Periodontal (Gum) Disease
What is periodontal (gum) disease?
“Peri” means around, and “odontal” refers to teeth. Periodontal gum disease is an infection of the structures surrounding the teeth – the gums, the bone, the cementum that covering the root and the ligaments.
Your gum tissue should fit closely around the teeth. Periodontitis is a disease which attacks the bone and tissue and causes a gap between the gum tissue and the tooth. This causes a weakening of the gums and the formation of open pockets of bacteria to occur which over a long period of time. This can result in more serious infection which can lead to bone and gum tissue loss.
With the early stage of gum disease – gingivitis – the infection affects the gums only. In later stages, all structures are affected. The early stages are seldom painful.
Gum disease is evident by the swelling, soreness or infection of the gums supporting the teeth. There are two main types of gum disease: gingivitis and periodontal disease.
The causes, symptoms and treatments of periodontal (gum) disease
How to prevent periodontal (gum) disease
The best way to prevent periodontal disease is a program of good dental hygiene throughout your life. Brush your teeth at least twice daily; in the morning and evening, and floss at least once a day. Better still is to brush after every meal or snack or as your dentist recommends. Floss before you brush to clean away the loosened food particles and bacteria. Choose the right toothbrush: Select a toothbrush with soft bristles, as stiff or hard bristles can injure your gums. Only the tips of the brush do the cleaning, so there’s no need to exert too much pressure. Replace your brush every three to four months, or if the bristles are splayed.
- Use an Electric Toothbrush
Some dentists recommend electric toothbrushes with rotating or vibrating bristles because they may be more effective at removing plaque and maintaining healthy gum tissue. Electric brushes may be especially helpful for people with dexterity problems. But you don’t have to invest a lot of money to achieve good oral health, since a manual toothbrush will give good results if used properly.
- Brush your teeth well
Brushing doesn’t do much good if you don’t do it correctly. Clean the outer surfaces of your teeth and gums, using short, side-to-side, then up-and-down strokes. Use vertical strokes to clean inner surfaces. To clean the junction between your teeth and gums, hold your brush at a 45-degree angle to your teeth. Flossing: This is the part of oral care that most people tend to ignore.
- Brushing action
Some toothpastes claim to remove plaque and tartar or to kill the bacteria that cause plaque. The truth is that all toothpastes, including natural ones without additives of any kind, remove plaque if you brush properly. No product can remove tartar below your gum-line, although tartar control toothpastes can help prevent tartar from building up on your teeth.
Flossing is an essential part of good oral care. How to use floss: Hold about 14 inches of the floss and bent around each tooth, scraping up and down each side of each tooth and go slightly below your gum-line until you feel resistance. Flossing removes plaque between your teeth and also helps massage your gums.
- Healthy diet
To help protect your teeth and gums, eat a well-balanced diet containing plenty of fresh fruits and vegetables. A potent antioxidant and major player in the synthesis of collagen is vitamin C, which is essential for healthy gums. Many fruits and vegetables, including citrus fruits, berries, melons, broccoli and spinach, are sources of vitamin C, and most natural foods stores and pharmacies carry vitamin C supplements. Calcium is essential for bone health, and experts recommend getting 1-2 grams every day.
What are the causes of gum disease?
Periodontitis begins with plaque. This invisible, sticky film forms on your teeth when starches and sugars in food interact with bacteria normally found in your mouth.
Although you remove plaque every time you brush your teeth, it re-forms quickly, usually within 24 hours. Plaque that stays on your teeth longer than two or three days can harden under your gumline into tartar (calculus), a white substance that makes plaque more difficult to remove and that acts as a reservoir for bacteria. Unfortunately, brushing and flossing can’t eliminate tartar — only a professional cleaning can remove it.
The longer plaque and tartar remain on your teeth, the more damage they can do. Initially, they may simply irritate and inflame the gingiva, the part of your gum around the base of your teeth. This is gingivitis, the mildest form of periodontal disease. But ongoing inflammation eventually causes pockets to develop between your gums and teeth that fill with plaque, tartar and bacteria. In time, the pockets become deeper and more bacteria accumulate, eventually advancing under your gum tissue. These deep infections cause a loss of tissue and bone. If too much bone is destroyed, you may lose one or more teeth.
