What is Gum Disease?
The Periodontium relates to the supporting structures that help to keep your teeth in place and this includes the root, bone and ligaments. Gum disease is an inflammatory disease that leads to damage of these supporting structures resulting in inflamed gums, loss of bone, sometimes with gum recession, loose teeth and if left, teeth can fall out.
There are two main types of gum disease. The first is fairly common and is called Gingivitis.
Gingivitis is the inflammation of the gums around teeth and is completely reversible without any long-term damage. The gums can bleed and look swollen and tender.
The more severe type of gum disease is termed Periodontitis.
Periodontitis is where the bone and ligaments are affected leading to irreversible damage. Sometimes recession is visible but often there may be no obvious visible signs to patients. In the later stages teeth can move or become tender to bite on. Periodontitis is more common in smokers and has, in some circumstances, been linked to other more general disorders such as cardiovascular/ heart disease and again diabetes.
How will I know if I have gum disease?
In most cases gum disease is not painful and often patients will not realise something is going a miss.
Gingivitis is extremely common and around 80% of people at some time will have some gingivitis. Periodontitis is less common.
A dental examination includes a thorough assessment of your gums and the supporting structures for teeth. The use of specific dental probes and radiographs (x-rays) can help to identify periodontal disease. Your Dentist will explain to you if gum disease is present and what treatments are recommended.
What can I do to fix it?
Good oral hygiene routines at home along with scaling and polishing from a Dentist / Dental Hygienist may be all it takes to help reduce and prevent gingivitis. Brushing the teeth and gums twice a day with good interdental cleaning (such as Tepe brushes or Floss) will help to prevent gingivitis. We can help you with flossing and using Tepe’s. Some patients are more susceptible to gingivitis such as Diabetic patients or patients who are pregnant. Dr Redmond wrote her Masters Dissertation on Gum Disease in Pregnant Patients.
Worryingly there is no cure for periodontitis and unfortunately damage to the supporting structures of teeth are irreversible. However, we must still try to prevent it from getting worse and many patients with periodontitis can remain stable for years with good oral hygiene routines and with regular dental appointments
The treatment is slightly different with periodontitis compared to gingivitis. Where a gum pocket exists through bone loss and gum recession, it will need to be cleaned under the gums to disrupt the bacteria present, which are responsible for the condition. As a patient you may not realise the difference when having this treatment from a normal regular scale and polish but on occasions the Dentist or Hygienist may provide a local anaesthetic to make sure it is more comfortable for you. Often patients who have periodontitis may be advised to see the Dentist more frequently and the latest evidence based research would advise every 3 to 4 months.
Are there any other treatments I can have which may help?
Sometimes even after several visits of cleaning some infected areas still remain and sometimes this is termed 'refractory periodontitis'. One of the problems with seeing the Dentist/hygienist every 3 months is that sometimes there may not be enough time in one visit to get everything done and when you return in 3 months time it may be that we have taken 3 steps forward and 2 back. One of the best methods to prevent this is to have a more intense full mouth clean with the Dentist so all the appropriate cleaning can be completed in one visit and then we can simply try to maintain this. This has often been termed full mouth disinfection and, with research, has been shown to be one of the most effective methods in treating periodontitis. Sometimes supplementary aids to cleaning are used such as Chlorhexadine Gluconate (Corsodyl) to disinfect the gum pockets.
If there is infection will Antibiotics fix it?
On occasions Antibiotics may be prescribed for periodontitis. However, these are used primarily for acute flare-ups such as gum abscesses or sometimes used in severe cases along with the regular cleaning. Antibiotics are not a substitute to the most important factor, which is your home care routine of regular brushing and interproximal cleaning. Sometimes an antibiotic gel can be directly applied to a stubborn infected pocket although these types of treatment are often a last resort.
Can anyone else help?
With patients who do not seem to be improving or where a particular aspect of their gum disease is a problem either from a cosmetic point of view or if the infection simply will not resolve we can always offer to refer you for advice/treatment from a Dentist with further training in Periodontal Disease. Fortunately Dr Emma Redmond has completed a Masters Degree in Periodontology- the study of gums and gum disease.
Sometimes gum surgery is needed or in certain circumstances you may even be advised to have selective extractions of hopeless teeth.
We will always advise what we feel is the best and latest evidence based treatment to suit you.
Please do not hesitate to contact us if you have concerns about your gums.
You can find out more about Gum Disease HERE
Gums in a patient with gum disease before treatment
The same teeth and gums after periodontal treatment
Images from the BSP guidelines on gum awareness (Click on the photo to open the PDF)
Preventing Periodontal Disease- from the American Periodontal Association