Periodontal (gum) disease: everything you need to know
What is periodontal disease?
Periodontal disease, commonly known as gum disease, is a condition that involves either inflammation of the gums (known as gingivitis) or more serious gum infection (called periodontitis). In advanced cases it can cause loss of the bone structures that support the teeth and, subsequently loss of the teeth themselves. Periodontitis may be associated with heart disease, stroke, whole body (systemic) infections and low birth weight in premature babies.
What are the causes?
Periodontal disease is caused by poor dental hygiene – that is, inadequate brushing and flossing – which allows plaque and tartar to build up and eventually compromise the health of your gum tissue. Poor dental hygiene will almost certainly lead to gingivitis; and for some patients who are susceptible, or “at risk”, it may lead to periodontitis. It is believed that genetics influence whether any one individual will develop severe periodontitis.
Other causes of gum disease include medications (causing overgrowth of gum tissue), chronic medical conditions such as diabetes (which may pose a greater risk of infection or poor gum healing), poor nutrition such as vitamin and mineral deficiencies, and viral or fungal infection. Patients who smoke are also at an increased risk of suffering periodontitis.
What are the signs and symptoms?
Swollen and red, bleeding gums are the classic signs of gum disease. Symptoms depend on the severity of the condition, with bleeding being one of the most common. However, this sign can be masked or even absent in smokers as a result of a compromised blood supply, which compounds the issue further.
Additional signs include bad breath, or halitosis, gum recession resulting in the formation of dark or black triangles between the teeth, or the classic “getting long in the tooth”. Mobility of the teeth can also occur, which can result in movement or migration of the teeth. The end stage of the condition is tooth loss due to loss of supporting structures around the teeth.
What to look out for:
- bleeding gums
- swollen gums
- painful gums
- loss of gum tone and texture
- gum recession
- bad taste
- halitosis or bad breath
- tooth loosening
- difficulty chewing
- tooth migration
While both acute and chronic forms of gum disease exist, it is the chronic form that predominates. Chronic periodontal disease goes largely unnoticed as it is a non-painful condition and the above signs and symptoms generally present at the later stages or with advanced disease.
The only true way to know if you have gum or periodontal problems is to be examined by your dentist. A simple screening exam can alert us to the presence of any disease, which would then warrant a more detailed mapping of the gum tissues, including radiological analysis of the supporting bone structures. Groups with a higher risk include smokers, uncontrolled diabetics and those with a genetic predisposition. Stress and poor diet have also been implicated.
How do I prevent periodontal disease?
To prevent gum disease, you should brush your teeth at least twice a day and use dental floss or the little brushes for cleaning in between your teeth (interdental brushes). If you have gingivitis, the condition is reversible with effective brushing.
Some patients with gingivitis will progress to periodontitis. Periodontitis does not cause symptoms initially, so it is important to have regular dental check-ups to identify its presence. Your dentist should be able to diagnose gum disease or suggest a referral to a gum specialist. If you arrest gum disease in the early stages, you may be able to prevent the early loss of a tooth.
Can it be cured and what is the treatment?
In addressing this question it’s important to first define the term cure.
A cure is the relief of symptoms of a disease or a condition. In relation to gum disease, the answer is yes; a cure (in this sense) is possible. However, the matter is complicated by the constant presence and growth of plaque and bacteria in the oral cavity (the primary cause of gum disease). That’s why gum disease treatment is better described as ongoing maintenance, rather than a cure – and this requires an active ongoing relationship with your dental practitioner.
Understanding the term gum disease is also very important.
The most common variety of gum disease is what we call ‘gingivitis’. Gingivitis is inflammation of the gums (or gingiva) due to plaque at the gingival margins. Most patients have some gingivitis, and this can be easily treated with improved home care involving brushing and flossing.
There are acute varieties of gum disease that can also be treated; these are often related to bad home-care, smoking and stress. This can be treated with a good professional clean, possible use of antibiotics, as well the elimination of bad habits and inadequate home dental hygiene.
In the dental practice, the gum disease we often talk about is the “destructive gum disease”. This is known as periodontitis and has multiple factors that affect its severity. These include genetics, quality of home care, smoking, systemic health, and regularity of dental visits.
