Information BookletGum Disease

Healthy Gums

Thanks to public awareness about the causes and prevention of tooth decay, the number of lost teeth due to this form of dental disease has steadfastly continued to decline for years. In fact the incidents of tooth decay have reached such a low point in the United States that more teeth are lost to gum disease than to tooth decay.


Good news about tooth decay. Not so good news about gum disease.

How widespread is gum disease? Studies show that three out of every four adults worldwide and one in three Americans suffer from some form of gum disease. The clinical term is Periodontitis.

There are four types of Periodontitis.

• Type One is known as gingivitis and is the most common type. The signs are inflamed, swollen or "puffy" and sometimes tender gums — most often around the base of the teeth. This can be caused by the presence of plaque or tartar buildup. An early sign of gingivitis is bleeding of the gums.
  
  
• Type Two is when the space between the tooth and gum is abnormally deep. This is what the dental professional calls "periodontal pockets". The cause is the same as Type One but more advanced.
  
  
• Type Three is when radiographic (x-ray) evidence of bone loss accompanies the symptoms described in Type One and Type Two.
  
  
• Type Four is when the condition has reached a stage where the disease is so advanced that tooth loss is likely.

Gingivitis is most often painless, and, as a consequence, it can progress to a more serious condition without you being aware.

Types One through Three are treatable. Type Four almost always results in the loss of teeth. Obviously it is easier to treat Types One and Two than Type Three, but the very best possible scenario is preventative treatment.

How does this happen?
Plaque, calculus (tartar) or irritants such as ill-fitted dental restorations or appliances are the potential culprits. Plaque is a word commonly used in toothpaste advertisements, so it is familiar to all of us. Basically, it is a film of sticky material and bacteria on the tooth surface. Calculus, also known as tartar, is a hard, yellowish/brownish deposit on the teeth, consisting of bacteria secretions and food particles deposited in various salts, such as calcium carbonate. Dental appliances, such as orthodontic brackets, crowns, bridges and other restorative materials, once placed in the mouth, potentially increase the risk of creating a home for bacteria/plaque/calculus growth — if not properly maintained. It is all the nooks and crannies as well as the surfaces of some of these devices that provide a safe haven for these unwanted irritants — which means the risk of gum disease is now greatly increased.

The primary cause is bacteria. You see, the outer layer of the tissue in your mouth (epithelium) is the first line of defense against the invasion of bacteria and their waste products into the sub layer of tissue, which is called connective tissue.

Actually, the bacteria are too large to pass through that first layer of tissue. But when there is something called volatile sulfur compounds (VSCs) present, the offending bacterial toxins can gain entry and begin to cause all sorts of connective tissue problems which lead to the periodontal conditions described.

VSCs are created from decaying food particles, dead cells that naturally slough off from the walls of your cheeks, tongue and gums, and the by- products of bacteria. VSCs are found first on the tongue and later on the gums and other oral tissue.

But let's start at the beginning.
There is a film like substance called pellicle that builds up on the tooth surface and is considered the first link in the plaque chain. Pellicle originates from the mucous salivary glands and is essentially bacteria free. Once established however, pellicle attracts bacteria that then "stick" to the tooth's surface and appliances placed in the mouth (such as braces, partials, etc.). The bacteria, in turn, thrives on carbohydrates found in the mouth and in our diets.

This is how plaque is formed. Among the waste products of metabolized carbohydrates are acids which cause tooth decay. To complicate things, volatile sulfur compounds are also being created during plaque formation, and together, if left undetected and untreated, can cause serious gum problems.