The first cause is the mix of bacterial strains in the oral cavity, which are present at all times. Some are more aggressive than others. Allowing bacteria to remain in between the teeth undisturbed encourages bleeding, which fuels the bacteria. There are many types of calculus (tartar) that can form, dependent on the bacterial mix; the calculus is an environment the bacteria make for themselves, much like the Great Barrier Reef is a total environment for coral, fish, invertebrates, etc., and is at about the same scale to bacteria.
The gingiva (gums) is a living gasket that seals and protects the bone from the outside world. Exotoxins produced by bacteria break down this seal, and then destroys the bone. It progresses at rates dependent on the bacterial strains, the health of the individual (diabetes for example).
The easiest prevention is flossing or using a WaterPik. Brushing does not affect disease between the teeth to a practical degree, nor do mouthwashes.
The bacteria can pass from one person to another via kissing. This becomes very evident with Aggressive Periodontitis which is caused by one specific bacteria in the mouths of 3–7% of the population. It is not prevented through oral hygiene, destroys bone quickly, and deep cleanings and bone grafts are ineffective. It is sometimes known as the poor man’s periodontitis. The good news is that it is easily cured with antibiotics after scaling, and most of the bone will grow back (as seen on x-ray).
What can I do to treat my own periodontal disease?
Bone loss is the reaction of the bone to exotoxins generated by bacteria. The usual preventive measures are brushing and floss, regular scaling (followed with 20mg doxycycline for inflammation twice a day for 2 weeks) and prayer.
This presumes that you do not have Aggressive Periodontitis, which is literally a different animal. Caused by only one bacteria, it attacks bone aggressively and all the brushing, flossing or scaling in the world will not stop it. Fortunately, it can be treated successfully with the antibiotic doxycycline, after debridement, and radiographic bone loss can be reversed (the bone matrix may still be intact).
In chronic adult periodontitis, the trick is to remove the bacteria. If there is cratering between the teeth, SuperFloss can be used, if the cratering isn’t too bad. A WaterPik is also effective, with the caution of not placing it right on the gum.
Using a very dilute laundry bleach solution in the WaterPik twice weekly has dramatic effects. It breaks down the tough biofilms that bacteria form for protection, and stunts the bacterial growth, thus reducing exotoxin damage to bone. I learned this from a patient in 1985, who said he learned it from an older dentist in 1970. He had stopped doing it, I had planned periodontal surgery, but he resumed dilute bleach rinses, and in one week, the sub-gingival calculus was super-gingival and we cancelled the surgery after scaling.
For professional papers on clinical research, google: sodium hypochlorite and periodontal disease. You can also google: sodium hypochlorite and caries control.
The trick is to dissolve regular laundry bleach in water: two teaspoons in one quart of water with one teaspoon of baking soda. Pour this into your WaterPik reservoir and use it twice a week. No more than twice a week. Once may be enough. If two teaspoons is too much, use one. If you prefer not to use a WaterPik, then rinse one ounce of the solution, once or twice a week, for one minute.
The research uses a 0.25% Dakin solution, which is available at some specialty pharmacies (pretty strong concentration). It is still just laundry bleach.
How long does it take to cure periodontal disease?
periodontal disease is not a simple bacterial infection that can be cured with antibiotics. Sure bacteria are involved but is the complex interaction of the host immunological response to the bacteria that results in the bone loss and recession. The best we can manage at the moment is to slow the process down to a manageable level but in my experience it is a chronic disease that can not be cured.
We might think to ourselves how can this be? Why have we developed an immune response that attacks our own bone tissue in response to a bacterial infection? Throughout our body we have a mechanical barrier to bacterial infection known as skin and mucous membranes. The point where this barrier is weakest is where the tooth meets the gum and this is in an area populated by millions of pathogenic bacteria.
Our evolutionary response to this is a chronic inflammatory response to resist bacterial invasion which as an end result will cause loss of the tooth and healing with gum, a much better barrier to infection.