Adam Bellingham DDS

I get asked this question a lot, so let's talk about gingivitis vs periodontitis, AKA gum disease in all it's forms.

What is Gum Disease

Gum disease typically comes in 2 forms, Gingivitis and Periodontitis. Gingivitis is an inflammation of the gum tissue due to plaque or calculus (tartar) build up. This is what most people have when they aren’t brushing and flossing as well as they should be. The second form of gum disease is Periodontitis, and it is considerably more serious. Periodontitis is characterized by the loss of jawbone and tissue attachment levels. In regular terms this means recession of the gums and destruction of the bone that holds your teeth in. When not properly and regularly removed, plaque and calculus start to form below the gum line. This plaque and calculus is full of bacteria and keeps your gums constantly irritated and inflamed. This long-term inflammation is destructive and will start to dissolve away the bone that holds your teeth in. This lets your gums recede away from the buildup. Unfortunately, as your gums recede, the buildup continues to form on this newly exposed root structure. This leads to a cycle of continued bone loss and gum recession. Eventually this destruction will approach the end of the tooth root and, just like digging the dirt out from around a fence post, things start to get loose. If left untreated this will lead to the loss of teeth.

Gum Disease Symptoms

The signs of gum disease, whether gingivitis or periodontitis, can be similar. Both are characterized by red and puffy gums, along with bleeding when you eat, brush or floss. Periodontitis goes a step farther with receding gums and mobility, or loosening, of teeth. Periodontal disease is usually painless until a tooth becomes so loose that it hurts to chew on. Untreated periodontitis also causes a particularly strong type of bad breath.

How to treat Gum Disease

To effectively treat gum disease, we first must determine the type. This is typically done with periodontal probing and a comprehensive set of x-ray. When probing, we use a measuring device called a periodontal probe to determine if you have any loss of bone/attachment. X-ray are also used to measure your current level of bone and the extent of bone loss, if any.
If you only have inflammation, or gingivitis, then the treatment is a Prophy. This is what most people know as a regular cleaning. This involves removing plaque and calculus above the gumline. Insurance typically covers 2 of these a year.
If you have bone or attachment loss, then you have Periodontitis. To treat this, you need SCRP (scaling and root planing), often called a deep cleaning. SCRP involves cleaning above and below the gums to remove the calculus buildup and the use of medicated irrigation to reduce the bacteria in the pockets. Once the bone loss associated with periodontitis has started it cannot be reversed, it can only be halted. The bone that is lost cannot be grown back. Once the deep cleaning is done, we place you on a periodontal maintenance schedule. This involves cleaning, irrigation, and possible re-scaling of problem areas, every 3-4 months. This is done to try and prevent the need for subsequent rounds of SCRP or deep cleaning. Insurance only covers a percentage of SCRPs and perio maintenance, so you will have an out-of-pocket cost. Once you are a deep cleaning patient you typically cannot go back to just a prophy. Insurance will typically not cover a prophy once you have a diagnosis of periodontal disease.

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