Gum disease, also known as periodontal disease, is any disease that affects your gums and the structures surrounding your teeth. Gum disease is a progressive disease that may result in tooth loss if not treated properly.
Gingivitis is the earliest stage of gum disease. It involves the inflammation of the tissues surrounding and supporting your teeth. It is a very common dental condition among both children and adults and varies widely in severity. Gingivitis is typically categorised by red, swollen gums that bleed easily when brushing and flossing your teeth. It is important to pay attention to these signs as they act as warning signs for more serious conditions.
Gingivitis is most commonly caused by poor dental hygiene which results in the formation of dental plaque that sticks to the surfaces of your teeth. If dental plaque is not removed (by means of proper dental care) it can become mineralized and form tartar, or calculus. Dental plaque and tartar are filled with harmful bacteria, which irritate your gums. If left untreated, it will extend from your gums to the bones surrounding your teeth, leading to the development of periodontitis.
Periodontitis is when the bones below your gums and the structures that surround and support your teeth become infected or inflamed. This will cause your gums to recede and form deep gum pockets. This process is referred to as attachment loss. These gum pockets readily collect plaque and bacteria, resulting in more wide-spread infection and increased bone loss. As periodontal disease progresses (from early to advanced periodontal disease), more bone tissue is lost and the gum pockets become deeper, ultimately resulting in your teeth becoming loose and falling out.
Stages of Disease
There are generally 4 main stages of gum disease:
- Stage 1: Healthy gums and teeth
- Stage 2: Gingivitis
- Stage 3: Periodontitis
- Stage 4: Advanced periodontitis
Signs of Gum Disease
The general signs and symptoms of gum disease include:
- Persistent bad breath or a bad taste in your mouth
- Red, tender and/or swollen gums
- Gums that bleed during and after tooth brushing or flossing
- White spots or plaques on your gums
- General pain and tenderness in your mouth
- Pain when chewing
- Increased tooth sensitivity
- Gums that are receding or pulling away from your teeth, causing your teeth to look longer than before
- Formation of deep pockets between your teeth and gums
- Progressive migration or loosening of your teeth
- Developing sores in your mouth
- Pus present between your gums and teeth
- Notable changes in the way your teeth fit together when biting down
Regardless if you are experiencing any signs or symptoms of gum disease, we highly recommended that you go for a dental check-up every six months to assess your oral and dental health. This includes checking for any signs of gum disease, plaque accumulation and tartar build-up.
Irrespective of how stringent your oral and dental hygiene regimen is, most people start to produce tartar every 6 to 12 months.
What Causes Gum Disease?
The primary cause of gum disease is poor dental hygiene which results in the build-up of bacteria and plaque on your teeth. If not removed or treated, it can lead to more serious gum disease as well as tooth loss.
Other factors that increase your risk of developing gingivitis and periodontal disease include:
- Unhealthy lifestyle & bad habits: Unhealthy habits such as smoking and chewing tobacco can significantly prevent your gum tissue from healing once it is inflamed or infected.
- Hormonal changes: Hormonal changes that occur during puberty, pregnancy, menopause, and monthly menstruation is typically associated with a rise in gingivitis. The rise in hormones during these changes leads to increased gum sensitivity as well as causes the blood vessels in your gums to be highly susceptible to bacterial and chemical attacks.
- Dental problems: Crooked, cracked, severely gapped, misaligned, rotated, or overlapping teeth make you more prone to developing gingivitis. This is because there is more space for plaque and calculus to accumulate.
- Illnesses: Various conditions and illnesses such as cancer, HIV, and diabetes can affect your gums and increase your risk of gum disease. HIV and cancer (including cancer treatment) drastically impact and weakens your immune system, making you more susceptible to infection. Due to poor blood sugar control, individuals with diabetes are at a much higher risk for developing gum problems, cavities, and periodontal disease.
- Serious gum disease may cause blood sugar to rise. This makes diabetes harder to control because you are more susceptible to infections and are less able to fight the bacteria invading your gums. Diabetes also impairs your circulation as well as the ability of your gums to heal.
- Medications: Certain medications have the potential to affect your dental health. Some medications lessen the flow of your saliva, which has a protective effect on your gums and teeth. Some drugs and medications can also cause abnormal growth of gum tissue. These drugs include the anticonvulsant medication Dilantin and the anti-angina drug Procardia and Adalat.
- Poor nutrition & unhealthy eating habits: Diets that are high in carbohydrates and sugar will increase the formation of plaque. Low water intake and a deficiency of important nutrients such as vitamin C will further impair the ability of your gums and and/or surrounding tissue structures to heal once they are inflamed or infected.
- Alcohol: High alcohol intake negatively affects your oral defence mechanisms.
- Stress: High levels of stress and anxiety can adversely affect your mental, emotional, physical, and dental health in multiple ways. Stress can impair your body’s immune response to bacterial invasion. Resulting in an increased risk of infection and gum disease.
- Mouth breathing: Excessive and persistent mouth breathing can be very harsh on your gums when they aren’t protected by your lips, ultimately causing chronic irritation and inflammation.
- Genetic susceptibility: Some individuals are more genetically prone to developing gum disease than others.
- Infrequent or no dental care as well as not brushing and flossing your teeth daily.
