk of the type of stroke that is caused by blocked arteries.
• Premature births — A woman who has gum disease during pregnancy may be more likely to deliver her baby too early. The infant may be more likely to be of low birth weight.
• Diabetes — Diabetic patients with periodontal disease may have more trouble controlling their blood sugar than diabetic patients with healthy gums.
• Respiratory disease — Bacteria involved in gum disease may cause lung infections or worsen existing lung conditions. This is particularly important for elderly adults in institutions such as nursing homes. In this group, bacteria from the mouth may reach the lungs and may cause severe pneumonia.

What Causes Periodontal Disease?

Periodontal disease is caused by bacteria in dental plaque. Plaque is the sticky substance that forms on your teeth soon after you have brushed. In an effort to get rid of the bacteria, the cells of your immune system release substances that inflame and damage the gums, periodontal ligament or alveolar bone. This leads to swollen, bleeding gums, a sign of gingivitis (the earliest stage of periodontal disease). Damage from periodontal disease also can cause teeth to become loose. This is a sign of severe periodontitis (the advanced stage of disease).

You can prevent periodontal disease by practicing good oral hygiene and visiting your dentist regularly. Most people should see the dentist about once every six months. But if you already have gum disease you may need to visit more often.

Daily brushing and flossing, when done correctly, can help to remove most of the plaque from your teeth. Professional cleanings by your dentist or dental hygienist will keep plaque under control in places that are harder for a toothbrush or floss to reach.

If oral hygiene slips or you skip dental visits, plaque builds up on the teeth. Eventually, it spreads below the gum line. The bacteria are protected there because your toothbrush can’t reach them. If plaque is not removed, the bacteria will continue to multiply. Your gum inflammation may get worse.

The buildup of plaque below the gumline causes the gums to become inflamed. As the gums swell, they detach from the tooth. This process forms a space, or “pocket,” between the tooth and gum. Bacteria can grow rapidly in the pockets. This encourages further plaque buildup.

If left untreated, periodontal disease may destroy the periodontal ligament and the alveolar bone, the structures that support your teeth.

Another reason to remove plaque promptly is that over time it becomes hardened or calcified and turns into calculus. This is commonly called tartar. Even more plaque attaches to calculus because it’s a rougher surface than tooth enamel. It’s also rougher than cementum, a layer that covers the tooth root. Calculus and plaque build up in layers.

Using a tartar-control toothpaste may help slow the build-up of calculus around your teeth. It can’t affect the tartar that already has formed below the gum line, however.

Risks and Prevention

The bacteria in plaque are the main cause of periodontal disease. But several other factors also can contribute. They include other diseases, medicines and oral habits. These factors can increase your risk of gum disease or make it worse once the infection has set in.

• Genes — Some people are more likely than others to get periodontal disease because of their genes. But your genes do not make gum disease inevitable. Even people who are highly prone to periodontal disease can prevent or control the disease with good oral care.
• Smoking and tobacco use — Smoking increases the risk of periodontal disease. The longer you smoke, and the more you smoke, the higher the risk. If you have periodontal disease, smoking makes it more severe. Smoking is a major reason that some cases of periodontal disease are resistant to treatment. Smokers tend to collect more tartar on their teeth. They often develop deeper periodontal pockets once they have gum disease. They also are likely to lose more bone as the disease gets worse. Unlike many other factors that affect the health of your gums, the decision to smoke or not is under your control. Quitting smoking can play a major role in bringing periodontal disease under control.
• Misaligned or crowded teeth, braces or bridgework — Anything that makes it more difficult to brush or floss your teeth is likely to enhance plaque and tartar formation. The more plaque and tartar you have, the greater your chance of developing gum disease. Dentists and periodontists can show you the best ways to clean your teeth, even if they are hard to clean. For example, you can use special tools and ways of threading floss to clean around bridgework or slide under braces. If overcrowded or crooked teeth are a problem, your dentist might recommend orthodontics. This could straighten out your smile and give you a better chance of preventing disease.
• Grinding, gritting or clenching of teeth — These habits won’t cause periodontal disease. However, they can lead to more severe disease if your gums are already inflamed. These habits exert excess force on the teeth. This pressure appears to speed up the breakdown of the periodontal ligament and bone. In many cases, people can learn to stop this habit simply by recognizing when it is happening and then relaxing. If these efforts don’t work, your dentist or periodontist can create a custom guard appliance to help reduce the pressure of clenching or grinding on the teeth. This device is sometimes called an occlusal guard, night guard, mouth guard or bite guard.
• Stress — Stress can make periodontal disease worse and harder to treat. Stress weakens your body’s immune system. This makes it harder for your body to fight off infection, including periodontal disease.
• Fluctuating hormones — Whenever hormone levels go up and down in the body, changes can occur in the mouth. Puberty and pregnancy can temporarily increase the risk and severity of gum disease. So can menopause.
• Medicines — SSeveral types of medicines can cause dry mouth, or xerostomia. Examples include certain drugs for depression and high blood pressure. If you don’t have enough saliva, plaque is more likely to form. This may lead to tooth decay (cavities). Other medicines may cause the gums to enlarge. This makes them more likely to trap plaque. These medicines include:
  • Phenytoin (Dilantin and other brand names), used to control seizures
  • Cyclosporine (Neoral, Sandimmune), used to suppress the immune system in people who have had organ transplants
  • Nifedipine (Adalat, Cardizem and others) and other calcium channel blockers, used to treat high blood pressure, chest pain (angina) or heart arrhythmias.
• Diseases — People with certain diseases have a higher risk of developing periodontal disease. For example, people with diabetes are more likely to get periodontitis than people without diabetes. Their gum disease is also likely to be more severe. Other diseases that increase periodontal disease risk include inflammatory conditions such as rheumatoid arthritis and HIV infection. Having one of these diseases can make the control of your periodontal disease more difficult. But a good periodontist or dentist who is aware of these problems can give you guidance on how to maintain your periodontal health.
• Poor nutrition — Nutrition is important for overall good health, including a working immune system and healthy gums and mouth. Severe vitamin C deficiency (scurvy) can cause bleeding gums.