When gingivitis is left untreated, it can advance to periodontitis. At this point, the inner layer of the gum and bone pull away from the teeth (recede) and form pockets. These small spaces between teeth and gums may collect debris and can become infected. The body's immune system fights the bacteria as the plaque spreads and grows below the gumline. Bacterial toxins and the body's enzymes fighting the infection actually start to break down the bone and connective tissue that hold teeth in place. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed.
At this point, because there is no longer an anchor for the teeth, they become progressively looser, and the ultimate outcome is tooth loss.
Today, in many dentists' offices, a periodontal screening is included along with the cleaning and checking for cavities. Find out if your dentist conducts this screening. If he or she doesn't, ask for one. Known as a Periodontal Screening and Recording (PSR), this exam can reveal the early stages of periodontal disease. Using a mirror and a special calibrated probe, the dentist checks for bleeding gums and pockets. If a pocket is found, the dentist measures its depth by placing the tip of the probe inside the pocket down to where the connective tissue attaches to the tooth. Pocket depths greater than 3 millimeters indicate disease; depths greater than 4 millimeters indicate periodontitis. A new automatic probing device may prove to be more sensitive and accurate than the manual probe most dentists use. After the screening, the dentist records where pockets were found, how deep they were, where the gum appeared inflamed or injured, and which teeth were loose. If the condition is severe, the dentist may refer the patient to a periodontist for treatment. Although PSR appears to be more reliable than X-rays in diagnosing gum disease, it is still recommended that you receive a full series of mouth X-rays every two to three years, not only to discover early bone loss but also to find cavities or fractures in the teeth.