Although the destructive cycle that starts with the accumulation of plaque is the most common cause of periodontal disease, a number of other factors can contribute to or aggravate the condition. These include:
- Tobacco use. Smoking is the most significant risk factor for periodontal disease. Chewing tobacco also contributes to periodontal disease. Tobacco use in any form damages your immune system, putting you at greater risk of periodontal infection. It also creates a favourable environment for harmful bacteria and interferes with the normal mechanisms for limiting bacterial growth in your mouth. Even exposure to second-hand smoke appears to contribute to periodontal disease. And because smoking impairs healing, smokers are less likely to respond to treatment than non-smokers are.
- Sometimes you may do everything right and still develop periodontal disease. In that case, you — along with close to one-third of the population — may have inherited a predisposition to gum problems.
- Hundreds of prescription and over-the-counter antidepressants, cold remedies and antihistamines contain ingredients that decrease your body’s production of saliva. Because saliva has a cleansing effect on your teeth and helps inhibit bacterial growth, this means that plaque and tartar can build up more easily. Other drugs, especially anti-seizure medications, calcium channel blockers and drugs that suppress your immune system, sometimes cause an overgrowth of gum tissue (gingival hyperplasia), making plaque much tougher to remove.
- A number of health problems can take a toll on your gums. One of the most significant of these is diabetes, which makes you more prone to many infections, including gum infections. But the relationship between diabetes and periodontal disease doesn’t end there. Gingivitis and periodontitis impair your body’s ability to utilize insulin, making diabetes harder to control. And because diabetes and periodontal disease may make you more susceptible to heart attack and stroke, having both conditions increases your risk of cardiovascular disease.
- Nutritional deficiencies. A poor diet, especially one deficient in calcium, vitamin C and B vitamins, can contribute to periodontal disease. Calcium is important because it helps maintain the strength of your bones, including the bones that support your teeth. Vitamin C helps maintain the integrity of connective tissue. It’s also a powerful antioxidant that counters the tissue-destroying effects of free radicals — substances produced when oxygen is metabolized by your body.
- Heart disease and stroke: Having long-term gum disease may increase your risk of heart attack and stroke, and the more severe your gum problems, the greater the risk. Research suggests that the bacteria responsible for periodontitis could travel via the bloodstream to the arteries in your heart creating a cycle of inflammation and arterial narrowing that could contributes to a heart attack. Oral bacteria could also make you more prone to develop blood clots, increasing the likelihood of a stroke. Complications of pregnancy: Women with periodontal disease may be more likely to give birth to a premature baby than are women with healthy gums. The problem is exacerbated by diabetes, considered at high risk in pregnancy. Uncontrolled blood sugar: Diabetes puts you at greater risk of developing periodontal disease and other infections, as it makes blood glucose levels harder to control. Infection anywhere in your body can raise your blood sugar level, requiring more insulin to keep it under control.
- Pneumonia: If you have serious gum disease and lung problems, inhaling (aspirating) bacteria from your mouth into your lungs may result in aspiration pneumonia, a condition that’s especially common in hospitals where patients may be sedated or have tracheal tubes.
What are the symptoms of gum disease?
In the earliest stages, periodontal disease causes few signs or symptoms, and you may not be aware of a problem until your gums become soft and bleed slightly when you brush your teeth. As the disease progresses, you may notice more-serious changes, including: swollen, bright red or purple gums; gums that feel tender when touched; gums that recede from the teeth, exposing the roots; gaps developing between your teeth; pus between your teeth and gums; persistent breath odour or a bad taste in your mouth, and loosening of the teeth.
Because several types of periodontitis exist, you may experience problems that are unique to a particular form of the disease. For instance, aggressive periodontitis, which affects otherwise healthy young people, causes a rapid deterioration of teeth and gums. The condition can also occur with periods of severe disease alternating with periods when signs and symptoms improve or seem to disappear.
