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    • Dr Riccardo Zambon
    • Dr Elisa Agudo
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What causes gum disease?

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(1) Healthy gums
In health, the roots of your teeth are embedded in the jaw bone. The gum overlies the bone and wraps around the teeth forming a collar around the neck of the teeth. The gum at the neck of the teeth is pale pink and firm.
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(2) Gingivitis
Bacteria are always present in the mouth and accumulate on the tooth surfaces after meals or drinks. They form a soft, sticky mass called “plaque”. Plaque is usually removed through regular tooth cleaning (brushing and cleaning between the teeth). However, if some plaque remains near the gum margin, inflammation of the gums may result (gingivitis). This form of gum disease does not include any loss of bone and tissue that hold teeth in place. The initial stages of periodontal problems are easily reversed by regular dental cleanings and proper attention to oral hygiene.
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(3) Moderate Gum Disease
Gum disease begins with gingivitis (gum inflammation).
If not treated, this inflammation can progress to gum disease. 
Where periodontal gum disease occurs, the bacteria grow down below the gum margin along the root surface. The gums detach from the tooth and the so called “deep gum pockets” are formed. Bacterial toxins and the body's natural response to infection start to break down the bone that hold teeth in place. 
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(4) Advanced Gum Disease
As gum disease progresses, the loss of bone support becomes evident. Is at this stage that the teeth may become loose. The gums may start to recede giving the appearance of elongated teeth; the teeth may become more sensitive. The space that forms between the teeth and gum tissue becomes pockets filled with inflammation, infection and possible pus formation. Without treatment the  bone destruction is likely to progress and the tooth will loose more of its support. In the final stage of the disease the teeth can get extremely loose and be lost spontaneously.

Healthy gums

Gum disease

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These slides &  x-rays show the difference between a healthy patient (left) and one with advanced periodontal disease (right). You can see the gum recession and open ‘gaps’ between the teeth as well as the significant amount of bone loss around the roots of the teeth.
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