Saturday, September 27, 2014

The Gums, Part II (If you Ignore Your Teeth, They'll Go Away)

My last post addressed gingivitis, the reversible form of gum disease.  Gingivitis is reversible because although the gums are infected with germs and are bleeding and swollen, removal of the plaque with good brushing and flossing, as well as regular dental hygiene visits, can restore the gums to health.

Periodontitis, the irreversible form of gum disease, means that the bacterial infection of the gums has now spread to the supporting structures of the tooth.  These supporting tissues are the ligaments and bone that hold the teeth in the mouth.  In its most severe form periodontitis causes the teeth to become loose and fall out.

There are several things that contribute to periodontitis.  A person may have a family history of the disease, have other health issues such as diabetes, or take medications that affect the mouth.  Smoking is a also a huge factor in periodontitis and tooth loss.  (A special note for smokers: the gums of smokers may not bleed.  Blood and oxygen are being sent by the body elsewhere, like the lungs, brain and heart, to compensate for the damage being caused by smoking and nicotine also constricts the blood vessels.  Smoking is very devastating to the teeth and smokers have higher and more severe incidence of periodontal disease and more tooth loss than nonsmokers.)

Periodontitis occurs because plaque germs have been able to get below the gum line and harden.  The gums pull away from the teeth, forming a pocket.  This makes it even more difficult to keep the teeth clean.  The deeper the pocket, the harder it is for a toothbrush or floss to reach the bacteria hiding in the pocket.  When the pocket is deep enough, and this is just millimeters in measurement, it become impossible to remove the bacteria with ordinary brushing or flossing.  In this pocket the bacteria explode in number and type.  The plaque hardens, forming in layers on the teeth.  The body, in its effort to fight the bacteria off, begins an assault that will eventually destroy the connective tissues - ligaments and bone.  If this process continues unchecked eventually the gums recede, the teeth loosen and then they fall out.  The insidious part of all this is that, often, periodontitis is completely painless, but there are signs to look for:

- Lack of personal daily oral hygiene (brushing and flossing are not happening)
- Bleeding gums
- Swollen, "puffy" looking gums
- Bright red or purple colored gums
- Persistent bad breath
- Receded gums
- Sensitive teeth
- Teeth seem to have "shifted"
- Loose teeth
- Gums may be sensitive or hurt when touched but are otherwise painless
- Pockets around the teeth greater than 3 millimeters (as measured by a hygienist or dentist)
- Tooth abscess, pus

Once the ligaments and bone are destroyed, they are gone.  However, with proper treatment the condition of the gums and teeth can be maintained and further tooth loss prevented.  This may involve scaling and root planing ("deep cleaning") to remove deposit below the gum line, medications applied topically or given orally, and even surgery.

If you have any of the signs of gum disease get to a dental professional right away and find out what you can do to restore or maintain the health of your mouth.  If you haven't been brushing and flossing start today, now.  Your teeth will thank you by sticking around.

Photo courtesy of

Please see your dental or medical professional for treatment.  This blog is not intended to diagnose or treat any disease or condition.

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