Other types of periodontitis and their characteristics include:
- Chronic periodontitis: This most common type of gum disease is characterized by progressive loss of the bone and soft tissues that surround and support your teeth. The damage usually develops more slowly than it does in aggressive periodontitis.
- Periodontitis as a manifestation of systemic disease: This usually develops at a young age and occurs in conjunction with another health problem, such as diabetes.
- Necrotizing periodontal disease: A severe form of periodontitis, this causes the death of gum tissue, tooth ligaments and even bone. People suffering from malnutrition or living with HIV/AIDS are especially vulnerable.
Treatments of periodontal (gum) disease
- Preventing gum disease at home
The only way to effectively cure gum disease is by seeking professional help. However, maintaining a good oral hygiene routine at home can help prevent periodontal disease. Regular brushing of the teeth, flossing and using a mouthwash at least twice a day will reduce the amount of plaque that builds up on your teeth. Using the correct techniques for cleaning teeth and gums is also important. This can help prevent the onset of gum disease.
Periodontitis is treated by cleaning the pockets of bacteria to prevent more damage. If you have pockets between your gums and your teeth that are 4 mm or less in depth, you may be a good candidate for scaling and root planning, sometimes in conjunction with antibiotic therapy.
- Scaling and root planning
If you regularly practice good oral hygiene at home, this might be the only treatment you need. Scaling removes tartar and bacteria from your tooth surfaces and beneath your gums, and may be performed using hand instruments or an ultrasonic scaler.
Root planning smooths the root surfaces, discouraging further accumulation of tartar. In addition to these procedures, your dentist may prescribe antibiotics or other medications to help control bacterial infection.
Either of these treatments may be complemented with a course of antibiotics.
- Topical antibiotics
Modern developments in the treatment of topical antibiotics maybe used instead of traditional antibiotics which are taken orally. This has the benefit of reducing unpleasant side-effects and prevents bacteria becoming resistant to antibiotics.
Some of the topical antibiotics include the application of gels or the insertion of a special thread into the pockets or between the gum and tooth following a cleaning procedure in the dental surgery. Some dentists recommend antibiotic mouth rinses. Such treatments appear to reduce the level of bacteria and can be used to prevent further problems in the future.
However, you may have more advanced periodontitis when the depth of the pockets between your gums and teeth more than 4mm. In these cases, gum tissue may not respond to non-surgical treatments and oral surgical treatment may be required.
If the periodontitis is very advanced – with the gap between the tooth and gum being deeper then 4mm – such techniques as described above may not be effective and oral surgical treatment may be required.
Recent advances in topical antibiotic treatment may reduce the need for systemic medications that, in addition to the potential for side effects, increase the likelihood of antibiotic-resistant bacteria. Some dentists, for example, recommend antibiotic mouth rinses. Others may insert threads and gels containing antibiotics into the space between your teeth and gums or into pockets after deep cleaning. Although more research is needed, these products appear to lower bacteria levels and may help prevent future problems. Sometimes, though, you may have more advanced periodontitis when the depth of the pockets between your gums and teeth is more than 4 mm so your gum tissue may not respond to non-surgical treatments.
Periodontal (gum) disease – further information
Get in touch with us!
Please get in touch if you have any questions about periodontal (gum) disease or if you have any questions about our gum treatments, would like to book a periodontal gum assessment or are a referring dentist with patients who are showing signs of periodontal gum disease.
Periodontal (gum) disease treatment fees
|Periodontal gum assessment (with CBCT scan and / or X-rays, taken in-house)||£150*|
|If you have had a periodontal consultation elsewhere, send a copy of the plan for a ‘like for like’ cost comparison.|
*Fee includes: in depth oral & periodontal assessment, dental 3D Cone Beam CT (CBCT) scan / x-rays as necessary, detailed treatment plan with options and definitive costs. Fee also includes all CBCT scans and x-rays throughout the course of treatment.
Dental CBCT scans alone cost up to £300 at clinics with similarly qualified clinicians, so our fee is very reasonable.