(MONEY Magazine) – With everything else seeming to fall apart with each birthday, the one thing you may not think about much is your gums. You should. Most adult tooth loss is caused not by tooth decay but by gum infections. Three of four Americans over 35 can expect to fall victim to gum disease sooner or later, whether it's gingivitis (sore, swollen, occasionally bleeding gums) or, more seriously, periodontitis, in which bacteria and their toxins build up around the tooth roots and attack gum tissue and bone. Although gingivitis can be treated fairly easily, periodontitis treatment is painful, costly and doesn't always work.

That is why four new, noninvasive approaches to periodontal disease are worth discussing with your dentist. Until recently, there were just three options, all uncomfortable, for treating gum disease. For the 10% to 20% of patients who have severely damaged gums, the treatment of choice was--and remains--gum surgery. For less serious cases, the standard treatment has long been scaling and root planing (SRP), which is also called deep cleaning: The dentist or periodontist scrapes the tooth roots where gums have detached from the teeth (yes, you'll get local anesthesia first). You may need repeated SRPs. The third option--extracting teeth and cleaning out the gums--has obvious drawbacks.

The topical treatments and pills discussed below now provide another alternative--less as a substitute for the traditional treatments than as a supplement to SRP. These innovations help reduce the depth of gum pockets, improve gum reattachment to teeth and reduce bleeding. The advantages: They're not painful, and they may delay or even eliminate the need for surgery. The disadvantages: They're too new to have been proved effective over the long run, and most aren't covered by insurance or Medicare (Medicare and many other plans either don't cover gum surgery, or they provide only partial coverage). Depending on your dentist's pricing policy, some of these treatments may cost as much as SRP, which averages roughly $176 per quadrant (eight teeth). But if you have gum disease, it's worth talking to your dentist about which of these treatments would be most cost-effective and whether you can pay in installments. And consider that by spending $200, you may stave off $1,000 worth of surgery.

--Actisite, the breakthrough antimicrobial treatment that was introduced in 1994, is a dental-floss-size fiber treated with the antibiotic tetracycline. After cleaning out infected gums, the dentist laces teeth roots with Actisite. There are two drawbacks: Patients may work the string loose with their tongues, and a second office visit is required to remove the fiber. The fibers cost the dentist $22 to $25 apiece.

--PerioChip, a gelatin tile about the size of a baby's fingernail, contains chlorhexidine, an antiseptic long used in prescription mouthwash. Introduced in 1998, PerioChip is placed in the gum pockets and dissolves in about seven days. In clinical trials, PerioChip improved results of SRP by 50%. Sold to dentists for $14 a chip, PerioChip typically is used in only a few stubborn pockets of infection.

--Atridox is a polymer gel that bastes gums with the antibiotic doxycycline. Once a dentist applies the gel, it hardens, then dissolves over seven days. Atridox caused a stir last fall when the U.S. Food and Drug Administration approved it as a stand-alone treatment for chronic periodontitis. In nine-month clinical trials, the gel was at least 75% as effective as SRP; no studies show that Atridox alone matches SRP over time. In practice, most dentists use Atridox with SRP, or as a maintenance therapy when disease recurs or when invasive methods might be risky (for patients on blood thinners, for example). Atridox wholesales for about $29 to $45 per syringe (enough for half of your mouth).

--Periostat takes a totally different approach. A low-dose (20mg) doxycycline capsule taken orally twice a day for three months, Periostat inhibits the action of collagenase, an enzyme that breaks down connective tissues in response to infection. The FDA approved Periostat in September 1998 as a supplementary treatment after clinical studies showed that patients who took it after SRP had significantly better results than those who had SRP alone.

Some doctors prescribe Periostat only for patients with severe, recurrent disease. But Dr. Mark Sclafani, a New York City dental reconstruction specialist, says he prescribed it for his dad because "he has moderate inflammation and he doesn't come to see me as often as he should." Periostat costs about $50 a month but is covered by most prescription drug plans.

One hopeful note: Regular brushing, flossing and professional cleaning will help keep your teeth and gums healthy. And floss costs pennies.

E-mail your health questions to health_column@moneymail.com.