The presence of plaque and calculus on the teeth is a source of continuous
release of irritating bacterial substances, harmful for the mouth's tissues. Of
course the gums also have the possibility of defending themselves: they are
irrorated by capillary vessels that carry the immunity system cells. But a
physical anatomical problem does exist: plaque and calculus are actually
pathological structures which are external to the gum and cannot be reached by
our defensive cells. This is, in the end, the reason why plaque cannot be
spontaneusly removed by the organism.
The prolonged presence of plaque and calculus over and beneath the gingiva
has the gum's disease as a consequence.
Gingiva shows itself in a continuosly, more or less irritated status.
According to patient's age, plaque quality, better or weaker capillary blood
irroration of the tissue, it may show different intensity.
The gum is recognizable because of its diffused reddening, a certain
sensation of burning and dolency, from the (very frequent) presence of bleeding.
Of course in some subjects, a lower quantity of plaque is enough to cause the
disease, while in others, a bigger amount is necessary.
This is often an evolution of gengivitis. The organic defenses of the tissues
(bone and gingiva) begin to give in, and the bacterial plaque opens itself a
road downwards, pacing the tooth's root. The gingiva detatches itself from the
tooth's neck and leaves plaque in contact with the underlying bone. At this
point, the very sustaining tissue of the tooth is attacked, so that it begins to
recede downwards (to the root's apex), reabsorbing itself.
The gum may also hold its position, so that to an external view, what is
happening underneath may not be detected. This way a dental pocket is created: a
situation in which bacterial palque keeps sneaking under the gingiva and
consumes the bone.
Symptoms and signs of this pathology are extremely variable. In particularly
resisting subjects, the pockets can be even asymptomatic, but generally a
diffused bleeding is expected, a certain quota of pain (even acute), a heavy
reddening, bad smell, outcome of pus, and sometimes the forming of
Not all these symptoms are present at the same time, but they outline an
actual disease. When the consumed bone amount reaches a sufficient level, the
tooth has lost so much support that it shows instability and begins to
oscillate. At this point situation can degenerate to the total loss of the
sustaining bone, leading to the loss of the tooth.
c) Gingival recession
It's the spontaneous retreat of the gingival neck along the dental root. It's
not necessarily a disease: within certain limits it can be considered
phisiological coming with age, something like the graying hair or some sight
problems. Usually it alarms the patient more than a gingivitis, because it
happens mostly on teeth that have an aesthetic meaning and therefore jumps into
evidence for its effect of elongation of the visible crown.
Patients as an average don't have a continuous vision of their denture and,
beginning with the moment they discover a recession, they begin to worry much,
thinking it happened very quickly. Of course the process is much slower and
lasts years. It is favoured by less resistant and thin gums, wrong and too
aggressive teeth brushing, traumatic occlusion, presence of frenums (fibrous
chords similar to tendons situated in the mucosa and that act with a "traction"
on the gingival neck).
The direct consequence on the tooth is that the root is being uncovered so
that the increase of thermal or mechanical sensitivity is to be expected, or
even the appearance of abrasions on the root itself, having the looks of an "axe
chopping": these problems can be solved with desensitizing substances or with
the filling of the neck abrasion.
In all cases in which the situation is judged to be dangerous, it is possible
to stop the process or at least to slow it strongly down with a gingival graft
surgery, with palatal drawing (or from other areas where rigid gingiva can be
fetched). According to some operators it is also possible to cover the root thus
regaining the lost gum: in this case though, the graft is sticked on the bare
root, without the possibility of regenerating bone too, so that the final result
has a more delicate stability in time.