What is Periodontal (gum) disease? Periodontal (gum) disease is a bacterial infection of the periodontium.

The periodontium includes the gums, bone, supporting ligaments and the structures of the teeth. There is a sequence of events that happens to the bacteria during the development of gum disease. It is important to know the 2 different types of gum disease, gingivitis and periodontitis.

What causes gum disease? There is a sequence of events that happens to the bacteria during the formation of biofilm (plaque). An increase in plaque helps to initiate and progress the infection from gingivitis to periodontitis. The body's immune system is the primary cause of disease and fights the bacteria as the plaque grows. The immune system along with the bacteria causes an inflammatory response resulting in tissue destruction. Phase 1-Aquirred Pellicle- is the attachment of free floating glycoproteins in the saliva and mouth to the tooth surface. This is considered the sticky tape phase, one side sticks to the tooth and the other side is sticky allowing for more bacteria to attach. This happens within minutes after cleaning. Phase 2-Intial attachment to the acquired pellicle-within a few hours free floating bacteria begin to attach. Many bacteria have hair like appendages that assist them in sticking to the acquired pellicle, this helps them attach rapidly. Phase 3- New bacteria join- bacteria attached to the tooth surface produce substances that stimulate other free floating bacteria to come and join the bacteria community that is forming. Phase 4-Slime layer formation/Micro colony formation-When the community of bacteria is growing it stimulates what we call a slime layer around the community of bacteria this helps to anchor the bacteria to the tooth and provides protection to the bacteria. As the bacterium continues to grow it is getting bigger and bigger and further away from the tooth surface at a rapid rate. Phase 5- Mature dental plaque formation-The rapidly growing bacteria forms a mushroom shaped colony (community) that is a complex collection of different kinds of bacteria linked to one another producing a mature biofilm/plaque on a tooth surface.

Gingivitis Is a bacterial infection that is confined to the gingiva (gums), the damage to the tissues is reversible, if proper oral care is used. Signs of gingivitis can occur in 4-14 days if not taken care of properly. You can have an acute case which lasts a short period of time or a chronic case that can last months or years. In many cases gingivitis can persist for years and never progress to periodontitis. Acute Red or reddish blue gums Soft tissues Swollen/rolled gums Bulbous gums No apical migration Slight bleeding on probing Chronic Bluish red or pale white gums Hard fibrotic/leathery tissues Rolled gums Blunted or cratered gums No apical migration Bleeding on probing

Periodontitis Is a bacterial infection of all parts of the periodontium including the gums, bone, cementum and the structures surrounding the teeth they are called periodontal ligaments. The once the tissue is damaged by periodontitis it is NOT reversible. Periodontitis is also associated with varying degrees of bone loss, gum recession, tooth sensitivity and teeth may become "loose" or mobile. Factors that contribute to Periodontitis is gums may be swollen bluish or a purplish red with a smooth shiny appearance, fibrotic in texture, margins appear blunted, there will be bleeding on probing and may have pus, this tissue will have apical migration and probing depths greater that 4mm. Periodontitis can be classified in many different ways some of the most common are: Chronic Periodontitis (most common form)- this can be characterized by localized less than 30% of the mouth or generalized more than 30% of the mouth is present with the disease. Aggressive Periodontitis (highly destructive form) and is characterized by localized affecting the 1st molars and the incisors or generalized affecting 2 or more teeth plus the 1st molars and incisors. Periodontitis as a manifestation of systemic factors. Characterized by two general categories of systemic diseases 1. Blood disorders and 2. Genetic disorders.

Local contributing factors Local contributing factors don't initiate disease but influence a person's risk of vulnerability to acquiring it. Examples of contributing factors are dental calculus, tooth structure, plaque, faulty restorations, dental caries, tongue thrusting and occlusal trauma. These factors cause damage to the surrounding tooth structures, increase plaque retention and increase severe risk of disease. Systemic Factors Do not cause periodontal disease but can increase a persons risk of infection. These factors may include diabetes, AIDS?HIV, Leukemia, Osteoporosis, genetic influences and hormonal changes such as puberty, pregnancy and menopause.

Frequently asked questions: 1. Is gum disease a normal part of aging? NO, gum disease does not have to be a part of growing older. With proper dental hygiene care and regular dental visits, people can reduce their chance of developing periodontal disease. 2. Are there ways to prevent gum disease? Yes, you can prevent gum disease with proper dental hygiene care and regular cleanings by your dental team. Specifically you should brush your teeth 2x daily (with a fluoride toothpaste). Flossing regularly to remove plaque from between teeth and visit the dentist routinely. Do not smoke, and eat a well-balanced diet.

3. What happens of gum disease is not treated? If left untreated, gum disease can lead to tooth loss. Gum disease is the leading cause of tooth loss in older adults.

References: National Institute of Health Senior Health. (2013). Frequently asked questions. Retrieved from http://nihseniorhealth.gov/periodontaldisease/faq/faqlist.html

Nield-Gehring, J., & Willmann, D. E. (2011). Foundations of periodontics for the dental hygienist. (3rd edition ed., pp. 54-204). Phladelphia, PA: Wolters Kluwer Health.