“What?” you say.
“My hygienist has been telling me for years that I could lose my teeth because of gum disease.”
That’s absolutely true—but periodontal disease itself is not a disease of the bone. The bone is actually healthy and doing exactly what bone is designed to do.
Warning: This is a long one.
Trigger warning: Pus involved.
So Why Do We See Pocketing, Recession, and Bone Loss?
If periodontal disease isn’t a bone disease, then why does bone loss happen?
Teeth are somewhat unique in our anatomy. They exist both outside and inside the body—much like our eyes. Inside the body, we have an immune system designed to keep things sterile. And while I won’t debate proctologists about which end of the tube is dirtier (an unpleasant thought), the mouth is full of bacteria that absolutely do not belong inside the body.
Because of this, teeth require a special sealing mechanism to keep bacteria out.
The Role of the Gums: A Critical Seal
The gums attach to the roots of the teeth to form this seal. This attachment has several components, including collagen fibers that actually penetrate the surface of the tooth root—tough, reinforcing material, much like rebar in concrete.
This attachment—not the bone—is what becomes “sick.”
What Happens When Harmful Bacteria Take Over
When certain bacteria in plaque are allowed to remain in the gum pocket, they release waste products that soak into the surrounding tissue. This triggers inflammation and sets off the body’s immune response—just as if a germ had invaded the body, even though these bacteria are technically still outside.
White blood cells rush to the area, believing they can eliminate the threat. (They can’t—but they try.)
What follows is a constant battle:
- Bacteria continue releasing waste into the sulcus (yes, gross).
- White blood cells release inflammatory chemicals (cytokines) in an attempt to reach and destroy the bacteria.
- These chemicals weaken the connections between cells so white blood cells can move through tissue.
Why the Attachment Breaks Down
The bacteria never leave, and the immune system doesn’t know when to stop fighting.
Over time, the cells that form the attachment between the gums and the tooth—about 2.2 mm wide on average—begin to weaken. The attachment releases near the site of ongoing inflammation.
Your body, however, has a rule:
“2.2 mm and nothing less.”
If it can’t reattach the gums in the contaminated area, it must move the attachment toward the bone, because keeping the inside of the body sterile always takes priority.
Why Bone Loss Occurs (and Why the Bone Isn’t the Problem)
To accommodate this shift, the bone remodels itself—a normal and healthy process—to provide a clean, uncontaminated root surface where the gums can reattach.
So the bone isn’t diseased.
It’s simply responding to instructions from the body.
Why Periodontal Disease Is Such a Concern
As this process continues:
- Gum pockets deepen
- Areas become harder to clean
- The bacterial battle intensifies
And that’s why periodontal disease requires close attention and ongoing care.
Dr. Bob
