What Is Periodontal (Gum) Disease?
The term “periodontal”means “around the tooth.” Periodontal disease (also known as periodontitis and gum disease) is a common inflammatory condition which affects the supporting and surrounding soft tissues of the tooth; also the jawbone itself when in its most advanced stages.
Periodontal disease is most often preceded by gingivitis which is a bacterial infection of the gum tissue. A bacterial infection affects the gums when the toxins contained in plaque begin to irritate and inflame the gum tissues. Once this bacterial infection colonizes in the gum pockets between the teeth, it becomes much more difficult to remove and treat. Periodontal disease is a progressive condition that eventually leads to the destruction of the connective tissue and jawbone. If left untreated, it can lead to shifting teeth, loose teeth and eventually tooth loss.
Periodontal disease is the leading cause of tooth loss among adults in the developed world and should always be promptly treated.
Types of Periodontal Disease
When left untreated, gingivitis (mild gum inflammation) can spread to below the gum line. When the gums become irritated by the toxins contained in plaque, a chronic inflammatory response causes the body to break down and destroy its own bone and soft tissue. There may be little or no symptoms as periodontal disease causes the teeth to separate from the infected gum tissue. Deepening pockets between the gums and teeth are generally indicative that soft tissue and bone is being destroyed by periodontal disease.
Here are some of the most common types of periodontal disease:
- Chronic periodontitis – Inflammation within supporting tissues cause deep pockets and gum recession. It may appear the teeth are lengthening, but in actuality, the gums (gingiva) are receding. This is the most common form of periodontal disease and is characterized by progressive loss of attachment, interspersed with periods of rapid progression.
- Aggressive periodontitis – This form of gum disease occurs in an otherwise clinically healthy individual. It is characterized by rapid loss of gum attachment, chronic bone destruction and familial aggregation.
- Necrotizing periodontitis – This form of periodontal disease most often occurs in individuals suffering from systemic conditions such as HIV, immunosuppression and malnutrition. Necrosis (tissue death) occurs in the periodontal ligament, alveolar bone and gingival tissues.
- Periodontitis caused by systemic disease – This form of gum disease often begins at an early age. Medical condition such as respiratory disease, diabetes and heart disease are common cofactors.
Treatment for Periodontal Disease
There are many surgical and nonsurgical treatments the periodontist may choose to perform, depending upon the exact condition of the teeth, gums and jawbone. A complete periodontal exam of the mouth will be done before any treatment is performed or recommended.
Here are some of the more common treatments for periodontal disease:
- Scaling and root planing – In order to preserve the health of the gum tissue, the bacteria and calculus (tartar) which initially caused the infection, must be removed. The gum pockets will be cleaned and treated with antibiotics as necessary to help alleviate the infection. A prescription mouthwash may be incorporated into daily cleaning routines.
- Tissue regeneration – When the bone and gum tissues have been destroyed, regrowth can be actively encouraged using grafting procedures. A membrane may be inserted into the affected areas to assist in the regeneration process.
- Pocket elimination surgery – Pocket elimination surgery (also known as flap surgery) is a surgical treatment which can be performed to reduce the pocket size between the teeth and gums. Surgery on the jawbone is another option which serves to eliminate indentations in the bone which foster the colonization of bacteria.
- Dental implants – When teeth have been lost due to periodontal disease, the aesthetics and functionality of the mouth can be restored by implanting prosthetic teeth into the jawbone. Tissue regeneration procedures may be required prior to the placement of a dental implant in order to strengthen the bone.
Ask your dentist if you have questions or concerns about periodontal disease, periodontal treatment, or dental implants.
What Periodontal Gum Disease Is
Periodontal disease is the term for a group of related conditions that affect the gums, the bone supporting the teeth, and the ligaments that connect them. The word 'periodontal' literally means 'around the tooth' — the structures the disease affects. In the earliest stage it is reversible and called gingivitis, affecting only the gums. In its more advanced stages it becomes periodontitis, which involves bone loss and is not fully reversible, only manageable.
The cause is bacterial. The mouth normally hosts hundreds of types of bacteria. When plaque (a sticky film of bacteria) is not removed regularly from teeth, certain bacterial species multiply and produce toxins that irritate the gum tissue. The body's immune response to this irritation produces inflammation, which is helpful at first but becomes destructive when it persists for months or years. Over time, this inflammation breaks down the ligaments and bone that hold teeth in place, eventually leading to tooth loosening and loss.
Periodontal disease is one of the most common chronic conditions in adults. Around half of all adults over thirty have some form of it, ranging from mild to severe. It is the leading cause of tooth loss in adults. The good news is it is largely preventable with consistent home care, and largely treatable when caught at an early stage.
