Gum (periodontal) disease is an infection that is a major cause of tooth loss in adults. Because gum disease is usually painless and develops slowly, a person may not be aware that the infection exists.

Gum disease is caused by plaque, a sticky film of bacteria (germs) that constantly forms on the teeth. These bacteria create toxins that can eventually damage the gums and the bone surrounding the teeth.

In the early stage of gum disease, called gingivitis, the gums become red, swell, and bleed easily. The disease is still reversible at this stage, and can usually be eliminated by careful daily brushing and flossing. In the more advanced stages of gum disease, called periodontitis, the gums and bone that support the teeth become seriously damaged. If the disease is left untreated, it can eventually lead to loss of teeth.

Any of the following conditions may indicate the presence of gum disease, and a dentist or dental specialist called a periodontist should be consulted. If the gums:

• bleed when brushing teeth
• are red, swollen or tender
• have pulled away from the teeth

Or if one of the following conditions is present:

• bad breath that doesn't go away
• pus between teeth and gums
• loose teeth
• a change in the way the teeth fit together when biting
• a change in the fit of partial dentures

Remember that pain usually is not present in the early stages of gum disease.

Although bacterial plaque is the primary cause of gum disease, other risk factors can affect the health of gums and increase the chances of contracting the disease.

Some of those factors include

• smoking
• stress
• certain medications
• diabetes
• poor nutrition
• clenching or grinding teeth
• hormonal fluctuations
• genetic pre-disposition

Regular check-ups with a dentist and/or consultation with a periodontal specialist are especially important if any of these risk factors are present.

Gum disease can be prevented by taking good care of teeth and by having regular dental checkups that include a periodontal examination. A little time invested in prevention of this disease can improve dental and general health and can help minimize dental expenses. Here are some suggestions to help keep teeth, gums and supporting bone structures healthy:

• Brush teeth thoroughly twice a day. This removes the film of plaque (germs) from the teeth. Be sure to use a soft-bristled toothbrush that is in good condition and anti-plaque toothpaste. Rinsing will not remove the sticky bacterial plaque.
• Clean between teeth every day. Cleaning between teeth with floss or interdental cleaners removes bacteria and food particles from between the teeth where a toothbrush can't reach. Early gum disease can often be reversed by daily brushing and flossing.
• Eat a balanced diet. Choose a variety of foods from the basic food groups, such as breads, cereals and other grain products; fruits; vegetables; meat, poultry and fish; and dairy products, such as milk, cheese and yogurt. Limit between-meal snacks and candy. Avoid excessive use of sweetened soda pop.
• Visit the dentist regularly. It is important to have regular dental checkups, which include a thorough periodontal exam. Professional cleaning is essential to prevent periodontal diseases. Once you have been treated for periodontal disease, these maintenance visits are especially important.
• Avoid use of tobacco. Tobacco use can inflame gum tissue and aggravate existing periodontal disease.

Periodontal Scaling: Once gum disease has begun to destroy the gum and bone around teeth, an ordinary cleaning will not be enough to stop the progress of the infection. A procedure called periodontal scaling, which is more extensive and time-consuming than routine cleaning, becomes necessary. It removes plaque and tartar that are causing the infection below the gum line. Root planing smooths the root surfaces, which allows the gum tissue to heal and to reattach to the tooth.

Other Surgery: When deep pockets of infection persist after periodontal scaling, corrective surgery or other treatment may be needed. Surgical treatment is designed to correct defects by reshaping or by regenerating new, healthy bone and gums.

After treatment, it is critical that patients practice good oral hygiene and that they seek regular professional maintenance care in the dental or periodontal office.