After the age of about 25, the most common reason for the loss of teeth is gum disease. Gum disease is generally characterized by swollen, red, bleeding, and receding gums often times associated with localized abscesses. Affected teeth loose clinical support which eventually become painful and need to be removed. Gum disease is caused by one thing, Bacteria. Other secondary factors contribute to advancing periodontal conditions. These include Genetics, Smoking, Systemic disease, Open contacts, Malocclusion, bad margins on current restorations, and Calculus. Gum disease may be prevented by proper brushing and cleaning between the teeth with floss and can be treated predictably with definitive periodontal therapies if it occurs. The goal of definitive treatment is to control the environment where the bacteria live while also to preserve/ maintain function and esthetics.
The progression of the disease is often painless. By the time the disease is first diagnosed, some teeth may already have un-repairable defects. Remember, the first sign of Periodontal/ Gum disease is bleeding gums.
In order to understand gum disease, you must first understand the way the teeth and supporting structures are built. The part of the tooth you can see in your mouth is called the crown of the tooth. It is held in the mouth by the root which is embedded in your jaw bone. It is attached to the bone by way of a thin "stocking" called the periodontal ligament . The bone is, of course covered by the gums which are called the gingiva . The gingiva attach to the teeth slightly below the highest level they reach on the tooth.
The topmost part of the gingiva is called the gingival crest, and the inside of the little pocket between the gingival crest and the bottom of the pocket is called the gingival sulcus . All the bony and soft tissue that supports the tooth is called the periodontium and when this organ becomes sick, we say the patient has Periodontal disease.
Gum disease and tooth decay are invisible and largely painless when they first start, but left untreated will always result in the loss of your teeth. It is important to maintain a strong relationship with your Dental health provider. Regular dental checkups are important to evaluate current radiographs, to recognize clinical signs and symptoms of periodontal disease and to evaluate current Oral Hygiene techniques. Especially, if you have a family history of Periodontal disease, a Comprehensive Periodontal Evaluation should be completed at least one time per year. During this type of exam, each tooth is evaluated for periodontal pocketing (probing depths of 5mm or greater), mobility, recession, Furcation involvement, occlusal discrepancies, and radiographic bone loss/ defects.
I encourage patients to brush twice per day, in the morning upon getting up and in the evening before going to bed and to use floss at least one time per day. Oral rinses or irrigators are also good adjuncts.