People who don’t brush and floss regularly and properly are asking for trouble. Most people react to this observation saying “True, that’s why we get cavities.” Other things begin equal, that’s a fair reply. However, it leaves out the other elephant in the room. Poor oral hygiene is without question the usual suspect in cases of gingivitis. Gingivitis – inflammation of the gingiva, the gums. This is the gateway gum disease. How common is gingivitis? Well, consider that 47.2% of Americans over the age of 30 have periodontitis and that periodontitis is preceded by gingivitis. Everyone with periodontitis “graduated” from milder gingivitis. However, not all cases of gingivitis progress to periodontitis. Thus, we can safely say that more than half of American adults have gum disease.


Since it’s so common, it’s likely you’re personally familiar (first-hand or second-hand) with the typical symptoms of gingivitis.  It usually begins with reddening and swelling of the gums. The gums then may start to bleed easily. Streaks of red appear when spitting after brushing and flossing. The gums become tender, sensitive.  They’ll recede, exposing more of the teeth’s roots. And then, there’s the odor. It’s a putrid smell. Some say it’s like the smell of rotting meat. This makes perfect sense. It is the smell of rotting meat. The gums. By the way, human nature being as it is, this last symptom is often the one that finally gets a patient to take action.  We’ll discuss the importance of early intervention later, but first, let’s talk about what’s really going on here.


Your gums are composed of mucosal tissue. They’re part of the inner lining of the mouth.  Mucosal tissue is the type found in other body openings, such as nostrils and eyes. Given these locations, it’s no surprise that mucosal tissues specialize in keeping disease-causing agents out of the body. While, of course, keeping inside the body what’s supposed to be there. A neat trick!

The gums pull this off with a few special features. First, they provide a seal around the teeth. Second, they’re very tightly bonded to the bones in which the teeth are set. This physical barrier protects the vulnerable deep tissues beneath them. It’s a tough barrier, withstanding chewing forces that average 171 lbs. for adult molars. There’s also an active defense of the barrier at work.  Gum tissue includes a network of specialized immune system cells.  These identify and fight off the bacteria that attack gums.


Most people are aware that tooth decay and cavities are the work of bacteria. So is gingivitis. The same plaque and tartar that grow on teeth attack the gums. In quick review, plaque is a transparent film of sugars and bacteria. It’s always forming on tooth surfaces. That never stops. Plaque is soft, squishy stuff, not hard to remove with proper brushing and flossing. Tartar is what plaque turns into if it’s not promptly removed. Tartar is hard, hard stuff, difficult to remove. Toothbrushes and dental floss don’t work at that too well at all. In fact, tartar removal is one of the missions of the hygienist with her power tools.

Tartar, then, is like a bunker for attacking bacteria. It protects them from our defense. The location is perfect for the attacker to be fruitful and multiply. All the while, these bacteria consume sugars and secrete the acids that scourge enamel and gum tissues.

For the discussion of gingivitis, it’s important to note that tartar penetrates beneath the gumline. This is what shifts the progression of gingivitis into high gear.


As noted earlier, gingivitis can progress to the more serious condition called periodontitis. New symptoms appear. Painful chewing, loose teeth, new spaces between teeth, pus, and changes in bite. These reflect the destruction of the soft tissues and bones in which the teeth are set.  When that happens, the patient’s taken the wrong fork in the road. The right fork led through regular dental care and interception of gingivitis in the very early stages. It’s important to note that these early, manageable stages of gingivitis often produce no discomfort at all. That’s why it doesn’t pay to wait for symptoms before taking action. Hygiene should be pro-active. Get it, before it gets you.


The speed with which periodontitis invades and attacks depends on several factors. In patients with a genetic predisposition tooth and bone loss can be devastatingly quick. Likewise with people who have compromised immune systems.  Howsoever fast or slow tooth and bone loss unfolds, this gum disease can cascade into body-wide problems, some very serious. Those bacteria, the enemy, can get into the bloodstream with greater ease as they destroy gum and underlying soft tissues. The results can be catastrophic. Studies are now connecting these bacteria to stroke, coronary artery disease, respiratory disease, and rheumatoid arthritis. Researchers are studying possible links to dementia.

We don’t want to go there. If the symptoms described above are not enough to get your attention, consider the treatment options.  In moderately advanced cases of periodontitis, the approach involves cleaning and scaling above and below the gumline with a metal tool. The dentist may elect to perform root planing. This basically roughs up a tooth’s root. This helps the gum re-bond with the tooth.

In more advanced cases treatment has to be surgical and radical. Periodontal surgeons can go deep below the gumline. They slice into gums and peel the soft tissue back to expose the roots. After scaling and root planing, the surgeon stitches the cuts closed. He or she can repair gums with grafts of tissue taken from other areas inside the mouth. Likewise, surgeons can perform bone grafts to restore structures around a tooth root. Finally, other techniques involve the insertion of mesh to guide bone re-growth.

Let’s not take the wrong fork. Gum disease is an unwelcome destination.


Remember, all cases of periodontitis started as gingivitis. However, not all cases of gingivitis lead to this terrible outcome.

Other things like genes being equal, it’s mostly the patient who decides which fork in the road to take. As noted earlier, over half of American adults have gingivitis. Even worse, about 28% of Americans in the 65-74 age group have no natural teeth left at all. The most compelling evidence shows tooth decay and gum disease are the reasons why. Since we know very well how to manage both of these conditions, why the grim statistics?

In fact, it appears to be a quirk in human nature. A landmark 2014 study for the Health Policy Institute of the American Dental Association (ADA) sheds some light on this puzzle. Cost turns out to be the most common reason adults give for not seeking dental care. One of the other top excuses was “don’t need it”. However, the toothless statistic strongly suggests we do need it. Your Royal Palm Beach dental practice provides it.

Let’s unpack that finding. Of course, dental care costs money. Dental hygiene undeniably calls for some effort and self-discipline. Together, these two are actually very cost-effective. All things considered, they’re a bargain compared to the alternatives.  This is especially true when checkups are regular and any treatments offered promptly. Think of the other things we spend more money on, and discipline ourselves harder on.

Preventing gum disease is worth anyone’s while. Happily, the very same measures that ward off gingivitis also prevent tooth decay. Unlike the people in the ADA study, we must admit that, yes, we do need dental care. Regular, timely checkups and early treatment. We need to choose to brush and floss regularly, and correctly.

We should choose health.