What is gum disease?
Gum disease is a bacterial infection caused by plaque (soft, white & sticky substance that builds up daily on your teeth). If bacterial plaque is not removed, it can turn into hard tartar (calculus). Plaque and tartar cause gum infection (gingivitis), which shows as redness, swelling, bleeding and soreness. If gum infection persists long enough it can start to break down the gum tissue and even the bone that supports the tooth. That is when we call it gum disease (periodontitis).
Gum disease is the primary cause of tooth loss after the age of 35. Over ½ of adults over the age of 35 suffers from the early stages of gum disease.
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Symptoms of gum disease include:
- Redness
- Swelling
- Bleeding
- Soreness
- Receding Gums
- Bad breath
- Teeth moving (becoming longer or spaces appearing between teeth)
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The stages of gum disease
Gingivitis
The first stage of gum disease is known as gingivitis, which is an infection of the collar of gum that surrounds the tooth. The gums become irritated, swollen and bleed easily. This stage of gum disease is easily treated by meticulous cleaning at home and by cleaning from your dentist and/or oral hygienist.
Periodontitis
If gingivitis is left untreated it can progress to periodontitis. Persistent gingivitis breaks the attachment between tooth and gum, allowing the infection to penetrate deeper and to erode the jawbone which supports the tooth. This leaves pockets that are too deep to clean. If left untreated, these pockets will deepen, more jawbone will be lost, and eventually, teeth can become loose and may have to be removed. Despite the destructive nature of this process, the symptoms are mild, even at a later stage.
Like all chronic diseases, gum disease does not go away. It will not get better by itself. As the condition worsens, it is harder to treat it successfully. That is why it is best to start treatment as soon as possible.
A periodontist can treat periodontitis and then carry out regular maintenance appointments to keep the condition under control, preventing it from causing further damage to the gums and supporting bone.
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How do periodontists treat gum disease?
Most patient can be treated successfully with non-surgical periodontal treatment. However, these procedures do have limitations. When non-surgical treatment does not achieve optimal periodontal health, your periodontist may recommend gum surgery.
There are five stages in the successful treatment of periodontitis:
- Oral-hygiene instruction and advice
The aim of the oral-hygiene phase of treatment is to reduce the number of bacteria in the mouth and thereby reduce the level of infection. Your periodontist will first explain the cause, contributory factors and risk factors of periodontitis, and give you clear instructions on how to keep your teeth and gums clean. You will be given advice on how to use different tools and techniques: for example, the most appropriate tooth-brushing technique and the correct use of interdental brushes, dental floss, and antiseptic mouthwashes. It is important to emphasise that your co-operation with oral-hygiene practices is essential for a successful treatment outcome.
- Professional cleaning
The oral hygienist and periodontist will remove all bacterial deposits (plaque and tartar) from your teeth, and polish your teeth. Sometimes fluoride is applied. Usually, several appointments of cleaning are necessary.
In some rare cases, antibiotics are prescribed in addition to professional cleaning.
- Reassessment
After several weeks (usually 8-12), your periodontist will re-examine your teeth & gums to check how you have responded to treatment. A special instrument called a periodontal probe is used to record the depth of periodontal pockets and to check for bleeding from the gums. If periodontal pockets greater than 3 mm are still present, further treatment options may be suggested, including corrective surgical therapy.
- Corrective surgical therapy
In cases of advanced periodontitis, where deep gum pockets remain after professional cleaning, gum surgery might be the only treatment that can further reduce these deep pockets.
Gum surgery is performed under local anaesthesia (using normal dental injections), during which the gum is raised and the root surfaces cleaned to ensure that all tartar and plaque accumulations are removed. Sometimes it is also necessary to remodel the bone so that the gums can be properly adapted to the tooth root surface.
Another commonly used approach in treating residual periodontal pockets is regenerative periodontal therapy. This involves using either proteins or bone-replacement grafts & membranes to reconstruct bone that has been lost because of periodontitis. At the end of the procedure, the gums are stitched back into place around the teeth and the stitches are usually left in place for one to two weeks before they are removed.
- Aftercare – Supportive periodontal therapy or Periodontal maintenance
The long-term success of periodontal treatment depends on two factors:
- Our patients’ meticulous oral hygiene
- Regular supportive/maintenance care from their oral hygienist and periodontist
After the first phase of treatment, your periodontist will need to re-evaluate the condition of your gums at regular intervals to check that the infection has been halted, and has not returned. The frequency of your follow-up appointments will depend on the severity of your disease and your individual risk of disease progression. Follow-up visits with an oral hygienist are usually scheduled for every three to six months, and a re-evaluation is scheduled with your periodontist once a year.
Regular follow-up appointments are vitally important to ensure that periodontitis does not return unnoticed, and cause further destruction of the gums and the bone that support the teeth. If you see your periodontist regularly, he/she will be able to diagnose recurring disease early and provide the appropriate treatment at an early stage.
After gum treatment, long-term success can be ensured only if patients practice optimal oral hygiene at home every day, thus preventing their gums from becoming infected & inflamed again.
In summary, successful periodontal treatment requires your full co-operation in daily oral-hygiene practices and attendance at regular follow-up appointments. 80% of the success of treatment is in your hands.
How to look after your gums
FAQs
We are often asked, “can gingivitis be cured?” or “can gum disease be cured?” and the answer is yes – as long as you spot the signs early and get the necessary treatment.
As with most things in life, “prevention is better than cure”. Gum disease (gingivitis and periodontitis) can be prevented by looking after your teeth and gums. This means adopting good habits in oral hygiene and getting regular professional check-ups (at least once a year).
Gum infection (gingivitis) will not develop if there is no bacterial plaque on the teeth, and periodontitis will not develop if there is no gingivitis. Continuous good oral hygiene at home, the regular removal of tartar at your dental practice, and addressing risk factors (such as smoking, diabetes, stress and poor diet) are the key steps to preventing periodontitis.
With careful professional assessment and treatment, it is usually possible to completely halt the progress of periodontitis. The key to success is eliminating the bacterial plaque that triggers the disease process and establishing excellent oral-hygiene practices.
Generally, no. Yet, under specific circumstances lost bone and gum can be regrown with the help of periodontal surgery.
Several studies have shown a link between periodontal disease and other systemic diseases. While a causal relationship has not been conclusively established, research suggest that periodontal disease may contribute to the progression of other diseases.
If your gum disease is not treated, you will lose teeth and that will significantly reduce your quality of life.
