Periodontal Disease

Causes, Prevention, Treatment & Home Care

Periodontal disease is a condition that affects the supporting structures, primarily bone and gum tissues, which hold your teeth in place. Having good periodontal health is important for maintaining the long term function and aesthetics of your teeth as well as being an integral part of maintaining your overall health. As gum disease progresses, you will see loosening and loss of teeth, longer teeth that compromise the natural beauty of your smile, a reduced ability to properly chew your food and an increased risk of systemic disease.

Causes of Periodontal Disease

There are two basic types of gum disease, periodontitis and recession. Both types of disease result in the loss of supporting structure, gum tissue and bone, around the teeth. Periodontitis, a loss of gum and bone due to a bacterial infection, will affect approximately 75% of the population at some point in their life and is the leading cause of tooth loss after the age of 35.

As soon as we brush our teeth, bacteria in our mouths begin attaching to our teeth. The bacteria take the food that we eat and turn it in to toxins and irritants. The combination of the bacteria, food and toxins is what makes up dental plaque. Plaque is a very soft material that is attached to your teeth and with proper daily brushing and flossing can be easily removed. If you do not get the plaque off, it will begin to calcify into a hard substance called calculus or tartar which you cannot remove easily.

The plaque and tarter can cause irritation in your gum and bone. As this irritation progresses, it will begin to dissolve the gum and bone attachment around the tooth. The inflammation causing the loss of bone and gum is also thought to get into the blood stream and cause inflammation and disease in other parts of the body. As the gum disease progresses, eventually the teeth will lose their support and be lost.

Ironically, gum disease is usually asymptomatic. People do not know that they have gum disease unless their dentist tells them they do after doing a thorough examination. Because periodontitis is usually a chronic disease that occurs over a long period of time, like heart disease or diabetes, symptoms are not noticed until the advanced stages of the disease.

Factors that contribute to the progression of gum disease include tobacco usage, diabetes, stress, clenching or grinding teeth, medications, poor nutrition and hormonal changes (puberty, menstruation, pregnancy, etc.).

Recession is a second common form of gum disease resulting in the loss of gum and bone support but usually has less to do with the bacteria in your mouth and more to do with the amount of supporting bone and gum tissue you have around your teeth. Recession results in the loss of gum and bone primarily on the outside of the tooth and results in the exposure of the root of the tooth. As the root gets exposed, the teeth appear longer than normal and may become sensitive.

The thicker the gum and bone are around the teeth, the more resistant the tooth is to having recession. Each tooth should have two types of gum tissue around it, a band of thick pink tissue called keratinized tissue right around the crown of the tooth and then the cheek tissue either above or below the keratinized tissue. The keratinized tissue is essential to maintaining the long term health of the teeth. If this tissue is either not present due to genetic factors or is lost due to traumatic brushing or by some other means, the gum and bone will frequently begin to recede and expose the root of the tooth.

Prevention of Periodontal Disease

The primary factors in preventing gum disease are maintaining good daily oral hygiene and seeing your dentist for dental cleanings on a regular basis. Daily brushing and flossing to remove dental plaque and oral bacteria is the most effective way to prevent gum disease. For the most part, you have control of your oral health. Individuals that are diligent with their home care rarely have problems with gum disease.

Seeing your dentist regularly for an examination and cleaning is also very important for maintaining good oral health. Regular examinations are important to identify any disease progression at the earliest stages where they can usually be managed with very conservative treatment. Cleanings allow deposits of calculus and tartar that have built up over time to be removed. This allows the health of the gums to be optimized and supports the efforts you are making at home.

Dr. Williamson and his staff are happy to answer any oral hygiene questions that you might have. Please feel free to call us at 512-346-2782 for more information or to schedule your periodontal disease screening today.

Treatment for Periodontitis

The loss of gum and bone due to a bacterial infection around your teeth is best treated by removing the bacteria and toxins that are causing the bone and tissue loss. If periodontitis is identified at its earlier stages, nonsurgical treatment is usually sufficient to correct any problems that exist. A deep cleaning, usually done under local anesthesia for patient comfort, allows us to go deeper under the gum line to clean out any plaque or tartar that is not accessible with normal oral hygiene efforts or with a regular cleaning. A deep cleaning is a noninvasive procedure that allows you to proceed with your day immediately after the treatment.

For more advanced gum disease, noninvasive deep cleanings are used to try to eliminate as much disease as possible. If deep cleanings are insufficient to correct the problem, more advanced strategies to eliminate the disease process will be evaluated.

Treatment for Recession

Most recession, loss of the bone and gum on the outside of the tooth, does not need to be treated. If the recession is progressing, treatment options will need to be evaluated to stop the disease progression. The most common cause of progressive recession is an inadequacy of supporting gum tissue on the tooth. Treatment for this problem is to add new supporting tissue around the tooth. Adding supporting tissue is predictable and has good long term success.

Home Care for Periodontal Disease

Proper oral hygiene is cornerstone to preventing and treating most types of gum disease. It is important to incorporate daily brushing and flossing along with regular cleaning visits at your dentist’s office to avoid having gum problems. Most gum disease problems, as well as decay problems, stem from bacteria causing damage to the tooth and gums. Oral hygiene is the mechanism by which we keep these bacteria in check and prevent them from doing damage to the teeth and gums.


Proper brushing daily is very important to your oral health. Selection of the right toothbrush is important to make sure that you are cleaning the teeth without damaging the teeth and gums. Medium and hard bristled brushes are not recommended and will do damage to the teeth and gums with over aggressive use. Always select a soft bristled brush. While electric toothbrushes are excellent tooth brushes and provide the best cleaning action, they are not necessary for most people. If you are going to use an electric toothbrush, Dr. Williamson recommends the Sonicare toothbrush.

To properly brush, position the brush at a 45-degree angle to the tooth and gums and gently massage the bristles of the toothbrush under the gums. After brushing the gum line, brush the tops of the teeth, the gums and your tongue. It would be best to brush 2 – 3 times per day.


Flossing is the most important, and usually the most neglected, aspect of daily oral hygiene. Flossing can be a little awkward and time consuming; however, flossing is the only way to clean between the teeth which is the most common place for gum disease to develop and a very common place for decay to develop. Flossing will remove the bacteria and plaque between the teeth and should be done at least one time a day.

To floss, use about an 18” piece of floss. Either waxed or unwaxed floss works, but Dr. Williamson feels that unwaxed floss is more effective at removing plaque. Wrap a majority of the floss around the middle fingers of each hand. Use the forefinger and thumb on each hand to gently guide the floss in between the teeth. Make a “C” shape against the surface of one tooth and in an up and down motion gently work the floss up underneath the gum tissue until you feel a slight resistance. Once you have cleaned that tooth surface reverse the “C” and floss along the adjacent tooth.

Rinse when you have completed flossing to remove any debris or plaque that you may have dislodged during flossing.

Sensitive Teeth

Cold sensitivity is common following periodontal therapy. The cold sensitivity will improve over time but it may take three months before you see any significant improvement. If cold sensitivity is an issue for you, try one of the sensitivity reducing toothpastes. If the sensitivity persists, let Dr. Williamson know and he will be able to give you additional recommendations.