How do dentists diagnose Gum Disease
Dentists use the following methods and procedures when assessing and diagnosing various stages of gum disease:
- Measuring the gums: By means of a thorough assessment the depths of the pockets around all of your teeth will be measured using a periodontal probe. Healthy gums typically have pockets that are between 1mm – 3mm deep. The deeper the pockets, the more severe the disease and infection.
- Taking X-rays: Dental X-rays are a great tool for assessing and diagnosing gum disease. X-rays will reveal the condition/level of your underlaying bone and whether or not any bone loss has occurred due to periodontal disease. Evaluating your jawbone will also help detect any breakdown of bone surrounding your teeth.
- Checking for loose teeth: As progressive migration or loosening of teeth due to bone loss is one of the common signs of gum disease, it is vital to check the stability and condition of each tooth. Proper teeth alignment is another important factor to assess.
- Examining sensitive teeth: Increased tooth sensitivity around the gum line may indicate areas of receding gums.
- Evaluating your gums: A comprehensive assessment of the condition of your gums is vital. This involves examining your gums for any signs of gums disease, including inflammation, red, swollen, tender and bleeding gums.
How do dentists treat Gum Disease
The treatment option is highly dependent on the stage and severity of the gum disease. Treatment options range from nonsurgical therapies that focus on removing plaque and controlling bacterial growth to surgical interventions to restore supportive tissues that were damaged and lost.
Before starting the process, you will come in for an initial consultation where we do a thorough evaluation to assess the condition of your teeth in order to determine the correct course of treatment best suited to you.
Non-surgical treatments for Gum Disease
- Professional dental cleaning:
This involves the removal of plaque, tartar, and calculus from above and below the gum line of all your teeth. As tartar and calculus is essentially plaque that builds up and hardens on your tooth surface, it can only be removed by means of a professional cleaning, performed by an experienced dentist.
If any early signs of gum disease are detected, your dentist will recommend professional dental cleanings more than twice-a-year to ensure optimal oral and dental health is maintained. It is important to note that dental cleanings are not a treatment option for those with active gum disease. It is rather an important preventative measure that can help you avoid the development of any form of gum disease.
Depending on the severity and how much ‘cleaning’ is required, professional dental cleaning can be divided into three main categories:
- Standard Cleaning: Standard dental cleanings are recommended for individuals who have their teeth cleaned on a regular basis, and have minimal plaque, tartar, or calculus build-up. This process involves the use of a specialised handpiece with a metal tip. This tip vibrates at a supersonic speed to loosen the hardened calculus deposits. Although occasional sensitivity can be expected, the pain is minimal. In instances where the sensitivity is too high, hand instruments may be used to decrease the sensitivity.
- Deep Cleaning: Deep cleaning is recommended when the individual’s gum disease has advanced into periodontitis, and pockets have started to form. First, the supersonic specialised handpiece will be used to remove the bulk of the tartar and calculus from the teeth. A switch will then be made to other specialised tools to clean the deeper-lying deposits on the root surface. These specialised tools are designed to reach the bottom of the pockets without harming the gums or teeth. This procedure is referred to as curettage.
- Scaling and root planning: This deep cleaning, nonsurgical procedure is performed under a local anaesthetic in the case of advanced gum disease where deep pockets are present and there is plaque and calculus under the gums. It involves scraping away plaque and tartar from above and below the gum line (scaling) and smoothing rough spots on the tooth root to remove any and all bacteria to create a clean surface for the gums to effectively reattach to the teeth (planning). Follow-up appointments may be required, with more frequent cleanings if necessary.
Surgical Treatments for Gum Disease
Surgery is needed when the surrounding tissue and structures are too unhealthy and damaged to be repaired with nonsurgical options.
Some examples or surgical treatments for gum disease include:
- Flap surgery/pocket reduction surgery
- Bone grafts
- Soft tissue grafts
- Guided tissue regeneration
- Bone surgery
- Laser therapy
How can Gum Disease be prevented?
- Proper plaque control: Early-stage gingivitis can be reversed, and the progression of gum disease can be stopped in nearly all cases if proper plaque control is practised. This involves professional cleanings by an experienced dentist at least twice a year as well as daily brushing and flossing.
- Floss or use an interdental brush to clean between every tooth at least once daily.
- Rinse your mouth and teeth with antibacterial mouthwash after brushing and cleaning between your teeth.
- Stop smoking / eliminate unhealthy lifestyle habits.
- Reduce stress and remove various stressors from your life.
- Get an adequate amount of sleep.
- Maintain a well-balanced diet low in sugar and carbohydrates.
- Increase your water intake and include important nutrients such as vitamin C into your diet.
- Avoid clenching and grinding your teeth.
- Reduce or eliminate alcohol consumption.
- Attend regular dental checkups twice annually.
Is it possible to reverse Gum Disease?
If gingivitis is detected early, the causes of early-stage gum disease are correctly identified, and the individual is committed to improving his/her oral and dental hygiene and seeking/implementing the necessary treatment, gum disease can certainly be reversed or halted. The prognosis is always best when detection and treatment is conducted in early stages of gingivitis. Once the condition advances to periodontitis and the bacteria spreads to the bones, irreversible changes such as bone loss and the attachment loss of the gums can take place. It is vital to catch and treat gum disease as early as possible for the best possible outcome.