If you are aware of looseness of some teeth, this is a very clear sign that advanced gum disease may be present. When the patient is aware of looseness, that is usually a very bad sign since patients don't perceive looseness until the teeth are very loose and sometimes hopeless.

What causes periodontitis?
Gum disease is caused by the bacteria that are normally in the mouth. The types of bacteria may vary with some patients having more types of bacteria that are associated with aggressive gum disease. The bacteria then accumulate where the gums meet the teeth. The gums normally form a 'ditch' or 'sulcus' that goes completely around the tooth like a 'cuff on a shirt goes around your wrist'. Once the bacteria cause the gums to become infected, the gums detach from the teeth. When the gums are healthy, the normal depth of the 'sulcus' is 1-3 millimetres. When the gums detach from the teeth as a result of the gum disease, a diseased 'sulcus' is called a 'pocket' and the 'pocket' has a depth deeper than the 3 millimetres. of the 'sulcus'.This deeper depth of the 'pocket' then prevents the patient from treating their own gum disease since a patient can not clean into a 'pocket' and eliminate the excess bacteria when the pocket depth is deeper than 3 millimetres. The untreatable (by the patient) gum disease then spreads into the underlying bone which supports the teeth. This causes loosening of the teeth. If the gum disease is not treated early enough, the patient will lose her teeth.

Risk factors of periodontitisthings that help gum disease (Periodontitis) to progress:

There are other considerations besides the gum factor that can cause or help gum disease to advance faster

Smoking
Smoking has been shown to increase the chances of getting gum disease and also of having more aggressive types of gum disease.

Diabetes
Patients who have diabetes or who have diabetes in their family can be predisposed to having gum disease or to having a more aggressive type of gum disease. If a patient has poorly-controlled diabetes, this may be associated with a more involved type of gum disease.

Genetically-reduced resistance to gum disease
There are genetic considerations which predispose patients toward a more aggressive, severe type of periodontitis. Patients who have a family history of tooth loss or parents wearing dentures, should be more concerned about a genetic resistance consideration.

Type of bacteria that are present in a patient's mouth
It is not known why some patients naturally have bacteria present in their mouths which are not associated with aggressive periodontitis while other patients have the more aggressive type of bacteria.

Periodontitis transmission
It has been shown that patients can transmit gum disease bacteria to their spouses, and that when the spouses have gum disease, the other spouse is more likely to have gum disease. If you are shown to have a more serious type of gum disease, it is important to check the gum health of your spouse.

How gum disease is detected
Normal healthy gums are usually described as 'coral pink' in colour and usually fit to a nice sharp point as they approach the point where the teeth come together and contact. The healthy gums have a 'pebble grain' appearance which is called 'stippling'.

When gums become diseased, they:
- change in colour from coral pink to a more reddish colour
- change in form from a nice sharp, tapered form into a rounded, swollen, less tapered form.
- lose their appearance of stippling and become shiny as well as reddened.

The Periodontal Probe
The periodontal probe is basically a thin nail like instrument the dentist will insert between the gum and a tooth and depending on how far the 'nail' will slide in - the dentist can evaluate if one has gum disease.If the nail (the probe) slides in more than 4 mm - then this could indicate gum disease.

How gum disease periodontitis can be treated

The treatment of gum disease varies depending on the degree of involvement
with the disease.
There are three ways of treating periodontitis:
1) non surgical planning - with a long thin drill like device
2) surgical removal of infected gum tissue
3) and then prevention = brush your teeth like mad

Non surgical Planning of gum disease A non-surgical treatment is called root planning.Root planning is where the gum tissues are usually anaesthetized with a Novocain anaesthetic and the dentist or hygienist will scrape the diseased tooth root until it is clean and no longer contains bacterial waste products.

This is done by a long thin drill type of instrument which slides between the tooth and surrounding gum, and the turning motion, plus water and disinfectant squirted via this drill
- clean out the bacteria and scrape the area around the tooth and between the tooth and the gum free of any material (infected tissue, pus, deep rooted tartar etc) that may be present.If this is done at the initial phases of gum disease, the disease can be stopped in it's tracks, and be prevented from progressing.If this is the case, the planning
- drill scraping, should then be repeated periodically
- say twice a year - even 3 to 4 times a year - or as often as suggested by your dentist.

Depending on how sensitive one is, this treatment can sometimes be done without anaesthetic, but if one is too sensible especially towards the outside of the teeth roots, then small injections of anaesthetic may be injected into the surrounding gum.Root planning may sometimes be enhanced with antibiotics that are taken orally or placed into the gum 'pockets'. Not all cases of gum disease will have antibiotic enhancements as a part of their root planning therapy. After root planning, the gum tissues are usually tender or sore, but not usually painful. When the periodontist determines the gum disease aggressiveness, the periodontist can determine the modifications in the root planning treatments that best fit your case.