Periodontal disease is the number-one cause of tooth loss in America. One hundred million Americans suffer from periodontal disease signs that may include bad breath, gingivitis, malocclusion and tooth loss. Prompt treatment can control the severity of gum disease and save the teeth.

Gum disease begins with the accumulation of plaque at the gum line. Plaque is composed of bacteria or germs that can irritate the gums, causing swelling and redness. Often the gums bleed when brushed. This is a condition known as gingivitis, the earliest sign of gum disease.

If the plaque is not removed with good brushing and flossing techniques, it may harden into tartar, or calculus. This substance accumulates below the gum line, causing gums to pull away from teeth and create a periodontal pocket. This pocket accumulates more food particles and bacteria. Eventually the supporting bone is infected, leading to a loss of tooth support and finally tooth loss. This infection often spreads into the tooth roots and jawbone as well as between the teeth, a condition known as periodontitis. Bad breath may develop or pus may be present among your signs of periodontal disease.

Inadequate brushing and flossing is the most common cause of periodontal disease. Most people require thorough brushing and flossing, and professional dental cleaning at least twice a year is required. Some people need more frequent cleanings. Even people with outstanding oral hygiene can get gum disease. Certain people are more susceptible than others. Diabetics and those with certain blood disorders appear to be at higher risk. Smoking also contributes to gum disease by working against even the best teeth cleaning practices.

Malocclusion, or bad bite, can make oral hygiene more difficult and increase the chance of pockets and infections developing. Clenching or teeth grinding may damage the oral tissues and make them more susceptible to periodontal disease. Once periodontal disease has passed beyond its initial stages, we can prescribe a variety of therapies. We use deep scaling and subgingival curettage to remove plaque and calculus from the surface of the roots and the soft tissue next to the teeth. This allows healthy gums to reattach themselves to the teeth.

Dr. Robert L. Mandell, DMD, MMSc, has been in periodontal practice since 1980. Dr. Mandell received his dental degree from Boston University Goldman School of Dentistry. Following a family practice residency at the Eastman Dental Center in Rochester, NY and a fellowship at Beth Israel Hospital in Boston, Dr. Mandell earned a research fellowship in periodontology and oral microbiology from Harvard School of Dental Medicine and Forsyth Research Center in Boston. Dr. Mandell won the 1980 Orban Prize competition for excellence in periodontal research awarded by the American Academy of Periodontology.

Dr. Mandell has held several teaching positions at well-known dental institutions, including the Medical College of Virginia and as the assistant director of Emory School of Dentistry's Periodontal Research Center.Dr. Mandell teached half time in the department of Peridontology at Tufts School of Dental Medicine, Boston Mass. Dr. Mandell continues to pass on knowledge and expertise to the next generation of dentists.

Dr. Mandell has received government research grants to study juvenile periodontitis as well as the periodontal complications of smoking and diabetes. In 1992, he was named to Marquis Whos Who in Science and Engineering. Dr. Mandells work has appeared in many scientific publications, including Journal of Periodontology, Journal of Clinical Periodontology, Journal of Dental Research and Infection and Immunity.

Dr. Mandell was board-certified by the American Board of Periodontology in 1991. The American Board of Periodontology is the only certifying board in the dental specialty of periodontics. A diplomate of the American Board of Periodontology is a periodontist who has made a significant achievement beyond the mandatory educational requirements of the specialty. This certification is a voluntary effort in continuing education and is a testament to Dr. Mandells ongoing professional development and commitment to excellence.

In 1993, Dr. Mandell was appointed by Governor William Weld to the Massachusetts Board of Registration in Dentistry to fulfill a six-year term. The Boards mission is to protect the health, safety and dental welfare of the citizens of Massachusetts and to raise the standards of dental practice, ensure quality dental services and establish acceptable codes of ethical behavior in dental practice. Dr. Mandell served as Chairman of the Board in 1996. In 1994, his research work on the role of smoking in periodontal disease was selected by the journal Periodontology to receive the Clinical Research Award.