What is periodontal disease?

Do your gums bleed when you brush your teeth? When you have a cleaning at the dentist, have you been told that you have bleeding gums?

Did you know that bleeding gums are not “normal”? In fact, bleeding is one of the first signs that a hygienist looks for when screening for periodontal disease. So, what is periodontal disease? 

The Journal of the American Dental Association defines periodontal disease or gum disease as “an inflammation of the gums that, if severe, can lead to the loss of tissues that hold the teeth in place”. It is caused by the accumulation of plaque (sticky bacterial colonies) on the teeth. The body’s response to that plaque creates an inflammatory reaction which includes bleeding, swelling, redness and tenderness. When the plaque is not adequately removed through regular brushing and flossing, it becomes hardened. Hardened plaque is called tartar and cannot be removed without the help of a dentist or dental hygienist. Tartar is barnacle-like and a great harbor for even more bacteria to collect; and so the cycle continues. As time goes on, the inflammation increases until supportive gum tissue and bone is lost around the teeth creating deep pockets or troughs that are impossible to keep clean. The bacteria in these pockets can enter the blood stream and contribute to other more serious health conditions such as diabetes, heart disease and stroke. 

To prevent gum disease, it is important to visit the hygienist at least every 6 months for regular cleanings. At the cleaning appointment, the hygienist will perform the type of cleaning you need based on your individual screening for periodontal disease. The screening includes a combination of assessments including x-rays and gum measurements. Dental X-rays will reveal areas of bone loss between the teeth and around the roots of teeth. Gum measurements known as a “perio-chart” allow the hygienist to probe under the gumline around each tooth checking for depth, bleeding and gum recession. They also check for unusual movements in the teeth. They even look for pus. (Yes, I said PUS!) These measurements are recorded and updated in subsequent visits to make sure that disease is not getting worse. 

Ideally, the measurements under the gumline will be shallow. For health, this is 1-3mm with no bleeding. When the tissues are not healthy, the measurements get deeper forming a “pocket”, and bleeding is evident. Pockets of 4mm are often reversible without permanent damage to the surrounding tissue. Pockets of 5mm and over are considered active bone loss and require special intervention to regain health. Left untreated, the bone-loss will continue until the tooth is lost. 

What about gum recession? Won’t I automatically get “long in the tooth” as I age?  Not necessarily. Gum recession is tooth root exposure where the gum tissue has receded away. Recession is the result of an inflammatory process, and several factors can cause inflammation leading to recession. One factor, as we have already discussed, is bacteria as in periodontal disease. Another is trauma caused by abrasion from improper brushing/flossing techniques. Recession can also be a result of the controlled inflammation produced in orthodontic treatment, or the inflammation created from clenching/grinding. Yet another factor might be oral accident. While some factors make recession more difficult to avoid, with proper plaque removal, a person may be able to maintain their teeth with very little gum recession at all. Once the gums have receded, they cannot grow back; only be maintained. This is another reason to see the hygienist every 6 months.