How gum disease starts

Plaque is a soft film of bacteria that forms on teeth constantly. Left alone for a day it hardens into calculus, or tartar, using minerals from saliva. Calculus is bonded to the tooth, brushing does not remove it, and its rough surface holds still more bacteria against the gum.

The gum responds with inflammation. It reddens, swells and bleeds when disturbed. At this stage the damage is confined to soft tissue and the bone is intact, which is gingivitis. Remove the deposits, keep the area clean daily, and the tissue returns to health. That stage is genuinely reversible.

If deposits stay below the gum margin, inflammation carries on for months. The fibers holding gum to root break down, the bone anchoring the tooth resorbs, and the groove around it deepens into a pocket that no brush or floss can reach. That is periodontitis.

Much of the destruction comes from the immune response rather than the bacteria, which is why two people with similar plaque end up in different places. Lost bone does not grow back on its own, so treatment aims to stop the process and keep the teeth.

Gingivitis and periodontitis are not the same thing

The two words get used loosely. The difference decides what treatment you need and what to expect from it.

Consideration Gingivitis Periodontitis
What is involved The gum tissue only. The fibers and bone holding the tooth are intact. The attachment fibers and the bone that hold the tooth in the jaw.
What you notice Redness, puffiness, bleeding when you brush or floss, often bad breath. The same, plus receding gums, teeth that look longer, root sensitivity, teeth that drift or loosen.
Can it be reversed Yes. With deposits removed and daily cleaning, the tissue returns to health. No. Lost bone does not come back on its own. The disease can be arrested and the teeth kept.
What treatment involves A thorough cleaning and a real change in daily home care. Scaling and root planing, a re-evaluation, then maintenance at a shorter interval.

What raises your risk

Plaque is necessary for gum disease but not sufficient. Whether inflammation turns into bone loss depends on the rest of the picture.

  • Smoking and other tobacco use. The largest changeable risk there is. It makes the disease worse and healing slower, and nicotine constricts the vessels in the gum so it bleeds less. Smokers can look healthier at the gumline while doing worse underneath.
  • Diabetes. The relationship runs both ways. High blood sugar makes gum infection more likely and more severe, and active gum infection makes blood sugar harder to control.
  • Family history. Some people mount a more destructive response to the same plaque. If a parent lost teeth to gum disease rather than decay, tell us.
  • Medications. Some blood pressure, anti-seizure and immune-suppressing drugs cause gum overgrowth that traps plaque. Many more cause dry mouth, and saliva is a main defense.
  • Stress and broken sleep. Both alter the immune response, and home care is the first thing to slip during a hard stretch.
  • Hormonal change. Puberty, pregnancy and menopause all make gum tissue react more strongly to the same plaque.
  • Crowded or overlapping teeth. Some mouths cannot be cleaned properly however careful the owner is, and old fillings with overhanging edges do the same thing.
  • A previous history of periodontitis. The strongest predictor of future breakdown is past breakdown.

None of these is a verdict. They decide how often we measure and how hard we treat, which is the point of charting.

Why gum disease is the leading cause of adult tooth loss

Decay takes teeth from the young. Gum disease takes teeth from adults. A tooth can be free of decay and perfectly comfortable and still be lost, because the bone that held it has quietly gone. The tooth is fine. The foundation is not.

It is also easy to explain away. Blood in the sink gets blamed on hard brushing, a longer-looking tooth on age, and by the time something feels loose most of its support has gone.

Teeth can be replaced. Dental implants and dentures and partials both do real work when a tooth cannot be kept. Neither is as good as your own tooth, and an implant sits in the same mouth with the same bacteria.

How periodontal care works here

Dr. Brosi is a general dentist, and non-surgical periodontal treatment is part of general practice. Two registered dental hygienists handle most of the treatment and maintenance alongside him, and cases needing surgery go to a periodontist. More about Dr. Brosi, USC School of Dentistry 1981, and our team.

Understanding it
What gum disease is, the signs that show up first, why pain arrives so late, and what the research does and does not say about the links to general health.
Diagnosis
Measured charting rather than a glance. Six readings around every tooth, bleeding points, recession, mobility and bone levels compared against earlier x-rays.
Treatment
Scaling and root planing under local anesthetic, usually a quadrant at a time, then a re-evaluation about four to six weeks later.
Maintenance
Periodontal maintenance every three or four months instead of every six, because treated pockets repopulate well before six months are up.

Common questions about gum disease

How do I know if I have gum disease?

Watch for bleeding when you brush or floss, breath that does not improve after cleaning, gums that look puffy or have pulled back, and teeth that look longer or have moved. Symptoms alone will not tell you. It is diagnosed by measuring pockets around every tooth.

Can gum disease be cured?

Gingivitis can be reversed, because nothing structural has been lost. Periodontitis cannot, because bone loss does not undo itself. Treatment stops the process and holds it there, which for most people means keeping their teeth. It is managed rather than cured.

Is gum disease linked to heart disease and diabetes?

Research has repeatedly found associations between periodontitis and cardiovascular disease, poorly controlled diabetes and adverse pregnancy outcomes. They are worth taking seriously, but they are not proof that treating your gums prevents those conditions, and no dentist should tell you gum treatment prevents a heart attack. The diabetes link runs both ways.

Do I have to see a periodontist?

Usually not. Most non-surgical gum treatment is done in a general dental office. When pockets stay deep after thorough treatment, or when surgery is the answer, we refer you to a periodontist and stay involved in your general care.

In this area of treatment

Each of these has its own page with the detail that does not fit here.

  • What Is Periodontal (Gum) Disease?

    A bacterial infection of the gums and bone that supports the teeth, usually painless in its early stages.

  • Periodontal Diagnosis

    Measured pocket depths, bleeding points and bone levels that turn a vague worry into a specific diagnosis.

  • Periodontal Treatment

    Deep cleaning below the gumline to remove the bacterial deposits that keep the infection going.

  • Periodontal Maintenance

    The ongoing three to four month recall that keeps treated gum disease from coming back.