Periodontal disease means bone loss around the teeth. This is different from gingivitis which means inflamed, swollen and possibly bleeding gums but does not, by definition, involve any loss of bone.
Both gingivitis and periodontal disease are caused by the bacteria that live in our mouth and grow on the teeth at the gum line. The big problem is that we cannot and do not want to completely eliminate these bacteria. We have evolved to have bacteria in our mouths and, for that matter, throughout our entire gut. We cannot live without them.
Without bacteria in our gut we could not digest and process the food we eat, and our blood would not have the Vitamin K it needs to clot. In our mouth the bacteria prevent viruses and fungi from growing and spreading.
So the idea of eliminating bacteria is an oversimplification. Instead, it is about controlling the volume (number) and types (friendly versus harmful) and not allowing them to harden onto the teeth. Once they do, nothing available at home will remove them, not even the hardest toothbrush.
Fortunately, the solution is relatively simple though it is not “sexy” or high tech. It doesn’t require lasers or antibiotics. It does require some time and effort. It means brushing twice a day, for at least two minutes each time, and flossing once or twice a day.
Most of us have accepted the idea of brushing twice a day, although we probably don’t spend nearly enough time. Often, what seems like two minutes is probably 20 seconds (it is certainly not the most exciting activity). The problem for most of us is that flossing is not a habit. Our mothers made us brush our teeth but not floss. They likely didn’t know its importance.
The problem with just brushing is that you’re cleaning only half of the tooth. The surfaces where the teeth meet are largely untouched, even by fancy electric toothbrushes (no matter what they advertise). The only thing that fully cleans the surfaces between the teeth is floss (or a small interproximal brush if you have enough space – you never want to force them).
The other important part of the equation is regular, timely professional cleanings at an interval determined by the professional doing the cleaning. It should be based on how good you are at cleaning the teeth, how rapidly plaque and calculus (tartar) develop in your mouth and how resistant your body is to the effects of having the plaque and calculus present for extended periods of time. It should not be based on some arbitrary and predetermined interval (although every six months is probably the minimum for most adults). It definitely should not be dictated by your insurance company. Your insurance company really doesn’t care if you keep your teeth or not, nor if they are attractive and comfortable.