The periodontium is the functional unit of tissues that surrounds the tooth. There are four parts: the gingiva, periodontal ligament, cementum, and bone (last three are the attachment apparatus).

In contrast to caries which is basically a disease of children and adolescents, periodontal problems generally occur in adults. The recognition of normal gingiva, gingival infections, and deeper periodontal involvement depends on proper examination. Dental hygienist should recognize the signs and effects of inflammation from these markers:

According to the extent parts, we distinguish gingival infections (gingiva is involved), and periodontal infections (gingiva, periodontal ligaments, bone, and cementum are involved).

Gingivitis is a reversible inflammation of gingiva, the first stage of periodontal disease. It is caused by poor oral hygiene. Plaque and calculus collects at the gum line, between the teeth and the gums and provoke gingival inflammation from realising toxins that irritate and erode the gum tissue. The other causes of gingivitis include defective dental fillings that promote food and plaque retention, and poor alignment of the teeth, which promotes plaque and calculus accumulation in hard-to-clean places.

Many patients´ gums problems do not end at the reversible stage. In the next phase, gingivitis is getting worse. The patient who still not carefully brush his teeth and gums, will not be able to cope with spontaneously bleeding gums and advanced infection of the gums. The tartar penetrates directly into the gums and the teeth, it can continue to root, and destroys the periodontal ligament that attaches the tooth to the jawbone. As the disease progresses, the pocket deepen and more gum tissue and bone are destroyed. When the alveolar bone around the tooth and the roots are infected, the loss of the bony tissue leads to tooth mobility of one or more teeth. This stage is irreversible.

In the final stage, periodontitis leads to loss of the tooth. The increasing inflammation can be stopped by thorough scaling and cleaning of the infected root and bone surfaces. Patient must help with daily cleaning and try to reduce all the irritating factors.

The actual position of gingiva is the level of the attached periodontal tissue. It is not visible but can be determined by probing. Recession is the exposure of root surface that results from the apical migration of the junctional epithelium. Visible recession is the exposed root surface that is visible on clinical examination. When the visible recession may extend to or through the mucogingival junction, we talk about localized recession.

The dental hygienist should teach her patient:

Dental hygienist can explain the potential connection between gum disease and serious health problems. Toxins are released into the bloodstream. There is the link between gum disease and diseases such as heart disease (heart attack), it increases the risk of cerebrovascular diseases (stroke), atherosclerosis (hardening of the arteries), diabetes mellitus, adverse pregnancy outcomes.