Gum Disease
Gingivitis and Periodontitis
In this section we will cover:
- What is gum disease?
- What are the stages and symptoms of gum disease?
- Gingivitis vs Periodontitis: signs and symptoms
- How does my dentist know I have gum disease?
- Can it be treated?
- How can I prevent it?
What is gum disease?
Gum disease is inflammation of the gums and structures around the tooth (such as the jawbone) caused by a build up of plaque and bacteria along the gum.
Plaque is a sticky layer of bacteria which sits on the tooth surface which starts to form just a few seconds after you brush your teeth. Over time, plaque hardens into "calculus" or "tartar" which can only be removed by your dentist or hygienist (see here).
The term "gum disease" is used to describe two different conditions: gingivitis and periodontitis.
Factors which increase your risk of developing gum disease are:
- Smoking
- Poorly controlled diabetes
What are the stages of gum disease?
- Healthy Gums
Twice daily brushing and once daily interdental cleaning will help you maintain healthy gums. - Gingivitis
If plaque is left on our teeth for 4 or 5 days, it triggers a process called "inflammation" where our body sends fighter cells to the affected area. The gums become tender, swollen and bleed more easily than they should. You may find blood on your toothbrush or in the sink after brushing your teeth. - Periodontitis
The longer the bacteria stay on the teeth, the more damage is done. You may find blood on your pillow when you wake up or your gums start to bleed when you eat.
Bone loss
Eventually the bone around the teeth starts to get "eaten away". As more bone is lost, a gap (or pocket) develops between the gum and the tooth. As this pocket gets deeper, it becomes harder and harder to clean and more bacteria get trapped there.
Gum recession
As more bone is lost, the gum will start to shrink away from the tooth and expose the root surface, making your tooth look longer than normal. This is called "gum recession". You may start to experience sensitivity when eating and drinking.
Wobbly teeth and periodontal abscesses
Over time your teeth become wobbly and the gums may become infected. You may find pus around the tooth or an abscess on the gum. It is at this stage that you start to lose your teeth - either they'll fall out by themselves or you will need them removed (dental extraction) to relieve any pain and infection.
Gingivitis vs Periodontitis: signs and symptoms
Gingivitis
- Early stage of gum disease
- Inflammation of the gums only
- Two types:
- plaque-related: occurs within a few days
- medication-related: nifedipine, amlodipine and phenytoin - Symptoms:
- bad breath
- sore, puffy, bleeding gums - Damage is reversible but if left untreated, this will develop into periodontitis
- Treatment: scale and polish, good oral hygiene
Periodontitis
- Late stage of gum disease
- Inflammation of the gums and loss of bone support around the tooth
- Two types:
- chronic: damage occurs over years
- aggressive*: damage happens very quickly - Symptoms are similar to gingivitis, plus:
- shrinking gums
- wobbly teeth - Loss of bone is permanent (we cannot grow it back) but you can stop it from getting worse
- Treatment: deep clean, good oral hygiene
*Aggressive periodontitis is a rather nasty form of gum disease where the damage happens very quickly. There is usually a family history of early loss of teeth due to gum disease. Fortunately, this affects a very tiny proportion of people.
How does my dentist know I have gum disease?
At every check up appointment, your dentist will perform a simple gum screening called a "basic periodontal examination" (BPE). This involves your dentist walking a thin ball-ended instrument (a bit like a pen) around the gum of each tooth to measure the pocket and to note down any bleeding. Bleeding indicates active inflammation (a sign of gum disease).
A BPE measures gum disease from 0 to 4. In this case, the lower the score, the healthier the gums.
- A score of 1 or 2 indicates gingivitis.
- A score of 3 or 4 indicates periodontitis or extremely swollen gums
If you score a 3 or 4, your dentist will need to determine how advanced your gum disease is. To do this, they will take some xrays and carry out a test called a "6 point pocket chart". This is a similar process to the BPE but your dentist will take down more detailed measurements, including:
- gum pocket depth
- bleeding
- amount of gum recession
- tooth mobility
Once your dentist has identified how advanced your gum disease is, they can come up with a treatment plan to make your mouth healthy again.
Can it be treated?
Gingivitis is completely reversible and can be treated quite simply. We can stop periodontitis from getting worse but it is not possible to grow back the bony support around the teeth once it is lost. In both cases, good oral hygiene is critical.
Treatment can be split into 3 stages:
Stage 1: Good oral hygiene at home
The first and most important part of treatment starts with
good oral hygiene:
- brushing your teeth twice a day for two minutes
- cleaning in between your teeth once a day with floss, interdental brushes or a water flosser
Your dentist or hygienist is your first port of call for giving you personalised brushing advice - this is especially useful when trying to find what interdental aids work for you as we all have different sized gaps between our teeth.
It is also important to manage any factors which are making your gum disease worse such as smoking and diabetes.
- Stop smoking
As well as improving the health of your gums, this will lower your risk of mouth and lung cancer. - Control your diabetes
If your diabetes is poorly controlled, your gum disease gets worse. And if you have gum disease, your blood sugar control gets worse.
There is also a strong link between gum disease and heart
disease. Although it's unclear if gum disease causes heart disease, there is
definitely a higher chance of developing heart disease if you have periodontitis.
Yet another reason to keep your mouth healthy!
Stage 2: Having your teeth cleaned professionally
This will provide you with a "clean slate" from which you can continue to keep your teeth clean with good oral hygiene. There are two types of treatments to clean the teeth:
- Scale and polish
This is for patients with gingivitis where plaque/calculus needs to be removed from around the gum. - Deep clean
For patients with periodontitis, a deep clean will remove any bacteria which have hidden themselves in the pocket between the gum and the tooth. Depending on how sore your gums are, this may need to be done over several visits with the use of local anaesthetic to numb the gum.
Having your teeth cleaned is only an adjunct to good oral hygiene at home. It is not a replacement.
Stage 3: Maintenance
Treatment can move to the maintenance phase once there are
clear signs the gum disease has stopped progressing. This includes healthy looking pink gums with no bleeding, swelling or tenderness.
Maintenance involves regular hygiene visits to ensure your gum health does not relapse as well as keeping up with a strict oral hygiene routine at home.
In absolutely all cases of gum disease, commitment to treatment is essential. There is only so much your dentist can do to help you if you aren't keeping your teeth clean yourself.
How can I prevent it?
It is actually very simple to prevent gum disease once you know how:
- Brush your teeth twice a day
An electric toothbrush with a small roundhead is more effective at removing plaque than a normal toothbrush. A battery-operated toothbrush is not the same as an electric toothbrush!
- Clean in between your teeth once a day
Brushing your teeth does not reach the surfaces in between your teeth. To clean these surfaces, you can use floss, interdental brushes or a waterflosser.
- See your dentist for regular check ups
Your dentist will be able to identify any early signs of gum disease which you may not have noticed. - Stop smoking
- If you have diabetes, make sure your blood sugar is under control