Sometimes, due to extensive decay or physical injury, the pulp of a tooth (the living structure on the inside of a tooth that houses nerve fibres and blood vessels) may eventually get colonised by bacteria and get inflamed and infected. Most of the time this is a painful process, and since the tooth has a very limited capacity to heal, early intervention is recommended.

In gingivitis, the gums gets inflamed and swells. They will be sore to touch, and may bleed easily. At this stage, healing occurs simply if the patient brushes more thoroughly. The gums presents ‘false’ pockets of >2mm, as the depth of the healthy pocket is increased only because the gum is bigger, not because of bacterial destruction.

These pockets are colonised by bacteria which relase their own toxins thus making the periodontal fibres loose and weak, leading to further shrinkage of the gums and the bone that supports the teeth. Periodontal disease may not be painful except in end-stage disease, where the teeth start getting mobile and painful to bite on.

In initial periodontal disease, plaque stagnates in the ‘false’ pockets which become a safe haven for bacteria. Bacterial toxins infiltrate the gum and cause destruction of the gum next to the tooth margin.

At a later stage as the gums shrink back further, bone destruction occurs, thereby reducing the structural support for the tooth. Pockets deepen, and mobility may set in.

It is therefore quite a dangerous disease as it may go un-noticed by the patient for a number of years and may be diagnosed casually on a routine dental check-up when it might be too late to treat in certain cases. It is therefore important to visit the dentist regularly, even if there is no obvious cause for concern or any symptoms, and have a scaling done regularly to remove all calculus from the teeth, which might be a factor that promotes periodontal disease.