Understanding Gum Diseases

Periodontal diseases are mainly of two types:

Gingivitis: involves inflammation of gums
Periodontitis: involves inflammation and loss of tooth supporting structures like periodontal ligament and/or bone.

Gingivitis

Gingivitis is caused by inadequate tooth cleaning and retention of dental plaque around marginal gingiva for an extended period of time. As a result, the microorganisms become more complex and initiate the process of gingival inflammation.

Brushing and flossing (interdental brushing) removes plaque adequately and resolve the situation.
Dental prophylaxis by a professional dentist or hygienist also significantly improves this situation.

Periodontitis

Periodontitis is an inflammatory condition that affects underlying support of teeth. Periodontitis weakens tooth support; in advanced stages, it leads to tooth mobility. If not treated adequately in a timely manner followed by regular maintenance, periodontitis may be a principle cause of tooth loss.

What causes Periodontitis?

Periodontitis is a multifactorial disease with interplay of plaque, multiple genes, and risk factors.

Role of Plaque:

The Primary Cause of gum disease is plaque, which is a biofilm. Plaque, being a biofilm, is a community of bacteria helping each other for the survival of the “community” against external factors like host inflammatory response, antibiotics, antiseptics (mouthwashes), etc.

Role of Genetics:

Genetics is a central factor with studies showing genetics making up to 82% (average 50%) contribution towards periodontal disease is governing inflammatory response of body. Periodontitis is a mixed genetic disease due to interaction of multiple genes so not allowing a simple genetic test.

Other Risk Factors:

Poor oral hygiene over a long time period
Smoking: an important factor which a patient can make a change.
Uncontrolled diabetes: another important factor which a patient can control with some effort.
Obesity: Effect is similar to Diabetes.
Stress: Extreme stressful events (divorce, long term financial stress, death of close-ones) or even more appropriately coping behaviour after the stressful events determines the nature of periodontal destruction. Poor oral hygiene (brushing and flossing) may be a last priority during this hard-to-cope stressful time, and smoking may increase - both would further contribute to periodontal disease progression.
Age: Impaired healing potential with increasing age affects periodontitis progression.