What is periodontal disease (gum disease)?

Periodontal (gum) diseases, including gingivitis and periodontitis, are infections that, left untreated, can lead to tooth loss. Periodontal disease is a chronic infection, caused by bacteria, that affects the gums and bone supporting the teeth. Periodontal disease can affect one or many teeth.

It begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) causes the gums to become inflamed.

Gingivitis

This is the first form of periodontal disease that affects the surface of the gums. It causes them to become red, swollen and bleed easily. There is usually little or no discomfort at this stage. Everyone who allows plaque to build up around the teeth will develop gingivitis. It is reversible with professional treatment and good oral home care.

Periodontitis

With time, plaque can spread and grow below the gum line, along the roots of the teeth. If there is more plaque than your body’s immune system can cope with, the infection continues to spread. A space, known as a ‘pocket’, develops between the gum and the tooth, as the socket bone is gradually eroded away. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very few symptoms. However, if untreated, the teeth can become loose and may have to be removed.

Causes of Periodontal Disease

Periodontal health is achieved when your body is in harmony. Periodontal disease occurs when something upsets this balance, with the following factors affecting the health of your gums:

• Dental Plaque – The main cause of periodontal disease. It is imperative dental plaque is kept under control.

• Genetics – research proves that up to 30% of the population may be genetically susceptible to gum disease. Despite aggressive oral care habits, these people may be six times more likely to develop periodontal disease.

• Age - As we get older, we become more susceptible to periodontal disease

• Smoking – recent studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease.

• Poorly controlled diabetes – if you are diabetic, you are at higher risk for developing infections, including periodontal diseases.

•  Stress – you are less likely to look after yourself and keep your mouth as clean as necessary, when you are experiencing additional stress in your personal or professional life. Your immune system may not function very well, during these stressful periods, making chronic infections such as periodontal disease more likely.

• Nutrition – having a healthy balanced diet is important to maintaining healthy gums

• Immune Response – if your body's immune response is in any way hindered due to systemic disease, this may increase your susceptibility to periodontal disease.

Treatment

Personal Cleaning

Proper plaque control is paramount to maintinaing healthy gums. What you do in the bathroom is way more important than what your dentist/hygienist does during your dental appointments.

It is essential that you keep your mouth as clean as is necessary, to reduce the amount of plaque to a level that your body can cope with. Therefore, you will be taught how to clean your teeth really well and shown various toothbrushes and other items that you will be expected to use. You will need to continue this better standard of cleaning for as long as you want to control the disease.

Professional Cleaning

The Dentist and Dental Hygienist will thoroughly clean your teeth, above and below the gumline, to give your gum tissues a chance to heal in a clean environment. You may be offered local anaesthetic, so that you can be comfortable during the treatment. The cleaning and teaching stage will require several appointments.

Occasionally, it is necessary to provide other treatments, such as antibiotics during this cleaning stage.

This thorough, professional cleaning will need to be repeated on a regular basis, depending on how well your gums recover from the treatment and how clean you can keep your mouth.

Surgery

For some patients, the gum tissues do not heal completely after the cleaning stage of treatment. Periodontal surgery may then be necessary. This can be done in several ways, depending on the problem that remains. 

What are the risks/side effects/complications?

• The gums occasionally feel sore after cleaning but should feel better after a few days.

• Your teeth may become more sensitive to hot, cold or sweet substances. Usually this decreases within a few weeks, but sometimes you may need to use a special toothpaste or have other treatment.

• As the gums become healthier they may shrink or recede. Sometimes spaces may appear between the teeth and the teeth may appear longer.

What are the available alternatives and their risks/benefits?

No treatment

The result of not having treatment will depend on how severe your disease is.

• With no treatment the gum disease is very likely to get worse.

• Your teeth could become painful.

• You may lose your teeth sooner.

Extractions

For some patients, the periodontal disease has advanced too far to be treated. In these cases, when your teeth become too troublesome for you, usually because they are unattractive, loose or painful, you may choose to have some or all of your teeth removed.

There are three main ways of replacing missing teeth. Most patients have teeth replaced with removable dentures. Some can have a fixed bridge that is attached to the adjacent natural teeth if they are suitable. Occasionally, it is also possible to use dental implants to support replacement teeth.

https://www.periodontal-health.com/

https://bostondental.com/blog/what-is-periodontitis-signs-symptoms-and-treatments/

https://www.bsperio.org.uk/patients

https://mft.nhs.uk/app/uploads/sites/3/2018/09/UDH-128.pdf