Once plaque begins to form in the pocket, it is protected against most forms of oral hygiene. As plaque moves into the once healthy gum pocket, the infection begins to involve the place where the ligament attaches the gum to the tooth surface.  Infection here is bad enough by itself, but the whole process is made even worse by the formation of subgingival calculus.  As the calculus grows and spreads, it pushes against the swollen gum tissue. The new plaque, which is continually forming on top of the expanding calculus, comes into contact with areas of gum tissue that are still healthy.  When this happens the inflammation and infection spread more rapidly than ever. When the infection reaches the place where the ligament attaches the gingiva to the tooth, the ligament is forced to let go of its h old on the tooth surface, and the pocket now begins to deepen.  In essence, the calculus acts as a scaffold by which the plaque gains access to the surrounding gum tissue.

Once the infection involves the ligament that holds the tooth to the bone, you have officially moved from gingivitis to periodontitis.  As the infection destroys the ligament, both the root and the bone are exposed to the bacterial hoards and the toxins they release and to the deadly plaque and calculus.  Periodontitis and root decay go hand in hand because the thin, soft layer of cementum that surrounds the root and the vulnerable dentin underneath it are directly exposed to the acid-producing germs found in the plaque.

The bone surrounding the tooth is also now at risk. The bone of the jaw is extremely susceptible to any form of irritation and infection,.  The bone resists this invasion on its own in the best way it knows, but without help from you, the hygienist, and the dentist, it is overwhelmed and soon has to retreat.  The retreat begins when osteoclasts, which are cells that dissolve bone, start breaking down your jawbone to remove it from the plaque invasion and its accompanying germs and toxins.  This is how bone loss occurs.

Over time, as more and more bone is lost, the tooth begins to loosen. This loosening is expedited by chewing because there is not enough bone supporting the tooth to resist the tremendous forces of mastication.  Eventually, the tooth becomes loose enough to be wiggled by your fingers.  And the once inaccessible opening between the tooth and the gum becomes a germ super freeway.

Now everything you put into  your mouth has direct access to the bone, the gum tissue, and the root of the tooth. More good is packed in, more germs are born, and more plaque and calculus are formed.  There is now very little you can do about it on  your own.  If left untreated the disease will soon pass the point of no return and it will be too late to save the tooth.  Once the framework that holds the bone cells is lost to gum disease, new bone won’t form to replace what has been lost, even after you get rid of the disease.  At this critical stage the damage is irreversible.  If the tooth is not pulled, it will eventually just fall out.