What is gum disease?

When we eat, the bacteria and food in our mouth produce a sticky substance called plaque. Within 2-3 days the plaque then causes the gums (gingiva) to become inflamed and bleed – this is called gingivitis. It can easily be reversed by brushing and flossing again. It can be very challenging to brush well when undergoing orthodontic treatment.

However, if it isn’t removed, the plaque mixes with the minerals in saliva and will harden into tartar (calculus) that can’t be removed with brushing becoming, gum disease. The tartar collects more plaque and starts to spread below the gum, destroying the bone. This is now called periodontitis, and is much more harmful than gingivitis. It progresses slowly and painlessly. It is an inflammatory response to the presence of calculus. The signs are bleeding, swelling, receding gums, bad breath, and a bad taste in the mouth. In time, if this is still not treated, it will advance to the stage where the teeth will develop gum abscesses, become loose and painful, and may have to be extracted.

Who is at risk of periodontal disease?

• If you are a smoker you have a higher risk of periodontal disease than someone that is a non-smoker
• If not controlled well, diabetes is a contributing factor of periodontal disease
• More likely during pregnancy
• Has an association with heart disease

There are various levels of gum disease. What level am I?

At each comprehensive check-up, our dentists will record your gum health and discuss the significance of your level with you.

• Level 0 is the healthiest level, no plaque (best)
• Level 1 gums bleeding slightly
  Plaque that is not removed irritates the gums and can cause them to get red, swollen and bleed when touched. It is called gingivitis. This is easily treated and reversed by careful and regular brushing and flossing at home.
• Level 2 calculus (often referred to as tartar) deposits
  Over time, minerals from our saliva are mixed with the plaque, which then hardens to become calculus. Typically it builds up around the teeth at gum level, which further irritates the gums. Calculus bonds strongly to the tooth surface and cannot be removed with a toothbrush, so home brushing will not remove this.
• Level 3 calculus deposits, areas of bone loss between 4-5 mm
  If the calculus is not removed the build-up will increase and work its way down the tooth surface under the gums. When it has reached the bone it is then called periodontal disease. The bone supporting the teeth will react and the bone will now start to resorb (dissolve) and it is likely you will have larger gaps in between your teeth. At this point, our dentists may refer you to a specialist dentist called a Periodontist for comprehensive treatment.Destruction of the bone at this stage is not reversible, but can be stopped!
• Level 4 calculus deposits with significant bone loss of more than 6 mm (worst)
  The usual symptoms are puffy gums, bad taste and bad breath. At this level, gum disease has caused significant levels of bone to dissolve and your teeth have likely drifted from their correct position. It is likely some of your teeth have become loose and tender and you could be in pain. If still left untreated, so much of the bone will be gone, that the only option is to remove the effected teeth.

What does gum disease look like?

How do we treat this disease?

Where the level of disease is limited and mild (1 to 3), the dentists can clean all calculus deposits off your teeth to reduce the bacteria and allow the gums to heal. This is called having a scale and clean. The dentist will then provide you with oral health education so you know how to brush & floss effectively at home to help prevent its return, and advise you on how social & eating habits as well as your overall health may be contributing to your condition.

The dentist may then recommend that you use a chlorhexidine mouthwash, daily for a short period of time. You will likely need to ensure regular appointments are made so the dentist can see if the disease has stopped.

How do I keep this disease away after treatment?

To maintain gum health after treatment when you have level 1 or 2, regular brushing and flossing, regular dental checks and following the dentists advice relating to your social & eating habits and general health, will easily keep the disease away.

To maintain gum health after treatment when you are at level 3, in addition to the above information, our dentists may recommend that you use interproximal brushes as part of your oral hygiene regime due to bone loss. If you have tooth sensitivity due to exposed root surfaces, desensitising dental treatments are available. Please don’t hesitate to let our dentist’s know this is happening to you. The damage done by gum disease often needs special care so further damage is avoided.

What if I don’t have treatment?

Periodontal disease is a slow disease which doesn’t give pain until the advanced stages. By then, the bacteria will have worked well down the root surface, destroying the bone supporting your teeth. Pus will form deep under the gum, & your teeth will become loose & sore. There may be no option but to extract the teeth now. Replacement of teeth can then become more difficult due to the loss of bone.

It is important to realise that gum disease treated in the later stages, causing bone loss, can make it more difficult to replace any lost teeth at a later date. Implants rely on bone depth and stable dentures rely on a good fit over the bone/ridge where teeth were once sitting. Bone loss may mean that implants are not an option and dentures can be ill fitting.

What is Periodontist?

A periodontist is a dentist who specialises in the management of periodontal diseases, which is diseases of the bone and gum that support the teeth, and in placement of dental implants and treatment of the gum and bone around dental implants. Following completion of 5 years at dental school and a period of time in general practice, periodontists complete 3 years of university based specialist training. They are familiar with the latest techniques for diagnosing and treating periodontal disease, and are also trained in performing cosmetic periodontal procedures.

Things to remember

• Gum disease affects most people at some stage in their life
• One of the common signs of gum disease is bleeding gums
• Careful cleaning can help prevent gum disease
• Getting treatment early can help save teeth that are at risk from gum disease and other conditions
• Brush your teeth/gums twice a day with a fluoridated toothpaste
• Floss in-between your teeth each day
• Visit our dentists regularly
• Drink plenty of fluoridated tap water
• Avoid smoking

These products can greatly assist in managing this disease after treatment and can be purchased at our practice.

• Plaque disclosing tablets to use at home so you can ensure your brushing technique is effective

• Extra-soft toothbrushes to prevent further damage to the gums during brushing, especially useful if your brushing technique is still a work in progress

• Interproximal brushes of various sizes that help clean the gaps between teeth, created by bone loss
• Various flavoured tooth mousses that create an acid free environment for vulnerable root surfaces
  
• Very high fluoride toothpaste
• Chlorhexidine mouthwash that reduces the bacteria in the mouth