Most People Don’t Know They Have Gum Disease. That’s the Problem.
If your teeth don’t hurt, you probably assume everything is fine. And for a lot of patients, that assumption holds right up until it doesn’t. Periodontal disease is one of the sneakiest conditions we deal with in dentistry, because by the time you feel it, things have usually been going wrong for a while.
I recently sat down with Dr. Steven Van Scoyoc, a periodontist who has been coming to Cary Family Dental one to three days a month for the past 20 years. He completed both dental school and his residency in periodontics at UNC Chapel Hill, has served as president of the North Carolina Society of Periodontists, and currently serves as clinical director for more than 24 periodontists across the Southeast. Basically, he knows gum disease. And I think what he shared is worth putting into writing, because a lot of it surprised even patients who have been coming to see us for years.
What Is Periodontal Disease, Exactly?
Periodontal disease is an infection of the structures that hold your teeth in place. We are not just talking about your gums. We are talking about the bone underneath, and the ligament that connects your tooth to that bone. When certain bacteria get into that space and your body cannot control them, you get inflammation. Inflammation breaks down the attachment. Over time, the bone recedes. The tooth loses its foundation. That is how people end up losing teeth, and it accounts for roughly 70 percent of tooth loss in this country.
The thing people miss is that this process usually does not hurt. Dr. Van Scoyoc put it well when he said that the absence of pain is both the blessing and the curse of periodontal disease. You can go years without knowing something is wrong. By the time your teeth feel loose, or you notice gaps forming, the disease is well advanced.
Why Your Overall Health Is Part of This Conversation
One of the things that drew Dr. Van Scoyoc into periodontics was an experience he had as a student. He watched a dentist examine a patient and then ask her if she had ever been evaluated for diabetes. He had no lab results, no chart history. He just looked in her mouth and made that connection. That stuck with him.
It turns out the mouth and the body are not separate systems. When bacteria from periodontal disease enter the bloodstream, they can settle in places they should not be, including the arteries around your heart and the brain. That is why we see links between periodontal disease and cardiovascular disease, dementia, and diabetes. The inflammation in your mouth adds to the total inflammation load in your body.
The relationship works in both directions. If you have diabetes and your blood sugar is not controlled, your immune system has a harder time keeping the bad bacteria in your mouth in check. That makes gum disease easier to develop and harder to treat. So if your doctor has flagged elevated inflammation markers or you are managing a chronic condition, it is worth making sure your dental team knows that.
How We Actually Detect It
At your routine exam, we are doing two things to screen for periodontal disease. The first is looking at your X-rays to see if the bone levels around your teeth look the way they should. The second is periodontal probing, which is when we use a small ruler to measure the depth of the space between your gum and your tooth. Healthy tissue is generally comfortable to probe. If it is tender, that tells us something is going on. Neither of these is high-tech, but together they give us a clear picture.
We also look at your history. About half of all periodontal disease has a genetic component. If your parents lost teeth early, or needed gum surgery, that matters. Smoking is one of the biggest risk factors we know of. It makes you more susceptible and makes treatment harder. Diabetes, as mentioned, is another strong predictor. None of these things are automatic sentences for your teeth, but they tell us how closely we need to watch.
A Story Worth Telling
Dr. Van Scoyoc described a patient of his, a woman in her thirties who had not had dental care in over ten years due to personal circumstances. When she finally came in, she had periodontal disease and significant decay. She wanted her smile back. She wanted white teeth, no black spots, something she felt confident about.
But before any of that could happen, the foundation needed to be treated. Within two to four weeks of periodontal treatment, the change in her gum tissue was visible. She went on to have a full-mouth restoration, crowns on all her teeth, and now she comes in for regular hygiene visits and is doing well.
Dr. Van Scoyoc described what the alternative path might have looked like for her. Probably losing a tooth every one to two years. The remaining teeth shifting under pressure. Gaps forming. Decay going untreated because the foundation was not stable enough to restore. Eventually, dentures.
That story is not dramatic by accident. It is the reality of what untreated periodontal disease looks like over time, and it is also the reality of what early treatment can change.
What Happens When a Tooth Is Already Gone
Sometimes patients come to us after the tooth is already lost, whether from gum disease, a cavity that went too far, or a crack that could not be fixed. When that happens, there are three ways to replace it.
The first is a removable option, a partial denture or, if all the teeth are missing, a full denture. The second is a bridge, which uses the two teeth on either side of the gap to anchor a fixed three-unit restoration that fills the space. The third is a dental implant.
An implant replaces the root itself. It is a small titanium post placed into the bone where the root used to be. Once it heals and bonds to the bone, typically over a few months, we can place a crown on top that looks and functions like a natural tooth. The process from extraction to final crown is usually four to seven months, depending on the situation. Studies show a 97 to 98 percent success rate over 10 to 15 years, which is a strong track record for anything in medicine.
The Takeaway
Gum disease is quiet. It does not announce itself. The goal is to find it before it costs you teeth, before the foundation is compromised, and before the options get more complicated. That is what your hygiene visits are for, and it is why Dr. Van Scoyoc has been part of what we do here for two decades.
If you have been putting off a visit, or if something in here sounded familiar, reach out. We are happy to take a look and give you an honest picture of where things stand.