Periodontitis is marked by the destruction of the tooth-supporting ligament and bone. This can rarely be replaced, so treating this back to its original health is, unfortunately, not possible.
Instead, this situation can often be stabilised and maintained; however, with genetics often playing a part, it means an individual who has periodontitis will always be susceptible to further periodontal destruction if they do not maintain high-quality home care and regular professional deep cleaning.
In summary, the question of whether periodontal disease can be cured should rather be a question of whether the disease can be stabilised and then maintained. This will only be possible with excellent home care and ongoing maintenance by your dentist or gum specialist.
If you have periodontal disease you may be referred to a gum specialist known as a periodontist. Periodontists are dental specialists who specialise in the prevention, diagnosis and treatment of periodontal disease, and in the placement of dental implants. The treatments offered by a periodontist include deep/extensive cleaning, gum surgery, bone grafts or regeneration of the supporting tissue, and replacement of a lost tooth with a dental implant.
In order to obtain the best outcome from gum treatment, patients should refrain from smoking. Patients with chronic medical problems, especially diabetes should maintain normal blood sugar levels. A healthy diet such as eating fruits and vegetables, especially those containing plenty of calcium, will also contribute to a good prognosis.
If I don’t have periodontal disease, why are my gums bleeding?
Bleeding gums may also be a result of rough cleaning. Gum tissue is delicate and brushing too hard, with incorrect technique or with a toothbrush that’s too firm, may be causing trauma. Traumatic cleaning may also result in the gums receding (gingival recession) and increase your risk of over-sensitive teeth or movement in the teeth.
Bleeding gums are sometimes associated with serious medical conditions and inflammation elsewhere in the body. In some people, bleeding gums have been associated with stroke, heart attack or hardening of the arteries. Those with diabetes or who struggle to control blood glucose levels may also have higher susceptibility to periodontal inflammation.
Do receding gums grow back?
The most common gum-related complaints our clinicians hear are those concerning receding gums. Receding gums don’t ordinarily lessen or improve without dental treatment. However, there are several things you can do to prevent gum recession and others that we clinicians can do to treat it.
Healthy gum tissue forms a protective collar around a tooth. Gum recession occurs when the edge of the gum tissue (gingival margin) moves away from the crown of the tooth. When gums recede, exposing the tooth’s root, the most common symptom felt is sensitivity. Tooth root decay may also develop because the softer root surface decays more readily than the enamel on the tooth’s crown.
There are several common causes of gum recession. These include:
- gum disease (periodontitis)
- excessive tooth brushing
- trauma to the gums
- abnormal tooth positioning
Less commonly, some people have thin, fragile or inadequate gums, making them prone to recession. This is especially so in patients where a tooth protrudes or the teeth are crowded and, as a result, there is insufficient bone to cover the tooth’s root, causing an increased risk for gum recession.
Periodontal disease Signs and symptoms
The most common symptom of receding gums is sensitivity to hot, cold, sweet, sour or spicy food and drink. The sensitivity tends to manifest as a short, sharp pain, lasting for seconds at a time.
Other possible indicators of gum recession are when:
- a tooth becomes loose
- teeth appear longer than normal
- roots are exposed
- a tooth feels notched at the gum line
- a tooth changes colour
- spaces between teeth seem larger.
Treatment of gum recession
The type of gum treatment required will be determined by the cause of the gum recession and its severity. When minor recession is ignored, continued recession and bone loss around teeth are likely, something many people may not be aware of.
If your gum recession is due to excessive brushing, a dentist, hygienist or periodontist can show you the most effective oral hygiene methods.
If your gum recession is due to periodontitis, the first step is to see a specialist in periodontics. The initial treatment involves deep cleaning. For many patients, this treatment, along with excellent home care and regular check-ups or maintenance, can help control the periodontitis and prevent further gum loss. In some cases, gum recession can be reduced by a gum graft procedure. This procedure helps to create more attached gingiva (the thick, pink and firm tissue that hugs the teeth) to prevent progression of the gum recession. It also helps to cover exposed roots, enhances the appearance of the gum line and prevents or treats root sensitivity.
