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Periodontal Disease – Not Cavities – Is the Leading Cause of Tooth Loss

Man Asking About Tooth LossIf someone asked you what the #1 cause of tooth loss is in people over age 35, what would you guess?

If you’re like most people, you would probably guess that it’s cavities.

Unfortunately…you’d be wrong.

It is generally accepted that the leading cause of tooth loss in people over 35 is periodontitis, more commonly known as gum disease.  In people under 35, cavities are the leading cause of tooth loss.

Teeth are normally held firmly in place under your gums by a strong bone called alveolar bone.

Gum Disease Can Cause You To Lose Your Teeth
©Jun Kawaguchi/

You Can Lose Teeth That Are In Perfect Condition

If you’ve brushed your teeth every day of your life and kept them in perfect condition with no cavities, but you’ve never flossed then you might be in trouble.  There are many people who believe that brushing is enough.  But while they are preventing cavities, their lack of flossing is causing other unseen effects on their gums.

Over the years, a lack of flossing will take its toll on your gum health.  Your gums will recede due to the constant irritation they’ve had from bacteria that hasn’t been removed by flossing.  Soon enough, your teeth begin to loosen and can even fall out if your gums are not cared for.

The x-ray below shows two teeth that have lost nearly half of the support from their bony foundation.

Periodontal Disease Associated Bone Loss
The blue lines show the level where the bone should be to provide adequate support to the teeth. The red line shows the current level of the bone. Click on the image for a larger view.

Your Gums Are the Foundation

House FoundationIn a healthy mouth, each tooth in your mouth is firmly gripped by strong, healthy alveolar bone.  Hopefully the building you’re in right now is rooted firmly in the ground by a strong foundation.

Try to imagine a beautiful home anchored firmly on top of a large hill by a strong foundation.  Let’s compare this house to a tooth.

As gingivitis progresses to periodontitis (gum disease), the bone that holds your teeth in place gradually erodes away.  This is similar to hundreds of rainstorms gradually washing away the dirt that surrounds the foundation of a house.

If enough dirt washes away, the house could eventually find itself on unstable ground and fall over.  Even if everything else on the house was in perfect condition, it could still fall.

This is the same in the mouth.  Even if you have a tooth that has never had a cavity, it can fall out due to a lack of support from the alveolar bone.


You now know that gum disease is the leading cause of tooth loss in people over age 35.

One of the best ways to prevent gum disease is to floss daily.  Flossing helps dislodge the bacteria that get stuck down between your teeth and gums.  Ordinary brushing can’t remove these bacteria, only flossing can get rid of them.

Do you have any questions or comments about gum disease?  Leave them in the comments below and I’ll get back to you.



    • That’s true! Many people don’t floss because they don’t really notice a difference. The early stages of periodontal disease aren’t easily detected by most people.

      Thanks for your comment, Dr. Stoner.

  1. How do one maintain healthy gums? Or revitalize “sickly” gums? Any food, way of brushing or lifestyle habits other than flossing?

    • Hi Paul – The best way to take care of your gums is through regular brushing and flossing. If there is a lot of space between a patient’s gums and teeth, then they may need to have a deep cleaning (known as scaling and root planing) done to remove any plaque and tartar build-up under the gum-line.

      Aside from that, eating a balanced diet is good for your gums. Exercising can help your gums by keeping your whole body healthier. Some people report that oral irrigators (such as a Waterpik) can help, but I believe that you need something to scrape away the plaque to really clean below the gum-line.

      I hope that helps. Let me know if you have any other questions!

  2. Hi, Dr. Tom —

    I have badly receded gums. This started around one upper front tooth when I was a child. My orthodontist said the tooth had “grown fused to the bone” and he couldn’t move it so he “luxated” it which as I remember it meant twisting and pulling the tooth mostly out then pushing it back in. I lost the tooth and the gum above it and in subsequent years the gums on either side began to recede. Fast forward a few decades and I’ve lost the tooth, the gum at the original site has nearly reached the point where the skin of my upper lip attaches and the also I have recession all the way out to my canine teeth. I can get the floss up very high next to the teeth in that area. It looks a little creepy. Doesn’t hurt and doesn’t bleed, though. My gums aren’t red or swollen. I can also floss deeper than Id like around my bottom front teeth – maybe 4,5 ,6 mm down (?) but again never any blood or soreness. No loose teeth.