Risk Factors for Developing Periodontal Disease
Several factors raise the risk of developing periodontal disease or having it progress more quickly:
- Inconsistent brushing or flossing
- Smoking — by far the strongest modifiable risk factor
- Diabetes, especially when not well controlled
- Genetic predisposition — some families have stronger immune responses to oral bacteria than others
- Hormonal changes — pregnancy, menopause, and certain hormone-affecting medications
- Stress, which affects immune function
- Certain medications that cause dry mouth or affect gum tissue (some blood pressure medications, certain anti-seizure medications, some immunosuppressants)
- Poor nutrition, particularly low intake of vitamin C and other nutrients that support gum tissue
- Crooked teeth or dental work that creates areas that are harder to clean
- Age — risk rises with age because of cumulative exposure to plaque and changes in immune response
- Immunocompromise from disease (HIV/AIDS) or medication (chemotherapy, transplant medications)
- History of severe gum disease in earlier life
Many of these are modifiable. Quitting smoking is the single biggest change. Consistent home care, regular dental cleanings, and managing systemic health (diabetes especially) significantly reduce risk.
Stages, Progression, and Treatment
Periodontal disease progresses through clear stages. Gingivitis is the earliest stage — gums are inflamed but no bone loss has occurred. This is reversible with proper cleaning and improved home care. Early periodontitis involves the start of bone loss (one to two millimetres) and is usually managed with scaling and root planing (deep cleaning under local anaesthetic) plus more frequent maintenance visits.
Moderate periodontitis involves more bone loss (three to four millimetres) and may require more involved treatment including surgical procedures to reduce pocket depths or regenerate lost bone. Advanced (severe) periodontitis involves more than five millimetres of bone loss, deep pockets, mobility of teeth, and significant risk of tooth loss without treatment. Treatment at this stage often involves surgical procedures, possible regenerative grafting, and very frequent maintenance.
Treatment is staged. Non-surgical treatment (scaling and root planing) is usually the first step. Six to eight weeks later, the disease is re-evaluated. Areas that have not responded well may benefit from surgical treatment. After active treatment ends, periodontal maintenance visits every three to four months replace standard six-month cleanings to keep the disease from returning. Long-term outcomes are good for most patients who follow through with maintenance and good home care; outcomes are less predictable for patients who do not, or who continue to smoke heavily.
What This Means for Your Care at Trillium
Trillium provides comprehensive periodontal care including evaluation, scaling and root planing, periodontal maintenance, and management of long-term cases. We refer to a periodontist for complex surgical cases or specialized procedures while continuing to manage other dental care. Our services follow the current Ontario Dental Association Suggested Fee Guide.
Most private dental insurance plans cover periodontal evaluation and treatment under their normal benefits framework; coverage for more involved or specialist procedures varies. CDCP includes periodontal services within its annual benefits framework. We submit insurance claims directly where the plan allows and run pre-determinations for larger treatment plans so coverage is clear before treatment starts.
Frequently Asked Questions
Can I cure my gum disease?
Gingivitis (the earliest stage) is fully reversible with cleaning and improved home care. Periodontitis (with bone loss) is not curable but is very manageable — with treatment and maintenance most patients can keep their teeth long-term and stop further progression.
Is gum disease contagious?
The bacteria associated with gum disease can be transmitted between people through saliva (kissing, sharing toothbrushes or utensils), particularly within families. Whether someone develops disease depends on their own immune response, oral hygiene, and other risk factors. Most people share some bacteria with family members without all of them developing disease.
Will I definitely lose my teeth if I have gum disease?
Not necessarily. With proper treatment and maintenance, most people with gum disease keep their teeth for many years or for life. Some teeth in advanced cases may not be salvageable, but the majority are.
Does mouthwash help?
Alcohol-free fluoride mouthwash adds a small layer of cavity protection but does not treat gum disease on its own. Antimicrobial mouthwashes (chlorhexidine) prescribed by your dentist may be used short-term during active treatment or post-surgical healing. None of them replace brushing, flossing, and professional cleanings.
Are there warning signs I should watch for?
Bleeding when brushing or flossing, persistent bad breath, gum recession, gum tenderness, loose teeth, and changes in the way teeth come together when biting are all signs to bring to a dental visit. Many early signs are mild and easy to ignore — paying brief attention to your gums when you brush helps catch problems early.
How often should I see the dentist if I have gum disease?
Most patients with active gum disease benefit from cleaning and maintenance visits every three to four months rather than every six months. The exact interval is set together with you based on disease stage and how you respond to treatment.