According to the American Dental Association approximately 75% of our over twenty population has periodontal problems. Based on my practice, and speaking to dentists around the country, I believe this figure is closer to 90%. In either case, these statistics have widespread implications for our general population.

Do your gums bleed? Are they red or puffy? Has you dentist ever told you that you need to brush better or see the hygienist more frequently? If your answer to any of these questions is "yes", then you have some form of periodontal or gum disease.

What exactly is periodontal disease?

As part of the answer, we need to understand how teeth are held in the mouth.. Teeth are not embedded in the jawbones but are totally surrounded by tissue called the periodontal membrane. Each tooth is totally surrounded by this tissue. The tissue acts as a shock absorber for the tooth.

Periodontal membrane is actually a continuation of the gum tissue that covers all the bone and tooth parts in the mouth with the exception of the crown of the tooth (the part we see). The periodontal membrane has thousands of tiny fibers called periodontal ligaments that go from the membrane and attach to the tooth and the bone.

In a normal healthy mouth there is always a slight space between the tooth and the bone called a pocket, which is usually about 1-2mm (about an eight of an inch).

HEALTHY GUMS Firm and light pink Hug the teeth tightly Don't bleed when brushed Pocket depth when measured is no more than 2mm	HEALTHY GUMS
GINGIVITIS First stage of periodontal disease which involves soft tissue only: bone has not been affected at this point. Gums bleed when brushed or probed Inflammation and redness present Possible bad breath	GINGIVITIS
MODERATE PERIODONTITIS Gum line starts to recede and teeth appear to be longer Sensitivity may appear Abscesses or gum boils may appear Teeth may shift and spaces can form between teeth Redness and bleeding is very apparent Further inflammation and loss of texture Mobility of teeth Pocket depths 4-6mm Significant bone loss is detected with x-ray	MODERATE PERIODONTITIS
ADVANCED PERIODONTITIS All of the above symptoms are very pronounced Pocket depths exceed 6mm Severe mobility and bone loss Possible need for extractions	ADVANCED PERIODONTITIS

Poor oral hygiene

will allow plaque, or hard deposits to form on the teeth. These deposits allow for the growth of bacteria that cause inflammation of the gum tissue. The bacteria also release minute amounts of toxins that help break down the tissue, helping the infection to progress. As the infection progresses, the gum tissue becomes red instead of its normal healthy pink color and will get puffy. As the infection continues, bleeding will occur, especially when you floss or brush. Aside from these effects the bacteria migrate into the pocket and begin to destroy the periodontal membrane. The toxins produced by the bacteria will also destroy the bone in the immediate area. The process can be seen by a deepening of the normal healthy pocket from 1 to 2mm to 3 to 4mm and in severe cases 7 to l0 mm or more. The effect of this over a period of time, is that the teeth involved are loosened and will eventually fall out. The supporting structures, (the periodontal ligaments) having been completely destroyed at this stage.

Bacterial plaque - a sticky, colorless film that constantly forms on the teeth - is recognized as the primary cause of gum disease. Specific periodontal diseases may be associated with specific bacterial types. If plaque isn't removed each day by brushing and flossing, it hardens into a rough, porous substance called calculus (also known as tartar). Toxins (poisons) produced and released by bacteria in plaque irritate the gums. These toxins cause the breakdown of the fibers that hold the gums tightly to the teeth, creating periodontal pockets which fill with even more toxins and bacteria. As the disease progresses, pockets extend deeper and the bacteria moves down until the bone that holds the tooth in place is destroyed. The tooth eventually will fall out or require extraction.

Periodontal disease can result from mechanical problems, usually from excessive pressure on a tooth either from a habit such as grinding or from a person's bite being off. More then normal pressure on a tooth will also cause disintegration of the underlying bone and result in problems. Dental restorations that do not fit properly can also be a factor by causing the gum tissue around the restoration to become irritated.

While these local factors are causes of periodontal problems, they are not the main factors responsible. Periodontal disease is a symptom of the body being in trouble. There are commercials on television that show how all the germs in the mouth are killed when certain mouthwashes are used. The problem is that the germs will be back within a few hours. The bacteria that are being killed are part of the normal population that is always present. Disease is not due to the presence of bacteria, but rather to the body being out of balance in such a way that the bacteria responsible for the inflammation are breeding out of proportion. Killing the bacteria is not the answer. Placing the body back in balance is a much more effective method of treatment.

Stress will also play a major part in the development of periodontal disease. High stress levels cause a lowering of the immune system response and will deplete the body of many valuable minerals and vitamins that are needed for general maintenance and repair.

The body must maintain blood levels of calcium and phosphorus. If there is a shortage of calcium or phosphorus or other minerals the body will take them from nonvital areas so that the more important parts of the body still function well.

As a dentist I am sorry to say that the mouth is not the most important part of the body and will lose out to other more life supporting parts in the race to have proper nutritional balance. What this means is that the body will take minerals from the jawbones and bring them to the body parts. This will result in a weakening of the bone that supports the teeth and for this reason, periodontal disease can be thought of as the beginning of osteoporosis.

When your diet is not what it should be, or stress is present, or you have a combination of both of these factors, the body will react. There are a number of bacteria that live in the mouth, some good, some harmless and some harmful. When you are healthy, the bacterial populations are kept in balance. Your healthy immune system has no problem dealing with this low level of harmful bacteria. When your general health starts to change for the worse, the mouth chemistry changes. Minerals that are in solution in saliva tend to precipitate out and form deposits on the base of the teeth. These mineral deposits are called plaque. The harmful bacteria are now finding that the mouth, is a great place to breed and they start to increase in number. The deposits of plaque tend to protect the bacteria which lodge in the pockets around the teeth and the infection process begins.