    Could this be periodontal disease even though (besides the recession) the gums look to healthy? I am so afraid that a dentist will want to scrape and prod down under my gumline or worse yet do a gum surgery or something extremely painful. But I don’t want to lose my teeth. Am I just being anxious or do I have something to worry about?

  3. I guess the gumline is only really high over one tooth. It’s more normal over the others but I can just floss so deeply it worries me.

  4. I knew that flossing was essential to dental health, but I didn’t know that the lack of it can cause bone loss. I also learned that it was called an alveolar bone. I’ll have to show this to my kids, it should be good motivation to keep flossing every day! Thanks for going into detail on why it’s so important.

  5. I’ve unfortunately just lost all maxillary teeth to Periodontal Disease.Same dental clinic for 8 years many fillings done and redone on the same tooth once,1st premolar pinned in 2009 and then root canal in 2013 on same pinned tooth. ENT ct scan in 2014 picked up moderate P.D. and vertical fracture to apices on root canalled premolar.How did the clinic miss this?

  6. I was diagnosed with juvenile periodontal disease at 11… at 20 I got my teeth pulled and wear dentures.. now I suffer from severe tmj…

  7. i was periodontal disease at 15… at 25 and i loss my 2 front teeth and my 3 upper teeth and now i’m scared that i might loss my other teeth…i very need some one help me!! if u guys know who can help me e-mail me at and i live in fresno ca!!!

  8. Brushing has always been a number one priority for me, but now I know that I should take flossing more seriously as well. I didn’t realize until reading this article that flossing has such a big effect on your gum health. I’ll be sure to stay on top of flossing from now on, if only to avoid gingivitis and periodontitis.

  9. Hi! Im a 41 year old with horrible reseeding gums. Been that way since i had all of my adult teeth. At 25 i had one of my bottom front teeth removed because the root was exposed causing pain kike I’ve never felt. Havent severly crooked overlapping teeth im certain didnt help, not having the financial means while a child i could never get braces. So at 25 when that tooth had to be extracted i paid for my own braces and hoped it would also fix my gum issue a little bit. Well over time my botton teeth started collapsing yet again, my gums are always sensitive and bleed i know longer have my ild dentist that did all the work and he also did mot give me a retainer for my bottom like he did my top. Now my one front tooth is pressing the tooth next to it, my gums are disappearing and im in pain ALL THE TIME. Have to use a straw to drink anything cold. Breathing in the cold hurts my teeth and my dentist tells me i need a deep cleaning which my insurance wont cover and since he put it in the computer already he cant take it out and until i have it done he cant do any more on my teeth. I found that obsurd he wont even clean them normally. I refuse to have a deep cleaning as i have done it against my better judgement 4 times now with the last 3 being as worse as the first although the dentist always say it wasnt done properly “this time will be different” because of medicaid I’ve changed dentist a lot. And now that i have proper insurance its starting all over with yet another new person. My teeth and gums have always been beyond sensitive. A deep cleaning destroys me for a week or more with pain that prevents me from being a single mom with 3 kids. Its intolrable and i wont do it. My teeth are average looking, white, clean ect… Its the underlying and the sensitivity that u cant see. The more i floss and loosen the gum line the next day or so my gums reseeded and you can see the tarter build up there. Im afraid im going to lose majority of my teeth! Dentures at 42?!! No way. I dont want mouth pain anymore! I do the best i can keeping my teeth clean. And it seems a losing battle. My last front tooth that at one time closed the gap of lossing the other one with braces looks as if the whole root is exposed. Its awful. I definitely have gum disease and i dont think a deep cleaning will answer my prayers. With every deep cleaning, my gums pushed down further, and now I’m afraid I’m going to start needed them pulled because of pain and exposure. I cant afford implants which is the only thing i could live with. I climbed through the darkest tunnels to get where i am today with my 3 kids and all i want is to be able to smile.


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