Does mouthwash help prevent gum disease, and which one should I use?
The answer is both yes and no! There are a number of types of mouth rinses, also known as mouthwash, available. Some are advantageous to oral health, whereas others offer no clear benefits.
Prevention and treatment of decay
Fluoride rinses are used, upon the recommendation of a dentist or hygienist, in order to assist prevention or to manage early decay. The significant volume of fluoride in these rinses helps to strengthen teeth and can help to reverse early decay.
These fluoride mouth rinses are recommended only by an oral health practitioner and thus are not readily available at a supermarket. For example, your hygienist may recommend a fluoride rinse after a professional clean at the practice, or a general dentist may recommend a high fluoride rinse to use at home on a regular basis.
These mouth rinses can be purchased from either Smile Solutions or from your local pharmacy but are only recommended for use under the guidance of your dentist or hygienist. They must always be kept away from children.
Prevention and treatment of gum disease
No mouth rinse has been proven to prevent gum disease; however, a “periodontist” (a dentist who specialises in gum disease) may recommend use of an antibacterial mouth rinse in conjunction with in-chair treatment in some situations.
These rinses may also be recommended by dentists in the case of some mouth infections or following the extraction of a tooth. These mouth rinses can have unwanted side effects if not used appropriately. Therefore, these too cannot be purchased at supermarkets but are available at pharmacies or at Smile Solutions.
Other mouth rinses
The other group of mouth rinses are those found at a local supermarket. They may be used in addition to brushing and flossing, as frequently as preferred. Some people find benefits such as fresher breath; however, studies reveal that their ability to improve oral hygiene is limited.
Research has indicated that there may be a link between oral cancer and the use of mouth rinses that contain alcohol. It is recommended, therefore, that only mouth rinses without alcohol as an ingredient should be used.
How does gum disease affect my overall health?
You might be surprised to know that your mouth is home to some 19,000-26,000 oral microbial species. While most of these live in harmony with their environment, there are some which are harmful. In the right conditions, a proportion of these bugs will thrive and lead to gum disease. When present, this disease can affect your general health in multiple ways.
Yes, that’s right! Gum disease can affect your heart! Bacteria present in gum disease initiate a variety of reactions from the body’s immune system. These reactions result in elevated levels of a protein which is associated with increased risk of heart attack. This protein can also cause peripheral artery disease in otherwise healthy individuals. Bacteria present in gum disease can also travel through the blood stream and attach to abnormal or damaged heart valves and cause a condition called endocarditis.
Diabetes and gum disease go hand-in-hand and have a symbiotic relationship. It occurs more in those with diabetes and once present, it can cause further progression of diabetes.
If not cleaned, the bacteria causes breakdown of the bone and surrounding attachment for the teeth, causing mobility and eventual loss of the teeth. This breakdown of the attachment for the teeth is accelerated in people with poorly controlled diabetes.
Conversely, the presence of bacteria associated with gum disease can cause a variety of reactions by the body’s immune system which causes progression of type 2 diabetes. For example, there is further destruction of the cells which produce insulin in the body and destruction of the substance which protects organs from damage. Thus, gum disease can increase the damaging effects of diabetes.
Bacteria present in gum disease and the body’s immune response can be the cause of pneumonia. Enzymes present in saliva may modify the surfaces of the lung, making aspirated bacteria stick and inhabit the surface of the lung causing pneumonia.
Complications during pregnancy
Toxic effects of bacteria that is present during gum disease can be transported via the blood stream to the placenta membrane and cause rupture of the placenta. Other responses by the body’s immune system in gum disease can also retard foetal growth.
There are many ways in which gum disease can influence general health and the best way to avoid these problems is to ensure that you have regular cleans at your dentist, floss once daily and brush your teeth twice daily for two minutes, ensuring you brush along the gum margin with gentle pressure. This will ensure that the bacteria that cause these complications to your general health are removed before they are able to do so.
How does smoking affect my teeth and gums?
