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Causes
By Mayo Clinic staffIt's thought that periodontitis begins with plaque. This invisible, sticky film is composed mainly of bacteria. Plaque forms on your teeth when starches and sugars in food interact with bacteria normally found in your mouth. Brushing your teeth removes plaque. But plaque re-forms quickly, usually within 24 hours.
Plaque that stays on your teeth longer than two or three days can harden under your gumline into tartar (calculus). Tartar makes plaque more difficult to remove and acts as a reservoir for bacteria. What's more, you usually can't get rid of tartar by brushing and flossing — you need a professional dental cleaning to remove it.
The longer plaque and tartar remain on your teeth, the more damage they can do. Initially, they may simply irritate and inflame the gingiva, the part of your gum around the base of your teeth. This is gingivitis, the mildest form of periodontal disease. But ongoing inflammation eventually causes pockets to develop between your gums and teeth that fill with plaque, tartar and bacteria. In time, these pockets become deeper and more bacteria accumulate, eventually advancing under your gum tissue. These deep infections cause a loss of tissue and bone. If too much bone is destroyed, you may lose one or more teeth.
Not everyone with extensive plaque and tartar develop periodontitis, though. Some research suggests that periodontitis occurs not simply from plaque but when the type of bacteria in your mouth changes, becoming more destructive.
- Nguyen HD, et al. Common dental infections in the primary care setting. American Family Physician. 2008;77:797.
- Wilder RS, et al. Gingivitis and periodontitis in adults: Classification and dental treatment. http://www.uptodate.com/home/index.html. Accessed Sept. 10, 2008.
- Neville et al. Periodontal diseases. In: Oral and Maxillofacial Pathology. 3rd ed. St. Louis, Mo.: Saunders Elsevier; 2009:154.
- The use and handling of toothbrushes. Centers for Disease Control and Prevention. http://www.cdc.gov/OralHealth/infectioncontrol/factsheets/toothbrushes.htm. Accessed Oct. 17, 2008.
- Cleaning your teeth and gums (oral hygiene). American Dental Association. http://www.ada.org/public/topics/cleaning_faq.asp. Accessed Oct. 23, 2008.
- Loesche W. Dental caries and periodontitis: Contrasting two infections that have medical implications. Infectious Disease Clinics of North America. 2007;21:471.
- Tanner ACR, et al. Clinical and other risk indicators for early periodontitis in adults. Journal of Periodontology. 2005;76(4):573.
