Periodontitis (Gum Disease)
Symptoms
Bleeding Gums
Bleeding gums are relatively common and called Gingivitis. This is caused by a build up of plaque bacteria which cause inflammation. over time, the gums steadily become red, puffy and swollen. When brushed, they bleed. If oral hygiene is improved, they will usually heal and stop bleeding. However, this can be a sign that there is an underlying issue which needs to be investigated further, such as true gum disease.
Receding Gums
This creates long looking teeth and black gaps where the gum used to be. When the bone shrinks away from the teeth, the gum follows it. The bone provides the support for the gum and so the two naturally follow each other. Sometimes gum disease can hide how much bone has been lost, because the gums are puffy and inflamed. An unfortunate side effect of the successful treatment of gum disease is further recession. This is because the gums become more healthy and less swollen, so drop back to meet the underlying bone.
Wobbly & Drifting Teeth
This is one of the main complaints as it is unsightly and can cause embarrassment. When the support around teeth is lost due to gum disease, they become more loose and wobbly than they should be. This is because their foundations have been reduced and they are less stable to bite on. They are also more prone to drifting due to forces from the tongue and lips. This is most apparent when gaps start to open up between the teeth.
Bad Breath
A very personal and embarrassing side effect that has a big impact on confidence. Bleeding and certain bacteria can cause bad breath in gum disease. In most cases, the successful treatment of gum disease will remove the bacteria and stop the bleeding. This in turn will prevent the bad breath. Halitosis is the professional name for bad breath.
What is Gum Disease?
Periodontitis
Periodontitis (Gum Disease) is a condition that causes the breakdown of the gum and bone around a tooth. If left untreated, the damage will progress steadily and the tooth can be lost. Periodontitis is an inflammatory condition and it is triggered by dental plaque bacteria . If there was no plaque in your mouth, you could not get the condition, even if you are susceptible to it. Treatment is aimed at ensuring excellent oral hygiene above the gum, whilst professionally treating the plaque below the gum that can’t be reached at home with deep cleaning.
Gum Recession
Recession is an unfortunate and unsightly side effect of gum disease. It can also occur in people who do not have gum disease. This is due to the position of the tooth root in the gum and bone and is most common after orthodontics. People often seek treatment to cover the recession for aesthetic concerns, due to discomfort, or to prevent further worsening of the problem. This treatment is called Periodontal Plastic Surgery. This treatment is most appropriate for people that have recession which is not due to gum disease.
Why do I have gum disease?
Gum disease is predominantly a hereditary condition which means it runs in the family. In general terms, people are either susceptible to gum disease or they are not.
If you are susceptible, then the severity of the gum disease can vary from person to person. It is also modified by factors such as stress, diet, smoking and some medical conditions.
Unfortunately gum disease cannot be cured, but with effective treatment and excellent oral hygiene, it can be stopped or stabilised. Ultimately, success depends on the patients ability to have superb oral hygiene. Without this, there will always be plaque around the teeth and this keeps the disease active.
Gum disease is an inflammatory disease and it is the body’s over-reaction to the plaque in the mouth that causes the damage. The damage allows the gums to break away from the tooth and also for the bone to dissolve away from the tooth. This forms a ‘pocket’ around the tooth and extends under the gum. The plaque bacteria move down into this pocket and continue the inflammation process under the gum. This results in more damage and progression of the disease.
Smoking
There is evidence to show that gum disease is worse in people who smoke and that the treatment is less successful. This is due to that fact smoking decreases the body’s ability to heal. Smoking is also well know to be harmful to your general healthy and can contribute to the formation of oral and other cancers.
Diabetes
Diabetes can make gum disease worse if it is poorly controlled. In addition, poorly controlled gum disease can make diabetic control worse. Well controlled diabetes will have a reduced effect on the severity of gum disease and well controlled gum disease helps with the management of diabetes. Gum disease can also be an early sign of diabetes, especially if the condition runs in the family.
Heart disease & strokes
There is emerging evidence that poorly controlled gum disease is partly linked to an increased risk in heart and blood vessel disease. This is because of the increased level of inflammation in the body caused by periodontitis. Well controlled gum disease could reduce these risks in combination with other therapies.
