Is Periodontal Disease Destiny? Dental Health Misconceptions and Cautionary Tales (Part 2)

Author: Joyce Guojun Ma (马国珺), DDS, PhD

About the Author

Dr. Joyce Guojun Ma earned her undergraduate degree from Peking University School of Stomatology and her DDS from New York University College of Dentistry. She has practiced as a general dentist in the United States for 15 years, holds the Master of the Academy of General Dentistry (MAGD) designation, and is licensed to practice dentistry in New Jersey, New York, and Pennsylvania. She also holds a PhD in Neuroscience from Johns Hopkins University and has completed seven years of intensive neuroscience research training during her doctoral and postdoctoral studies.

Read Part 1 here: https://eddytian.substack.com/p/the-dangers-of-ignoring-a-toothache

A Case That Began with a “Floating Tooth”

Periodontal disease is a chronic condition, capable of existing quietly for years without causing any pain or obvious symptoms. However, if you wait until symptoms to treat it, the disease will have already inflicted irreversible damage on your oral health. The second patient I saw on New Year’s Eve was a man in his 50s with end-stage periodontal disease, which caused severe swelling of the entire left side of his face.

He came in because of throbbing tooth pain.

He told me his industry had been hit hard by AI; he had just been laid off, and his insurance was about to expire. He had been busy with work for years and hadn’t paid much attention to his teeth. Occasionally his gums bled when brushing, so he brushed less in those areas. His breath wasn’t fresh, but he assumed it was genetic, as his father had the same issue; he used mouthwash, chewed gum, and managed as best he could to mitigate the symptoms. As he got older, his bite felt weaker; hard foods were difficult to chew.

This was the first time things had become this severe. Six months earlier, he had experienced pain once before, but it coincided with a mid-year performance review, so instead of seeing a dentist, he took some leftover antibiotics on his own, alleviating the pain.

I took X-rays.

The lower left two molars were what we call “floating teeth”. In other words, the teeth were almost entirely surrounded by inflammatory tissue, and the bone around the roots had been nearly completely destroyed. The entire left mandibular region was severely swollen.

He said his teeth felt like they had “grown longer”, and couldn’t close his mouth due to the pain. He said he felt like dying, but couldn’t because he had a child in college to support. He had a job interview in a week and begged me to “cure it today.”

Looking at those two teeth, essentially floating in inflammatory pus, I asked him what he meant by “cure.”

He said:

“Can you just fill them? Or give me some really strong medication and make it better?”

I was honestly speechless.

Doctors are not gods. Not everything can be easily cured in a single visit, or even at all. These teeth were beyond saving, like castles on sand without any foundation to make them last.

What made it even more pitiful was that these teeth had no significant decay; the two teeth were completely intact. The problem was massive calculus accumulation. The pain and swelling was an acute local flare-up of the two teeth, but the condition of the other teeth showed the same characteristic pattern: the symptoms of generalized severe periodontal disease.

I asked about his last dental visit.

He said that he immigrated here from India. He used to have good teeth back in India. After coming to the U.S., he focused mainly on building his career, neglecting his health needs due to lack of time. He only saw a dentist once five years ago. That dentist looked at him for two minutes and recommended an expensive deep cleaning procedure, which he did not understand why and felt completely overkill. Since he had no symptoms, he felt it was unnecessary. What upset him even more was that they wouldn’t offer a “regular, cheaper cleaning.” He only had the exam, and never went back.

Hearing this, I felt it is truly imperative to provide dental education to the general population. We have done far from enough!

There are so many misconceptions. Even people with advanced degrees—master’s, PhDs—can have an extremely low Dental IQ. In reality, the general level of understanding may be far worse than we assume.

So today, let’s talk about periodontal disease: Is it fate? Is it an endless, incurable money pit? Why does it happen? What should ordinary people actually do? How can we avoid letting the disease progress to the point of irreversible damage and losing teeth?

Is Periodontal Disease Fate?

No.

But it is a chronic disease.

Periodontal disease is fundamentally a chronic inflammatory condition, driven primarily by anaerobic oral bacteria. Its treatment is not like filling a cavity—something that can be done once and completed. You can’t quickly cure periodontal disease any more than something like hypertension or diabetes. It is not curable by miracle doctors or powerful drugs, but by careful long-term management of dental health.

It is not a bottomless pit, but rather a defending war that requires the patient’s participation.

How Does Periodontal Disease Develop?

Many patients ask:

“I brush my teeth. I don’t eat much sugar. I don’t even have cavities. Why do I still get periodontal disease?”

The answer usually unfolds in three steps:

1. Dental plaque is not adequately removed over time.

Brushing is incomplete, floss, waterfloss or interdental cleaning is not used, and the gumline remains chronically neglected, allowing bacteria to accumulate.

2. Once plaque mineralizes into calculus, the disease accelerates.

Calculus is a permanent stronghold for bacteria and a slow-burn fuse for inflammation. Once it forms, brushing alone cannot remove it.

3. The real damage comes from time.

Over years, anaerobic bacteria cause progressive bone loss. Periodontal pockets deepen, making self-cleaning impossible and allowing the disease to get worse and worse.

