Frequently, I am asked to explain gum disease. There are a large number of misconceptions and half-truths that are part of the "legend" of gum disease. I hope make the nature of the disease and its treatments easier to understand.
 Figure 1: Healthy gums |
 Figure 2: Gingivitis |
 Figure 3: Periodontitis |
 Figure 4: Advanced Periodontitis |
First let us consider what is gum disease is not. It is not inevitable, genetically determined, a product of aging, or an ethnic or generational disease. I have seen patients in their nineties with no evidence of past gum disease or any current disease. Although the disease does run in families, it is not predetermined by your family history. Studies have shown that 1 mm (1/25 of an inch) of gum recession in ninety years is the result of aging. The rest of recession is due to disease. Although the disease is more prevalent in the country in non-white minorities, the prevalence is even greater in Europe where most white Americans trace their ancestry. Gum disease can attack anyone of any age. The youngest case I have seen was in a four-year-old. However, the disease increases in severity with age so that most of the worse cases are seen in the elderly.
Why should we be concerned about gum disease? After the age of 20, gum disease is the leading cause of tooth loss in the United States. Some estimate that 80% of all Americans will suffer with some form of gums disease at some point in their lives. Early detection, treatment, and home care can stop the progress of the disease.
So what is gum disease? Gum diseases can be divided into two broad categories. Gingivitis is the inflammation of the keratonized tissue surrounding the teeth. If you look in the mouth of a young child, you will see that the tissue surrounding the teeth is pink, lays flat against the teeth, is stippled (has small dot-like depressions) and is distinct in color and texture from the red, smooth, translucent tissue in the rest of the mouth. One can frequently distinguish blood vessels in the red tissue, but one can never see them in the pink tissue. The pink tissue is what dentist call gingiva (gingivae is the plural) and what we mean by "gums". The red tissue is mucosa. The pink tissue is responsible for maintaining a healthy attachment between the tooth and the bones. The red tissue is responsible for lining the inside of the mouth and brings nutrients to the pink tissue.
Gingivitis is the inflammation of the pink gingiva. When inflammation has occurred, the tissue will be red, swollen (edematous), warm to touch, sometimes tender, will easily bleed, and is unable to maintain it's own health. It can't maintain the health of the tooth attachment. Gingivitis is cause by bacteria. Every mouth has many kinds of bacteria living in it. When these bacteria are allowed to grow unchecked, infection is the result. This infection leads to the inflammation, which is gingivitis. At this stage, the disease is easily reversible with no lasting changes to the health of the tooth attachment. Home care to avoid gingivitis is the same as the treatment for gingivitis. Rigorous (not vigorous) use of toothbrush and floss is all that is required to regain and maintain the health of the gingiva. Frequent dental cleanings remove those deposits that the patient has a difficult time removing aid in this treatment. However, the treatment for gingivitis is adequately applied home care (oral hygiene).If you have been instructed to brush and floss twice a day, and if you see the hygienist every six months, you still have 364 cleanings your are responsible for every one we are responsible for. That means that your treatment is more than 99.725% your responsibility.
Left untreated, gingivitis usually results in periodontitis. This is a disease of the gingiva, the tooth attachment, and may include the mucosa. This disease is usually not reversible but in it's earliest stages, can be stopped (dentist use the term arrested) with simple treatments and if caught early enough, without surgery. Once this form of the disease occurs, the types of bacteria seen next to the teeth change. We may use a microscope to monitor the kinds of bacteria seen is this disease. DNA probes can also be used to determine the specific bacteria present. The current state of the art in DNA test of these bacteria makes the test only useful if more traditional tests and treatments fail. In advanced stages of periodontal disease, enough bone has been destroyed that the teeth are in danger of being lost to lack of support. First stage therapy is designed to stop the progress of the disease and is nearly identical to the earlier stages of periodontitis. Often however, surgery is needed to correct the shape of the remaining bone, to get access to the deep pockets to thoroughly clean the roots, or to get new bone to form in the affected sites. It is our goal to help you avoid surgery by detecting gum disease early, treating it conservatively, and helping you to learn to be a gum therapist at home.
©2003 Dr. James S. Eaves, DDS
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