Periodontal disease is the term that is used to describe all of the diseases that involve the supporting structures of the teeth such as the gums and bones. In adults, chronic destructive periodontal disease becomes responsible for more loss of teeth than cavities, particularly in the aged.(1)

The most common form of periodontal disease begins as an inflammation of the gingiva and is known as gingivitis. It is generally painless, however gums may bleed upon brushing. As the disease spreads, it deepens and actually involves the periodontal ligament and alveolar bone. When this happens the ligament that attaches the tooth to the bone is lost. After that the soft tissue separates from the tooth surface causing a pocket with bleeding upon probing and chewing. Occasionally, an acute inflammation occurs, with the production of pus and the formation of a periodontal abscess. Ultimately, tooth extraction may become necessary if extreme bone loss, tooth mobility, and recurrent abscesses occur. Periodontal infections usually localize in oral soft tissue and very seldom spread into deeper structures of the face and neck.

Gingivitis and periodontitis are diseases associated with accumulation of bacterial plaque. This plaque may become mineralized and harden. We all know that this can be prevented by appropriate oral hygiene, including tooth brushing, flossing, and use of antibacterial mouth rinses. Acute and chronic inflammation of the gingiva can be caused by irritation and also by the invasion of bacteria.

There are several factors that lead to periodontal disease. The two major predisposing factors are poor oral hygiene and increasing age.(2) Other factors include hormonal effects, with a worsening of the disease activity during puberty, menstruation, and pregnancy.(3, 4) Diabetes mellitus causes an increased incidence, particularly in juvenile diabetic patients. Finally, various genetic disorders are associated with an increased incidence of periodontal disease.(5)

It has been known for two decades that brushing and flossing can prevent the development and progression of periodontal disease by removing bacterial plaque deposits. Mechanical interdental cleaning (e.g. flossing) and tooth brushing appear to be more effective than tooth brushing alone or antimicrobial mouth rinses in reducing gingivitis.(6) Professional care can also delay progression of periodontal disease because the dentist or hygienist can remove plaque and calculus from the areas that are difficult to reach. Professional care alone, however, is inadequate to prevent periodontal disease.(7) Thus we all need to take responsibility for our own oral health and develop some good preventive habits.