Commonly known as gum disease, periodontal disease is a family of related chronic inflammatory diseases that are all bacterial infections. The disease results in red, swollen gums and can lead to the destruction of the connective tissue and bone that hold teeth in place. It is a serious condition, the major cause of tooth loss, and may be a risk factor for heart disease, stroke, diabetes, and premature babies.

The word "periodontal" means "around the tooth." Each tooth is embedded in the gum, or gingiva, and attached by connective tissue to bone. Healthy gums are pale pink, smooth, and firm, and form a peak or cone between adjacent teeth. They surround your teeth like a turtleneck fits your neck, with just a narrow crevice in-between. It is in this crevice where problems can begin. Even when your gums are healthy and you brush and floss daily, this crevice teems with all sorts of bacteria.

Bacteria produce the sticky, soft, colorless substance known as plaque. As plaque accumulates on the surfaces of teeth and in the crevices, bacteria release toxins that irritate the gums, triggering an immune response that causes the gums to swell, turn red, and bleed easily. If you have these symptoms, you may have periodontal disease. Plaque that is not removed can harden into tartar (calculus). The buildup of tartar worsens the condition, causing the gums to pull away from the teeth. Over time, deeper and deeper pockets may form. Bacteria invade these pockets and from there can infect and destroy the underlying connective tissue and bone, loosening the teeth.

Not brushing and flossing or getting professional cleanings regularly encourages plaque and tartar formation. Even after you've developed gum disease, you can stop its progression and reverse its symptoms by getting professional treatment and practicing good oral hygiene at home.

There are two major types of periodontal disease: gingivitis and periodontitis.

Gingivitis

Gingivitis is the stage of periodontal disease when the gums are inflamed and beginning to pull back from the teeth, but there is no damage yet to the connective tissue and bone. Ordinary gingivitis is the most common and least severe form. Gums are red, swollen, and bleed easily. People with gingivitis may have persistent bad breath. Treatment at this stage of the disease is very effective.

Other forms of gingivitis are associated with certain medications (including Dilantin®, Procardia®, steroids, and cyclosporine), changes in hormone levels in women, or some allergies and skin diseases. When an allergy or a skin disease is the cause, tissue may literally peel away from the gum. In the most severe form of gingivitis, known as acute necrotizing ulcerative gingivitis, the gums are so infected that tissue begins to die. The gums bleed spontaneously and the cone of tissue between teeth decays and becomes blunted. The decay causes pain and produces a bad odor. Patients with AIDS often get this form of gingivitis. In advanced cases, the gums in the front may turn yellowish-gray and recede so much, that bone is visible.

Periodontitis

Gingivitis may lead to periodontitis, which is characterized not only by inflamed gums but also by deep pockets between gums and teeth; in advanced cases, there is destruction of the underlying connective tissue and bone. The most common type of periodontitis is adult periodontitis. It may start as early as the teen years, but symptoms usually don't become noticeable until the mid-30s or later. Symptoms slowly get worse as the person ages, but may come and go depending on a person's general health, oral hygiene, and ability to combat the bacteria that cause the inflammation. Periodontitis is also associated with several diseases and disorders, including type 1 diabetes, AIDS, and Down's syndrome.

Children can get periodontitis as well. On rare occasions babies can get the disease with the eruption of their first teeth. A more common, but still rare, condition affects children at puberty and involves the first molars and incisors. Juvenile periodontitis may be localized, that is, restricted to one or two teeth, or generalized where the inflammation and damage is more widespread. Kids with localized disease have very little plaque and tartar but exhibit rapid loss of the bone around the affected teeth. Generalized juvenile disease looks and acts more like adult periodontitis, with inflammation, buildup of plaque and tartar, and bone loss that loosens teeth. Young adults (ages 18 to 34) may get a rapidly progressive form of the disease.