Periodontal disease (also called gum disease or gum infection) is mild to severe inflammation and infection of the gums, tissues and bones supporting and anchoring teeth to the jaw. Gum disease is the primary reason for tooth loss in older adults.

Periodontal disease is typically caused by a build-up of harmful bacteria on the teeth and gums. The bacteria interact with acids and food particles in the mouth to form plaque, a sticky film on the surface of teeth and gums. When plaque remains on the teeth it can harden into tartar (calculus). Tartar that forms below the gum line can only be removed by a dental hygienist in a professional cleaning.

The bacteria that cause plaque and tartar also trigger a response from the body’s immune system. As a result, gums can become inflamed, red and sensitive. They may also bleed when touched or brushed. Periodontal disease may also cause persistent bad breath, loose teeth and other symptoms. However, in its early stages, periodontal disease often occurs without any noticeable symptoms, making diagnosis difficult.

The mildest and most common form of periodontal disease is gingivitis, which is inflammation or swelling of the gums. Gingivitis can be classified by the underlying cause or causes of the condition. These include weakened immune systems, poor diet, hormonal changes in women, oral fungus or viruses or as a result of taking certain medications.

Gingivitis sometimes, but not always, worsens into a more severe form of periodontal disease called periodontitis. In this condition gums pull away from the teeth, forming periodontal pockets that trap bacteria and food particles. Over time, periodontitis can lead to the destruction of gum and bone tissue, which may eventually cause the teeth supported by that periodontal tissue to fall out or have to be pulled.

The major classifications of periodontitis include chronic periodontitis, aggressive periodontitis, periodontitis caused by systemic disease, periodontitis associated with pupal infection, necrotizing ulcerative periodontitis and periodontitis as a result of developmental or acquired deformities.

Periodontal disease has been linked to increased risk of developing cardiovascular disease, including stroke and heart attack. In addition, studies have shown that pregnant women with the disease may be at higher risk of premature or low-birth weight babies.

Some people are at greater risk of contracting the disease, including those with poor oral hygiene or poor nutrition. Smokers, women, people with diabetes and those with a family medical history of periodontal disease are also at higher risk.

A dentist diagnoses periodontal disease using x-rays, dental examinations and dental histories. A probe is used to determine the level of gum and bone damage by measuring the depth of the periodontal pockets formed between the teeth and gums (sulcus).

Treatment methods depend on the type and severity of the periodontal problem. For mild gingivitis, this usually involves debridement or deep cleaning of the teeth and roots (scaling and root planing) as well as polishing the teeth so the smooth surface will be more resistant to bacteria growth. More vigilant home oral care may be recommended, including more frequent brushing and flossing and the use of specialized mouth rinses.

For more advanced periodontal disease, patients may be referred to a dentist who specializes in periodontal care (periodontist). In severe cases a variety of surgical procedures may be considered, including flap surgery, gum grafts, bone grafts or guided tissue regeneration.