The breakdown of dental problems is fairly simple and consistent; dentists see mostly tooth decay among the young, mostly gum disease, or periodontal disease, among adults.
We have bacteria to thank. Bacteria is a natural part of every mouth, billions of them forming an extracellular layer that covers all surfaces, says dentist Stanley H. Goloskov. Those bacteria feed on the carbohydrates, including the simple sugars, that we all ingest several times a day, As bacteria metabolizes the carbohydrate, it produces waste in the form of acid, which erodes the tooth. We call that decay—cavities—which can be prevented simply by removing the bacteria through regular brushing and flossing.
Bacteria that isn’t removed hardens into a dangerous plaque. That plaque is especially damaging when it becomes trapped in the space between the tooth and gums. We call the resulting infection periodontal disease. It is the No. 1 cause of tooth loss. “The infection is the same as anywhere else in the body, but gum disease doesn’t hurt,” says periodontist Michele Broder. “People think, It doesn’t hurt, so it’s OK. It’s not.”
Periodontal disease takes two forms: gingivitis and periodontitis. Gingivitis is a swelling of the gums that results in discoloration, bleeding and bad breath. “Most people will experience it at some time,” says periodontist G. William Keller, “but it won’t go any deeper.” Periodontitis is more dangerous, a swelling of the ligament that connects the tooth and surrounding bone.
The immune system’s reaction to both conditions is to deliver natural infection fighters to the area by increasing blood flow, or swelling. The body in effect “sees” the plaque, Keller says. With gingivitis, infection fighters heal the muscle, fat and other soft tissue around the tooth to protect the supporting bone. If the condition is more severe, the immune system instructs the bone to move away from the bacteria, taking the surrounding gum with. That’s periodontitis, and, “That’s what we mean by ‘long in the tooth,’” Keller says. When the bone recedes too far, the tooth loosens. Unaddressed, the tooth will eventually fall out.
In the worst cases, the correction is usually removal of the tooth and placement of a dental implant—surgical insertion of a titanium post in the bone that accepts an artificial tooth modeled on the original tooth. But one of the most exciting advancements is the use of human growth factors to build new bone at the infected site, basically cementing the tooth and connective ligament into place.
Even those who perform surgery would rather avoid it, so, again, prevention of disease is key. Though some people are more susceptible to periodontal disease, for most of us, proper hygiene goes a long way. Says Broder, “You must clean teeth effectively every day.”