Periodontal-gum disease


Periodontal diseases, also known as gum disease, consist of inflammatory changes in the tissues that surround the teeth. In its initial stages, it is called gingivitis, affecting only soft tissues.

Once it progresses, it spreads to the underlying bone, causing its destruction – this stage is called periodontitis. It can further be classified as mild, moderate or severe periodontitis, according to the severity.

Gum diseases are the main cause for tooth loss in adults, constituting a major public health concern. The Centres for Disease Control and Prevention estimates that nearly half of the adult population in the US suffer from some form of gum disease.


The primary cause of gum disease is the accumulation of bacteria in the space between the gums and the tooth surfaces. Under healthy conditions, this space is called gingival sulcus, and it is as shallow as 1-3 mm, as measured by the dentists with a blunt instrument.

What causes bacteria to accumulate is the lack of adequate flossing and brushing.

The body reacts to those oral bacteria with inflammation, and if they are not removed, the situation can deteriorate, the gingival sulcus becomes deeper (over 3mm in depth) and becomes a periodontal pocket.

Consequently, bacteria move deeper and daily oral hygiene can no longer reach them. The process escalates, leading to destruction of the bone and the tooth can become looser. If left untreated, it can lead to tooth loss.

Bacteria is the main cause of gum disease, however, there are other general and local factors that can increase its severity, such as smoking, diabetes, pregnancy, tilted and crooked teeth and bite problems.



For the majority of people, gum disease goes unnoticed because it usually causes subtle changes, with pain being a rare finding.

Those are the most common signs and symptoms of gum disease:

  • Bleeding of gums during flossing or brushing
  • Swollen, red, inflamed gums
  • Tenderness
  • Receding gums
  • Bad breath or bad taste
  • Loose teeth
  • Shifting of teeth
  • Pus
  • Dull pain when chewing

In order to evaluate the extent and severity of periodontal disease, the dentist or the periodontist makes a complete evaluation of the whole mouth and identifies areas with gum disease by measuring the space between gums and teeth. Basic treatment for gum disease consists of deep cleaning of teeth surfaces and all periodontal pockets to remove accumulated bacteria.

Some areas might not respond well to basic treatment, requiring further management.



It is not a new concept that persistent infection anywhere in the body can affect general health. This is certainly the case for untreated gum disease.

The body responds with an inflammatory response, which is intended to kill bacteria. However, in gum disease, bacteria are mostly out of reach because they are glued to the tooth and protected in huge communities.

This means that the body will keep producing strong inflammation for as long as bacteria are present. The inflammatory chemicals produced locally and some bacteria eventually go into the general circulation, reaching other parts of the body.

Several studies have shown that this is bad for oral health as well for general health. Gum disease can worsen heart problems, respiratory problems, diabetes and can even disturb pregnancy, potentially leading to premature birth and low-birth weight babies.



A bad bite has many negative consequences, including worsening of periodontal disease. There are many types of bite issues, including crooked, crowded, tilted teeth, open bite, deep bite, cross bite and others.

Tilted teeth, for instance, can present thin bone walls on the side where the root is prominent, predisposing it to bone loss. On the other side, the tilted crown makes it difficult to clean, facilitating plaque build-up and progression of periodontal disease.

Crowded an rotated teeth can also be tricky to keep clean. The lack of space can create food traps between the teeth, turning tooth brushing and flossing into a challenge.

Open bite, which is often associated with mouth breathing, can be another aggravating factor for periodontal disease due to the thin bony walls of front teeth and difficulty in plaque removal. Often, people with open bites breath through their mouths, leading dry mouth and bacterial changes that can predispose to periodontal disease.

In addition, a bad bite leads to unbalanced contact between upper and lower teeth; thus, chewing forces are not distributed equally over teeth and jawbones, resulting in excessive forces in some areas. These can accelerate the process of bone loss and create bone defects around teeth with periodontal disease.



The orthodontist can easily correct the position of the teeth to help control gum disease. This makes oral hygiene easier, decreasing the risk for decay and gum disease. While correcting the teeth, orthodontic treatment also adjusts the bite for better force distribution, improving the condition of the gums.

In many cases, changing the position of the teeth through orthodontic treatment can create thicker bone, which is a good condition for healthy gums.

In patients whose teeth have shifted because of gum disease, orthodontic treatment can be necessary once the infection in the gums in under control in order to realign teeth and jaws in order to re-establish healthy and avoid further disease progression.


Healthy gums are essential to keep your teeth and your body healthy.