Cigarette smoking is recognised as the leading preventable cause of human death in the western world. Smoking affects most, if not all, of the body’s organs and tissue – including the teeth and gums.
In the mouth the means of attack is twofold. The initial inhalation of tobacco smoke introduces high concentrations of tobacco products, which include 2000 to 3000 toxic substances (such as nicotine and carbon monoxide). Then, after the initial phase has passed, these same products mount a secondary attack once they have been absorbed into the bloodstream – where the condition of our blood is an important contributor to the health or otherwise of our gums. In the blood these substances have a much lower concentration but are absorbed over a prolonged period of time.
The past 20 years of research have produced a multitude of evidence that the severity of gum disease is linked to use of tobacco. Compared with non-smokers, smokers demonstrate much greater levels of gum disease, affecting a larger part of their mouth and starting at a younger age.
Tobacco smoke appears to have two main effects on the human body. Firstly, the toxins appear to disturb the body’s ability to respond to the progression of gum disease; and secondly the toxins appear to provide an environment in which the bacteria that cause gum disease are allowed to thrive.
The action of tobacco smoke on gum tissue has also been shown to lower a patient’s ability to respond to treatment of their gum disease. This is also evident in the long-term success rate of dental implant procedures. Both types of treatment are far more likely to fail in smokers than in non-smokers.
Quitting smoking has been shown to have a positive effect on the treatability of gum disease and hence on overall dental health. The response of patients who had never smoked compared with the response of those who gave up one year previously was the same. However, when both groups were compared with patients who still smoked, the non- or previous smokers responded far better to periodontal treatment than the smokers.
Smoking is also considered to be a major factor in the cause of oral cancer. This is generally related to high alcohol consumption. Patients who drink more than 30 standard drinks a week and smoke more than 20 cigarettes a day have a risk of developing oral cancer that is 20 times higher than those who drink and smoke at lower levels. Therefore, if you are a heavy smoker and heavy drinker you should have your mouth examined by a dentist regularly as oral cancer may be able to be effectively treated if detected early but is difficult to treat if found late.
All in all, smoking is seriously detrimental to the health of your mouth including teeth and gums hence your overall health – a very good reason to try to quit.
How can a Smile Solutions periodontist help with my gums?
At Smile Solutions, periodontists work in conjunction with dental hygienists and dentists to diagnose and treat more significant or problematic cases of severe periodontal disease, or patients with a complex medical history. An easy way to think of them is as the Smile Solutions gum experts.
Most patients’ periodontal needs are managed by their hygienist and dentist. However, if a patient is exhibiting signs of periodontal disease during a regular check-up, their dentist may refer them to see a Smile Solutions periodontal specialist.
Patients may also be referred if they suffer from a chronic disease, are taking medication, or if they are being treated for a condition that can affect periodontal care, such as heart disease, diabetes, or pregnancy.
Every patient receives care that is unique to his or her situation. Your Smile Solutions periodontist will examine your gums, check to see if there is any gum line recession, assess how your teeth fit together when biting, and check to see if you have any loose teeth. The periodontist will take a small measuring instrument and place it between your teeth and gums to determine the depth of those spaces (called periodontal pockets). All this helps the periodontist assess the health of your gums. X-rays might also be taken to observe the health of the bone beneath the gum line.
Smile Solutions periodontists offer a range of treatments based on the presentation and severity of the gum disease being treated. These might include scaling, root plaining (where the infected surface of the root of the tooth is cleaned) or root surface debridement (where damaged tissue is removed). Patients may also require surgery if gum disease is deemed severe.
The most important thing to remember…
…is that Smile Solutions periodontists receive extensive training, including three additional years of a master’s degree after completing a dental degree, as well as being members of professional organisations to keep up-to-date with the latest techniques for diagnosing and treating periodontal disease. Smile Solutions periodontists are here to help you take the best care of your gums, because without healthy gums our teeth have nothing to hold them in place.
As the Smile Solutions team is a large and diverse one, organizing a referral to a periodontist is easy. You do not need a referral. Simply call the friendly team at Smile Solutions reception. They will arrange an appointment for you to see Dr James van den Berg or Dr Constantine Ong.