CONDITIONS

Gum Disease (Periodontal disease)

What is gum disease?

The gums, also known as periodontal disease, involves inflammation and infection of the gums and the surrounding tissues that support the teeth and hold them to the bone.  

Gum disease starts with the proliferation of bacteria in the oral cavity. When teeth are not adequately brushed or flossed, bacteria accumulate, forming plaque along the gumline. Over time, plaque hardens into tartar, creating a conducive environment for bacteria to grow and cause irritation to the gums.  If left untreated, gum disease progresses, leading to symptoms such as swelling, redness, and discomfort in the gums. As the infection worsens, it can cause the gums to recede and the teeth to become loose. Ultimately, without intervention, gum disease can result in the loss of teeth.

What are the stages of the gum disease?

There are four stages of gum disease:

  • This is the earliest stage of gum disease. It starts with red, puffy gums that may bleed when brushing or flossing. At this stage, there is no bone loss. As a result, gingivitis is reversible with proper treatment.
  • Mild periodontitis. The bacteria have infiltrated the gums, impacting the supporting bone. Gums may pull away from the teeth, creating pockets around them. Plaque and bacteria like to hide in these pockets, where the toothbrush and floss cannot reach.
  • Moderate periodontitis. Left untreated, bacteria erode the ligaments, soft tissues, and bones that hold the teeth in place. Bad breath and pus (infection) around the gum line may be noticed. Some people develop pain at this stage.
  • Advanced periodontitis. As periodontal disease worsens, bone loss continues. This can cause teeth to become loose and eventually fall out.

What causes gum disease?

Plaque is the main cause of gum disease.

Bacteria collect on teeth after eating sweet or starchy foods. If one does not brush and floss well, those bacteria form a sticky film called plaque on teeth. Plaque turns into a hard deposit called tartar along the gums. Tartar traps bacteria on teeth. The bacteria cause even more tooth damage. Gums get irritated, red, and swollen. They may bleed when brushing teeth. After having gingivitis (swelling of the gums) for a while, gums may pull away from teeth and form pockets. These small spaces can fill with bacteria, plaque, and tartar and become infected.

The infection breaks down the bone and connective tissue that hold teeth in place. After a while, teeth may get loose enough to fall out.

What increases the risk of gum disease?

Possible gum disease risk factors include:

  • Poor oral hygiene
  • Smoking
  • Diabetes
  • Hormonal changes, particularly during puberty, pregnancy, and menopause.
  • Family history of dental disease
  • Some medicines (used to treat seizures and chest pain) that reduce the saliva production

What are the symptoms of gum disease?

  • Red, swollen, tender, or bleeding gums
  • Receding gums, making teeth appear longer.
  • Loose or sensitive teeth.
  • Pain while chewing.
  • Persistent bad breath.
  • Changes in the way teeth fit together when biting
  • Deep pockets between the teeth and gums

How is gum disease diagnosed?

The dentist will inquire about the medical history. Various conditions or risk factors, such as smoking or diabetes, may increase the risk of gum disease. 

The dentist will inspect the gums for any signs of inflammation and utilize a small tool known as a “probe” to assess pockets around the teeth.

X-ray images of the teeth and mouth will be captured to detect any bone loss caused by gum disease.

How is gum disease treated?

The treatment of gum disease depends on the severity of the condition, the treatments already tried, smoking habits, and overall health.

Various choices are available to address the issue, ranging from non-invasive methods to manage bacteria to surgical procedures aimed at repairing the supportive tissues of teeth.

Nonsurgical Treatments

  • Dental scaling is like cleaning; it only cleans more deeply under the gums. A dentist uses instruments, a laser, or sound waves to remove tartar, plaque, and bacteria from the teeth.
  • Root planing smooths out the surface of the root, the part of the tooth that is under the gums. This makes it harder for bacteria and plaque to collect again. It also helps the gums reattach to the teeth.
  • Antibiotic mouth rinses, gels, or pills get rid of the bacteria that caused the infection.

Surgical Treatments

  • Pocket reduction surgery may be necessary for individuals with moderate to advanced gum disease. The primary objective of this procedure is to eliminate deep-seated plaque and tartar. To achieve this, a periodontist (A dentist specializing in gum disease) will make an incision in the gums and create a flap, temporarily moving the gums away from the tooth roots. Subsequently, the periodontist will thoroughly clean the teeth roots, removing any plaque, tartar, and bacteria and smoothing out any rough areas. Once the cleaning process is complete, the gums will be repositioned, and the incision will be closed using stitches. In many cases, pocket reduction surgery is combined with other regenerative procedures, such as bone grafting, gum grafting, or guided tissue regeneration, which periodontists perform.
  • LANAP (Laser-assisted new attachment procedure) is an alternative option some periodontists offer for pocket reduction. This procedure utilizes a special dental laser to remove diseased gum tissue and bacteria while preserving the healthy tissue.
  • Bone grafting: It involves replacing lost bone due to gum disease. After removing the infection, the periodontist will place bone grafting material in the areas where bone erosion has occurred to hold the tooth in place. Over time, your own bone will get regenerated in that area.
  • Gum grafting: For individuals who have experienced gum tissue loss due to periodontal disease, gum graft surgery, also known as tissue grafting, may be recommended. In this procedure, periodontists place gum grafts over areas of gum recession, which can be sourced from the roof of the mouth or obtained from a licensed bone and tissue bank.
  • Guided tissue regeneration (GTR) is often used in conjunction with a bone graft. This technique helps in the regeneration of lost gum and bone tissue, promoting the growth of healthy tissue while preventing the growth of unwanted tissue.

The dentist may also suggest changing certain behaviours, such as quitting smoking, to improve treatment results.

How is gum disease prevented?

Here are a few basic tips to keep gums and teeth healthy:

  • Brush teeth twice a day
  • Flossing regularly removes the plaque from the spaces between the teeth and below the gumline. Daily flossing is very effective in getting rid of plaque from areas that a toothbrush cannot reach
  • Quit smoking
  • Visit the dentist regularly for cleanings and check-ups
  • Use antibacterial mouthwash

In conclusion, gum disease, or periodontal disease, is an infection of the tissues that support teeth. It typically starts with plaque buildup, leading to inflammation, and, if left untreated, can progress to serious damage to the gums and bone that support the teeth. Treatment usually involves professional cleanings to remove plaque and tartar buildup and scaling and root planing to clean below the gumline. In advanced cases, surgical procedures may be necessary to restore gum health and prevent tooth loss. Good oral hygiene practices at home, such as regular brushing, flossing, and using an antiseptic mouthwash, are also essential for managing gum disease.

References

  1. Cleveland Clinic. Periodontal disease (Gum disease) Available from: https://my.clevelandclinic.org/health/diseases/21482-gum-periodontal-disease. Accessed on 6th May 2024
  2. Gingivitis and Periodontal Disease (Gum Disease). Available from: https://www.webmd.com/oral-health/gingivitis-periodontal-disease. Accessed on 6th May 2024
  3. National Institute of Dental and Craniofacial Research. Periodontal (gum) disease. Available from: https://www.healthdirect.gov.au/halitosis. Accessed on 6th May 2024

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