Periodontitis begins with plaque. This invisible, sticky film forms on your teeth when starches and sugars in food interact with bacteria normally found in your mouth. Although you remove plaque every time you brush your teeth, it re-forms quickly, usually within 24 hours.
Plaque that stays on your teeth longer than two or three days can harden under your gumline into tartar (calculus), a white substance that makes plaque more difficult to remove and that acts as a reservoir for bacteria. Unfortunately, brushing and flossing can’t eliminate tartar — only a professional cleaning can remove it.
The longer plaque and tartar remain on your teeth, the more damage they can do. Initially, they may simply irritate and inflame the gingiva, the part of your gum around the base of your teeth. This is gingivitis, the mildest form of periodontal disease. But ongoing inflammation eventually causes pockets to develop between your gums and teeth that fill with plaque, tartar and bacteria. In time, the pockets become deeper and more bacteria accumulate, eventually advancing under your gum tissue. These deep infections cause a loss of tissue and bone. If too much bone is destroyed, you may lose one or more teeth.
Although the destructive cycle that starts with the accumulation of plaque is the most common cause of periodontal disease, a number of other factors can contribute to or aggravate the condition. These include:
- Tobacco use. Smoking is the most significant risk factor for periodontal disease. Chewing tobacco also contributes to periodontal disease. Tobacco use in any form damages your immune system, putting you at greater risk of periodontal infection. It also creates a favorable environment for harmful bacteria and interferes with the normal mechanisms for limiting bacterial growth in your mouth. Even exposure to secondhand smoke appears to contribute to periodontal disease. And because smoking impairs healing, smokers are less likely to respond to treatment than nonsmokers are.
- Heredity. Sometimes you may do everything right and still develop periodontal disease. In that case, you — along with close to one-third of the population — may have inherited a predisposition to gum problems.
- Drugs. Hundreds of prescription and over-the-counter antidepressants, cold remedies and antihistamines contain ingredients that decrease your body’s production of saliva. Because saliva has a cleansing effect on your teeth and helps inhibit bacterial growth, this means that plaque and tartar can build up more easily. Other drugs, especially anti-seizure medications, calcium channel blockers and drugs that suppress your immune system, sometimes cause an overgrowth of gum tissue (gingival hyperplasia), making plaque much tougher to remove.
- Diabetes. A number of health problems can take a toll on your gums. One of the most significant of these is diabetes, which makes you more prone to many infections, including gum infections. But the relationship between diabetes and periodontal disease doesn’t end there. Gingivitis and periodontitis impair your body’s ability to utilize insulin, making diabetes harder to control. And because diabetes and periodontal disease may make you more susceptible to heart attack and stroke, having both conditions increases your risk of cardiovascular disease.
- Hormonal changes. Changes in hormone levels that occur during pregnancy, menopause or even menstruation can make your gums more susceptible to periodontal disease.
- Nutritional deficiencies. A poor diet, especially one deficient in calcium, vitamin C and B vitamins, can contribute to periodontal disease. Calcium is important because it helps maintain the strength of your bones, including the bones that support your teeth. Vitamin C helps maintain the integrity of connective tissue. It’s also a powerful antioxidant that counters the tissue-destroying effects of free radicals — substances produced when oxygen is metabolized by your body.
When to seek medical advice
Healthy gums are firm and pale pink. If your gums are puffy, dusky red and bleed easily, see your dentist. The sooner you seek care, the better your chances of reversing damage and preventing more serious problems.
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