Periodontal (Gum) Disease

Gum disease is an infection that involves the progressive loss of the soft (gum) and hard (bone) tissues that hold and support the teeth. The word "PERIODONTAL" means "around the tooth", and this is exactly where the infection is localized. Gum disease may progress rapidly around some teeth, while more slowly around others. Most often, it goes in stages of faster and slower cycles. The disease process involves an ongoing struggle between the harmful bacteria in and around the gums and the patient’s own immune system.

There are many warning signs and risk factors which will be discussed below. Gum disease has two major forms: Gingivitis - the infection involves just the soft, pink gum tissue, and heals easily when the harmful bacteria are removed and kept away Periodontitis - the infection also involves the bone under the gum. Once bone is lost around a tooth, it generally never grows back. Gum disease may affect just one tooth, a few teeth, or many at any one time. There are some other forms of gum disease that do not involve actual infection, such as localized gum recession (see below).

In simple terms, the main cause of gum disease is the accumulation of bacteria in plaque and tartar (calculus). Plaque is the sticky film of food and bacteria that forms constantly on the teeth, while tartar is the hardened form it becomes when not cleaned off and has absorbed salts from the saliva. (It can be easily viewed when stained with a harmless dye)

Many bacteria produce harmful toxins. These toxins combine with the body's own immune reaction to them, causing inflammation and bone destruction around the teeth. As the gums become more red and swollen, the bacteria can penetrate deeper into the gum and bone. There is a constant struggle between the invading bacteria and the body's immune system - a healthy immune system is critical for a person’s lifelong struggle against gum disease. One thing to remember is that there may be more than 20 different types of bacterial species that live in the plaque and tartar. Some species are not harmful, while others are quite aggressive. The most harmful bacteria are the ones that can survive in the deepest crevices under the gums and inside the deepest pieces of tartar.

If you haven't been to a Dental professional in some time, or have not had your gums thoroughly checked recently, then keep a close watch for the common warning signs. A person may not even be aware of the signs or symptoms until the disease reaches an advanced stage. If you have any concern that you may have gum disease, then having your gums examined by a Dentist or Hygienist is very important. In particular, smokers often have worse gum disease before the warning signs become very noticeable due to the fact that nicotine causes reduced blood flow into the gums and tissues of the mouth. This means that the gums may appear on the outside to have a pale pink color while on the inside the bone loss is progressing faster. There are also definite familial or genetic tendencies towards gum disease, so if other members of your family have a positive history, then the chances are that you do as well.

	Gum disease and its severity is assessed as part of the complete oral examination.The periodontal assessment is made up of a visual, manual, and radiographic examination: Visually The color and contours of the gums gives us some useful information about the degree of inflammation present - (pale) pink and flat is the normal healthy appearance of gums, while red/purple and rounded or enlarged indicates inflammation or disease.
	Manually a) The gums are examined with a periodontal probe, which measures the gum sulcus around each tooth. A sulcus is the normal crevice between the tooth and gums. When everything is healthy, the bone comes up high around the necks of the teeth and the levels are even throughout the mouth. A healthy sulcus is 2 to 3 millimeters deep. When plaque and tartar invade a sulcus and it becomes deeper than three millimeters, it is called a pocket. Probing allows one to feel for the location of tartar under the gums where it cannot be easily seen. b) The probe is used to measure the amount of gum recession on the outside of the tooth from a line on the tooth where the enamel of the crown ends and where the root begins. c) The teeth are tested for their mobility, or looseness - teeth that have healthy supporting gums and bone are held tightly in the bone and are difficult to move from side to side, while teeth that have active periodontal infection and/or loss of supporting bone become movable.
	Radiographically Dental x-rays are an important part of the overall assessment because they allow for the visual determination of the quantity and quality of bone surrounding the teeth. X-rays allow also for the detection of tartar of the root surfaces of teeth that are hard to detect otherwise, thus helping in the cleaning phase of treatment.

	Simply, gum recession is the abnormal loss of height of gum attachment around one or more teeth relative to the rest of the teeth. It usually occurs on the outer surface of the teeth, but may also occur on the inner sufaces. To some degree, a slow type of gum recession occurs continuously with aging and progressive bone loss around the teeth, but we are more concerned with the type that occurs more rapidly and around only a few teeth.
Gum recession is usually caused by numerous factors, which may be identified as: anatomical, mechanical, and microbial.
	Anatomical: One or more teeth may be out of position in the dental arch, and the overlying gum and bone do not cover and protect as securely. Secondly, there is not enough vertical thickness of a special type of gum tissue called “attached gingiva” to resist the constant mechanical forces on a tooth.
	Mechanical: There are three main types of forces applied to the teeth and gums - those related to the bite (normal chewing forces, and abnormal clenching or grinding), those related to the action of the facial muscles, and those created by other objects such as toothbrushes. Individual teeth may be subject to heavier than normal forces due abnormal positioning in the dental arch, or uneven tooth wear. This can occur within the normal range of chewing force, or be related to those greater forces that are associated with negative habits such as clenching or grinding. When one tooth is subject to heavier than normal forces compared to its neighbour, the excess force may overload the local gum and bone, contributing to their destruction. There are many muscles in the face that are used in facial expressions and chewing that attach to the jawbones. Sometimes, these attachments are too close to the teeth, and the repetitive pull of the muscles on the thin zone of gum around the tooth slowly pulls the gum down away from the tooth. Objects such as toothbrushes can scrub so hard, that daily repetitive trauma to an area can lead to gum recession. This is why it is so important to be very gentle when brushing the teeth and avoid the temptation to scrub harder. The type of brushing stroke also is important - certain toothbrush movements are more likely to scrub the gum away than others. Microbial: The ongoing presence of abnormally high amounts of bacteria and inflammation (as discussed above) makes the gums weaker and less resistant to the factors just discussed above. The greater the overall amount of active gum infection or inflammation, the greater the likelihood of recession.