A “regular” cleaning that addresses only what is above the gumline would be akin to cutting weeds off at ground level instead of pulling them up by the roots: though it might look clean visually, the source of the problem is still there, and the disease will keep progressing.

What is the Difference Between “Regular Cleaning” and “Deep Cleaning”?

The difference is substantial.

Routine cleaning (prophylaxis) removes plaque and calculus above the gumline. Its purpose is prevention: the maintenance of healthy gums. For patients without significant pocketing or bone loss, this is appropriate and should be done regularly.

Once periodontal disease develops, however, the battlefield moves below the gums. Bacteria adhere to root surfaces inside periodontal pockets, areas that routine cleaning simply cannot reach. At this stage, superficial, routine cleaning will not be effective.

Scaling and root planing (deep cleaning) targets these subgingival (beneath the gums) infection sources. Deep cleaning removes bacterial deposits and inflamed tissue so the gums can reattach and inflammation can be controlled. This is no longer maintenance; it is fundamental first line treatment for a budding chronic disease.

Patients often ask:

“I’m not in pain; why can’t I just do a regular cleaning instead?”

For patients with periodontal pockets and bone loss, regular cleaning alone will not stop disease progression. The surface may look clean, but the bacterial core persists. This is where some patients feel confused:

“I get my teeth cleaned regularly, so why is my periodontal disease getting worse?”

The issue is that no amount of routine cleaning will remove bacteria and infection beneath the gums. Furthermore, even deep cleaning is not a one-time cure: its success depends on home care and regular follow-ups to prevent bacteria from recolonizing the cleaned areas. Periodontal disease management is never a once-and-done event.

Why Can’t the Immune System Take Care of It?

For periodontal disease, the immune system is part of the problem.

When the immune system detects pathogens within the body, it attempts to destroy the pathogens by sending phagocytotic cells (which engulf and destroy other cells) and pro-inflammatory signals (which cause inflammation) to the site of infection.

However, the immune response causes a lot of collateral damage; the majority of common disease symptoms (like fevers and coughing) are caused by the immune system fighting back against pathogens. If the infection is very resilient, this becomes a serious problem as the immune system will end up destroying the healthy tissues around the infection as it attempts to combat it.

Calculus is essentially a calcified bacterial army that is too resilient for the immune system to fully eliminate. Repeated battles destroy not only bacterial residues, but also surrounding bone cells. As bone support weakens, bacteria penetrate deeper. This process is known as host-mediated tissue destruction.

Why Can Periodontal Disease Exist for So Long Without Pain?

Because the alveolar bone contains very few pain receptors.

Early, middle, and even many late stages of periodontal disease are not painful. Early warning signs may include gum bleeding, bad breath, mild redness, widening spaces between teeth, or gradual tooth migration.

This mirrors many chronic systemic conditions. High blood pressure and high cholesterol can exist silently for years. But if you wait until the characteristic chest pain or stroke symptoms appear, it would be far too late.

Physicians diagnose hyperlipidemia through blood tests. Once abnormality is found, proper treatment will be recommended before symptoms occur. Likewise, dentists diagnose periodontal disease through X-rays and clinical exams. Treatment plan of deep cleaning, if necessary with additional laser assisted treatment may be recommended. Early diagnosis allows for effective intervention before irreversible damage such as tooth mobility occurs. Do not be tempted to skimp on regular dental checkups because your teeth have always been fine in the past; it is because of those regular checkups that any issues could be detected and treated early.

Is Periodontal Disease Genetic?

Strictly speaking, periodontal disease itself is not genetic.

What is inherited is how an individual’s immune system responds to inflammation: immune sensitivity and tissue susceptibility. Family environments and shared bacterial profiles also play a role. In other words: genetics determine how easily disease develops, not whether it must develop, similarly to many other chronic conditions.

Without plaque and calculus, genetics alone do not create periodontal disease. People with genetic susceptibility should be more proactive, not more resigned.

Periodontal Disease Is Not Just a Dental Problem

Below the gums are not air spaces; there are blood vessels.

Periodontal disease is a chronic open inflammatory source. During brushing, chewing, and even sleep, bacteria and inflammatory mediators can enter the bloodstream.

Research shows strong associations between periodontal disease and coronary artery disease, atherosclerosis, and stroke, due to chronic systemic inflammation.

Periodontal disease also has a bidirectional relationship with diabetes. Diabetic patients are more prone to get periodontal disease, and uncontrolled periodontal inflammation worsens glycemic control. Treating periodontal disease can improve blood sugar regulation.

Additionally, periodontal disease is linked to preterm birth, pregnancy complications, worsening of chronic respiratory disease in older adults, and increased risk of neurodegenerative conditions through sustained low-grade inflammation.

Periodontal disease may not cause immediate crises like heart attacks or cancer, but it slowly drains your body’s resilience, making you more susceptible to other infections.

It may not make you collapse today, but greatly increases the likelihood that something else will fail tomorrow.

Final Thoughts

Periodontal disease is not fate.

But it is a chronic condition that deserves serious attention and diligent maintenance.

Manage it early, and you preserve not only your teeth, but your overall health.