Periodontal Disease (Gum Disease)

Periodontal Disease (Gum Disease)

Periodontitis is often known as ‘Gum Disease’ and is a very common condition in which the gums and deeper periodontal structures, those that hold teeth in your jaw bone become inflamed and swollen and left untreated it can lead to tooth loss.

There has been huge developments in the early diagnosis and treatment of periodontal disease and at Gwynne Dental we follow the latest evidence based advice.

Periodontitis is very common and is widely regarded as the second most common dental disease worldwide, after dental decay, and has a prevalence of 30–50% in the population, but only about 10% have severe forms.

Early Periodontal Disease

Periodontitis is caused by certain bacteria known as periodontal bacteria and by the local inflammation triggered by those bacteria. Although these periodontal bacteria are naturally present in the mouth, they are only harmful when the conditions are right for them to increase dramatically in numbers. This happens when a layer of bacteria and food debris, known as plaque, builds up and is left undisturbed on the teeth, commonly in hard-to-reach areas such as between the teeth.

In many people, this is a gradual process that takes place over many years and, if detected and treated, can be halted. However, some young adults have a very active form of the disease which causes early loosening and loss of the teeth.

How can I recognise periodontitis?

Periodontitis always begins with inflammation of the gums, known as gingivitis. This is not always easy to recognize but one of the first signs that you may become aware of is bleeding from the gums when you brush your teeth. The gums may look red and swollen and you might notice a discoloured layer of bacterial plaque on the teeth.

Left untreated, gingivitis may progress to periodontitis, often without any obvious signs to alert you. However, some changes that you might experience over time include:

• increased bleeding from the gums, which may be provoked by brushing or eating, or even be spontaneous
• bad breath
• changes in the positioning of the teeth in the jaws
• lengthening of the teeth (gum recession); and possibly pain
• Bleeding from the gums may be less noticeable in smokers, because of the effect of nicotine on blood vessels, and so the disease process may be masked.

Advanced Periodontal disease

If the soft bacterial plaque is not removed by brushing the inflammation progresses deeper, the attachment of the gum to the root is disrupted and a gap or periodontal pocket is formed between them. This pocket is an ideal place for harmful bacteria to multiply, therefore driving the disease process forward. In their new habitat, the bacteria release toxins which further trigger the body’s defence mechanisms causing further damage and increasing the size of the pocket.

What are the causes of periodontitis?

Bacteria in dental plaque. A healthy mouth is colonized by more than 700 different species of bacteria, most of which are completely harmless and live in harmony with their host. However, when tooth cleaning is not thorough enough, the bacterial deposits build up next to the gums, forming a plaque, and the conditions become suitable for more dangerous bacteria to flourish. The natural defences of the body are also compromised.

In all cases, periodontitis is caused by the build-up of bacteria in the form of dental plaque.

If there is no plaque there will be no periodontal disease. There are however different genetic predispositions to periodontal disease and some people need only a very small amount to cause the disease.

The severity and speed of progression of periodontitis depends upon

• Patients ability to clean their teeth effectively
• The patient’s genetic predisposition to periodontal disease
• Whether the patient smokes, this increases the rate of progression of the disease, smokers will have 4 times the bone loss
• Whether the patient has poorly controlled diabetes, this will lead to a greater rate of progression of the disease
• Certain medications for heart disease and epilepsy can increase the risk of disease

This graphic shows a healthy gum on the left and periodontal disease with an associated pocket on the right 

What can I do to prevent periodontal disease?

The development of gingivitis and periodontitis can be prevented by adopting thorough oral hygiene habits, alongside regular professional examinations and support. No plaque = no periodontal disease

The basic elements of a good oral hygiene regime are:

• Use a good quality electric rotary toothbrush such a ‘Professional range Braun Oral B’ using the correct technique. https://www.youtube.com/watch?v=chqjw61B1IM
• Use a recognised technique to remove plaque in between your teeth such as interdental brushes or floss
• There is no such thing as the ‘chemical toothbrush’ ie mouthwashes are not effective at the removal of dental plaque, the cause of gum disease. The only way to remove plaque is to disturb it’s adherence to the tooth surface via mechanical action. A tooth brush bristle changing direction is highly effective at this.

Periodontitis is the leading cause of tooth loss

If the progress of periodontal inflammation is not halted, the supporting structures of the teeth, including the surrounding bone, are destroyed. The teeth eventually loosen and are lost, or require extraction. Other problems patients may experience include painful abscesses, drifting of the teeth which may interfere with eating, and unsightly lengthening of the teeth with exposure of the roots, as a result of gum recession.

It is now understood that untreated periodontal disease can have effects on general health; for example, it poses an increased risk for complications during pregnancy (pre-eclampsia, premature birth and low birth weight) and also an increased risk for heart disease and diabetes.

Smoking and periodontitis

Smokers are significantly more likely to develop periodontitis than non-smokers.

Periodontal treatments (such as gum/ bone grafts and implants) are less successful in smokers than non-smokers due to poorer healing.

Periodontitis progresses much faster, with more rapid tooth loss, in smokers.

Of cases of periodontitis which does not respond to treatment, about 90% are in smokers.

Treatment

With careful assessment and treatment, it is usually possible to completely halt the progress of periodontitis. The key to success is to eliminate the bacterial plaque which is triggering the disease process and to establish excellent oral hygiene practices.

• 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 therefore reduce the level of inflammation. Your dental practitioner will first explain the causes of your periodontitis and explain exactly how to keep your teeth and gums clean. You will be given individual advice on how to use the various cleaning aids most effectively; for example, the most appropriate tooth brushing technique and the correct use of dental floss and interdental brushes.

• Professional cleaning, usually 2 sessions under local anaesthetic

All soft deposits will be removed from accessible areas of the teeth and under the gums into the pockets, disinfecting the whole mouth

• Antibiotic therapy

In some cases antibiotics are prescribed to deal with active or persistent gum infections, which have not responded to oral hygiene measures.

• Reassessment

After 4 weeks, your dentist or periodontist will make a full assessment of your gums to check the progress of your treatment. A special instrument called a periodontal probe is used to record the depth of any periodontal pockets and check for bleeding from the gums. If periodontal pockets are still present, further treatment options may be suggested.

• Aftercare – maintenance and monitoring

The long-term success of periodontal treatment depends both on your own efforts with oral hygiene and those of the practice team who provide your regular care and ongoing assessment. The frequency of your follow-up appointments will depend on the severity of disease and your individual risk of disease progression. Usually, follow-up visits are scheduled for every three to six months.

Regular follow-up appointments are vitally important to ensure that the disease process does not recur. Successful periodontal treatment requires your full co-operation regarding daily oral hygiene practices and attendance at regular follow-up appointments.

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