"Getting long in the tooth" is a phrase thrown around, usually to mean you're getting old. It's actually got a literal meaning, as recession of the gums reveals more and more of the tooth roots as time goes on, creating a look of "long teeth". What we now know is that it's not a normal part of the ageing process, but rather a slow-progressing disease, so it's only apparent in older people. I'm talking about chronic periodontitis, which is relatively common yet not talked about in polite company. With symptoms like bad breath, bleeding gums, and loosening or loss of teeth, I wouldn't consider it polite dinner conversation either. It more than likely effects someone you know though, and shouldn't be accepted as part of getting older, but rather treated and controlled so teeth can be retained for life.
Periodontitis literally means "inflammation around the teeth". More specifically, it's an inflammation of the gums, caused by plaque, in which the ligaments and bone holding the teeth in are attacked and destroyed. The result is gum recession, where the gums appear to shrink down the tooth, teeth becoming loose, and after many years, tooth loss. The annoying thing is, it won't happen to everyone. Some people will have appalling oral hygiene, with the signature red and bleeding gums of gingivitis, but it will never progress to the destructive periodontitis. Other people will be taking relatively good care of their mouths, but the tiniest bit of plaque left behind results in periodontitis. Periodontitis can even happen in the absence of gingivitis, so it's important to visit your dentist regularly to be checked as you can't rely on bleeding gums to be your canary in the coal mine.
Are you at risk of periodontitis?
Periodontitis runs in the family. If a close relative has lost some or all of their teeth, you may want to ask what happened. If it was due to periodontitis, (or if you're asking your great grandmother, she may refer to it as "pyorrhoea"), then your risk is increased.
Among the other revolting things smoking does to your mouth, it also greatly increases your risk of periodontitis. Smoking reduces the blood supply to the oral tissues, meaning your capacity for healing and fighting off infections is greatly reduced. Not only does smoking increase your risk, but makes treatment extremely difficult if you continue to smoke. It's an uphill battle unless you quit.
This is a huge one. It's all about controlling blood sugar though, so not necessarily a death sentence for your gums. If you are diabetic but have good control over your blood sugar and keep it stable and low, you're less likely to get periodontitis. The massive breakthrough in research has come in the last 15 years, with evidence that treating periodontitis in diabetics makes it easier for them to control their blood sugar. Long story short, if you're diabetic then regular dental visits are a must. Not just to keep your mouth healthy, but to keep your diabetes in check.
Poor oral hygiene
Without plaque, chronic periodontitis doesn't happen. Unfortunately, none of us has a completely sterile mouth, so we fight the good fight every day when we brush and floss. Some people are better at this than others. I see patients who only need a scale and clean once every 2 years, and others who could probably do with one every month. If you've got other risk factors for periodontitis, you really need to become one of the best cleaners on the block. Leaving plaque behind when you clean at home means the bugs will release chemicals which provoke periodontitis. It's your dental professional's job to help you get great at cleaning, so don't be afraid to ask for tips. We spend so much of our time trying to motivate people to clean well, I know that I'm delighted when someone takes an interest!
Less common things
Above are the big ones, but there are a few other risk factors which occur less commonly. Having a compromised immune system, such as HIV infection, leukaemia, or chemotherapy, means your body is less able to fight off infection in your gums. Lots of common medications can reduce salivary flow, and saliva is vital in keeping plaque levels down. For some women, the hormonal changes associated with menopause, or even just their regular menstrual cycle, can cause their gums to be extra sensitive to plaque.
Don't just accept gum recession and losing teeth as part of getting older. With each generation, more and more people are keeping their teeth for life. Make sure you're one of them!