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  Dr Minh Nguyen
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Do I Have Periodontal Disease ?



Periodontal disease is an infection of the teeth, gums, and the bone that surrounds the teeth. Most people who have periodontal disease aren't even aware of it. It's rarely painful, especially in the early stages.

The main cause of periodontal disease is the accumulation of plaque. Plaque is the sticky film of food and bacteria that forms constantly on your teeth. It's hard to see plaque, but look at how it shows up after it's been stained with red dye.

You must completely remove plaque each day, or it builds up and mineralizes to become tartar, also called calculus. It takes a professional to remove tartar; there's no way for you to remove it at home. A toothbrush or floss won't budge it. If tartar isn't removed, it migrates to the root surfaces.

Tartar shows up on this x-ray as small white lumps on the sides of the teeth. Bacteria that cause periodontal disease thrive here. Bacteria produce toxins, and it's these toxins, combined with your body's reaction to them, that destroy bone around your teeth.

Some of the warning signs of periodontal disease are:

  • persistent bad breath
  • bleeding gums when brushing or flossing
  • soft, swollen or tender gums
  • gums pulling away from the teeth
  • loose teeth
  • changes in the spaces between your teeth, which reflect changes in the underlying bone

Keep in mind, however, that you can have periodontal disease and experience none of these symptoms!

The roots of the teeth extend into the bone of the jaw. When everything is healthy, the bone comes up around the necks of the teeth and is even throughout the mouth.

The crevice between the tooth and gums, called the sulcus, is two to three millimeters deep when it's healthy. When plaque and tartar invade a sulcus and it becomes deeper than three millimeters, it's called a pocket. Pockets are excellent hiding places for plaque and bacteria, so the problem usually worsens, and bone tissue is lost.
Once bone has been lost, it never grows back. When too much bone is lost, there's so little support for the teeth that they get loose and have to be removed.

Since you may have periodontal disease, yet have none of the symptoms, your dentist will perform a thorough examination using x-rays and a periodontal probe to measure bone levels around the teeth. When the bone level falls, the gums pull away from the tooth, forming a pocket.

Your dentist measures the depth of this pocket with a periodontal probe. The measurement is from the bottom of the pocket, where the gum is attached to the tooth, to the top of the gums.

These are healthy gums. They're tight against the teeth and there aren't any pockets. Below, notice the difference with early periodontal disease. In general, the deeper the pockets, the greater the spread of periodontal disease.

Bleeding is a sign of infection. Healthy gums don't bleed! Your dentist also examines the color and shape of the gums. Notice the pink color and the lightly stippled appearance of the healthy gums, like the surface of an orange.

Look especially close at the difference of the gums between the teeth. This is where periodontal disease usually starts. X-rays tell us a lot about periodontal disease.

So now you know how your dentist finds periodontal disease:
  • probe readings greater than three millimeters
  • bleeding upon probing of the gums
  • swollen and red gums, especially between the teeth
  • bone loss or tartar on your x-rays


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