Treatment
Oral Hygiene
Superb oral hygiene is the most important thing that you can do to take control of your gum health. This means brushing twice a day with an electric toothbrush (rotating oscillating type) alongside using interdental brushes every day. Floss can be helpful but is harder to use. Any bridges need to be cleaned under with a special floss that has a thicker section (such as Superfloss). Mouthwashes have a limited effect (apart from in certain situations, such as after mouth surgery or implant placement). Mechanical cleaning is by far the most effective. Plaque disclosing tablets are very useful to help actually see the plaque and to measure how effectively you brush you teeth and identify the bits you’ve missed.
Professional Cleaning
Excellent personal oral hygiene will go a long way to improving gum disease but the plaque below the gum cannot be reached. This is where professional cleaning comes in. A specialist assessment will identify your needs and provide you with the most appropriate treatment plan to get you back on track. Professional cleaning involves flushing out the plaque from under the gum with special ultrasonic instruments to remove the source of the inflammation and let the condition settle. This is called ‘Sub-gingival Debridement’ but also know as a ‘Deep Clean’. In some cases, regenerative therapies or surgery may be recommended in order to get the best possible outcome.
Life Long Care
Because gum disease cannot be cured, it will start to progress as soon as its given the chance. Keeping gum disease under control means excellent daily oral hygiene practices along with a professional deep clean under the gums on a three monthly basis. This is because the research shows that stability can be maintained using these time frames. Gum disease management needs to be taken ownership over. Accepting this and taking the necessary steps to keep it under control, puts gum disease management in the driving seat rather than the back seat.
Advanced Treatments
Bone Regeneration
In some cases, there may be the opportunity to undertake advanced bone regeneration procedures to encourage your own bone to re-grow around teeth. These procedures are very specific to certain defects and patients need to have superb oral hygiene in order to consider them. They can however be successful in helping maintain teeth for longer in the right situation.
Some biomaterials on the market have shown promise in accelerating or improving the outcome of gum therapies. These are usually from an animal origin but have undergone rigorous testing and research trials to show that they are appropriate for use in humans. The use of these will be discussed with you if they could play a roll in your care.
Overgrown Gums
Some medications, such as Amlodipine, can cause gum overgrowth. This is not the same as gum disease but can make cleaning around the teeth difficult and exacerbate existing gum disease.
It might be possible to change the medication but this is only done through your medical practitioner if appropriate. This can be effective at reducing the overgrown gums but surgery may still be required.
Surgery to remove the overgrown gum can make a big difference to aesthetics and also helps improve the ability to clean the teeth effectively and treat any underlying gum disease.
Dental Implants
A deeply unfortunate consequence of gum disease is the loss of teeth. Dental implants can play a roll in replacing missing teeth as long as the gum disease is under control. This is due to the fact that implants show an increased risk of problems in patients with aggressive forms of gum disease. Gum disease is not a contraindication to dental implants. indeed, they can often give patients fixed replacement to missing teeth when the adjacent teeth are not suitable or is the individual does not want to wear a denture.
What else can I do?
Healthy Mind
Stress has been shown to reduce the body’s immune system and can influence how active gum disease is at any one time. Of course we all have busy, hectic lives and reducing stress can be difficult, but if you can minimise stress then there are numerous benefits.
Healthy Diet
A varied diet that includes regular fruit and vegetables will provide your body with the micro-nutrients it needs to heal and function normally. In addition, vitamin deficiencies can have a negative impact on heating and gum disease. Vitamin D is a common deficiency so if there is ever a question over this, then it might be worth heading to your GP for a blood test.
Healthy Body
It goes without saying that a healthy body goes a long way to improving outcomes for any type of illness or disease. regular exercise, reducing stress and a healthy diet all contribute to this. Smoking cessation also plays a big part and the most up to date research on Vaping suggests that it is not as safe as previously though. Your GP should be your first port of call when quitting smoking as they can offer you support services that make success more likely. After this, it’s simply taking ownership and responsibility for ensuring you stay as well as you can. It is reassuring to know you have the power to take control of your own health.