Gum disease (Periodontitis)

Gum disease (Periodontitis)

What is gum disease (periodontitis)?

Periodontitis, pronounced “per-e-o-don-TIE-tis”, is a severe form of gum disease and involves periodontal infection that causes damage to the soft tissue of the gums, which may lead to the destruction of the supporting bone of your teeth. This infection can result in the loosening of the teeth and may ultimately lead to tooth loss.  

Periodontitis is a common but preventable condition as it is generally caused by neglecting your oral hygiene. Your risk factors for developing periodontitis will be significantly decreased through brushing your teeth twice a day, flossing once a day and attending regular, bi-annual check-ups and professional teeth cleanings with your dentist and oral hygienist.

There are different types of gum disease, gingivitis and periodontitis being the most commonly seen infections.Gingivitis is the inflammation of the gums that if left untreated, can progress, leading to periodontitis. The following article will focus on periodontitis, however, for your own understanding, the section that follows further explains the difference between gingivitis and periodontitis.  

Gum disease illustrated

What is the difference between periodontitis and gingivitis?

As previously mentioned, gingivitis can develop into periodontitis, meaning that it develops before periodontitis occurs. Periodontitis refers to an infection that leads to the destruction of bone and/tissue, whereas gingivitis refers to the inflammation of the gums specifically.

In the case of gingivitis, plaque and bacteria accumulate on the teeth’s surface, this leads to the gums becoming inflamed and red, the gums may also bleed easily when exposed to brushing. The teeth are not affected by the infection, besides the evident plaque build-up that is found on them.

Plaque is a sticky film or coating that develops on the teeth and contains bacteria. When plaque is not cleaned off when still in its soft form through daily brushing and flossing, then it forms tartar. This is a hard substance that is yellow-like in colour, can only be removed through professional cleaning conducted by your dentist or oral hygienist. Tartar can threaten the health of your gums and teeth and can lead to tooth decay and cavities.

Dentist removing plaque

Cavities are permanent holes in the teeth, which enlarge as bacteria and food exacerbate the formation of these holes if proper oral hygiene is not maintained.

When your mouth is healthy it will consist of teeth and bones that are surrounded by and connected with gum tissue that fits snugly around the teeth. There is no room for movement.

If gingivitis is left untreated, it can develop into periodontitis.

The point where your teeth meet your gum line is known as the gingival sulcus. In the case of periodontitis, your gums will recede from the teeth (i.e. pull away from the teeth) and form large pockets between the teeth and the gum line. The reason for the gums pulling away from the teeth is due to the infection spreading to the tissue beneath your teeth. Debris and bacteria then collect in these pockets and become infected. As these pockets (i.e. gingival sulcus) enlarge and become infected they develop into gaps known as periodontal pockets.

Once bacteria begin to reach the roots of your teeth and jawbone, they will slowly release toxins that wear away the bone and dental tissues, as these tissues no longer have the protection of healthy gums. The effects of this may include bone craters, tooth loss and/or the severe deterioration of the supporting bone.

The main difference between gingivitis and periodontitis is that the effects of gingivitis are reversible, whereas those of periodontitis are not, as the progression of the infection involves damage to the supporting structures of your teeth.

What are the stages of periodontitis?

Periodontitis begins as inflammation (gingivitis) and progresses over time. The following explains the stages of the infection:

Inflammation – This is known as gingivitis

As previously mentioned, periodontitis initially begins as gingivitis which is the inflammation of the gums. One of the initial symptoms of gingivitis is bleeding gums, especially when brushing or flossing your teeth.

You may also notice your teeth have some discolouration, this is due to the build-up of plaque. Plaque consists of food debris and bacteria that have accumulated on your teeth.

Bear in mind, every one of us has bacteria present in our mouths at any given time, however, the bacteria become harmful when certain conditions allow for rapid growth resulting in a bacterial infection. This is often the case in those with poor oral hygiene or a suppressed immune system. Gingivitis is a reversible condition and this can be achieved by brushing your teeth thoroughly twice a day, flossing once a day and attending regular check-ups with your dentist and having your teeth professionally cleaned.

Early periodontitis

During the initial stages of infection, your gums will begin to recede from the teeth they surround and form the larger pockets between the teeth and gums. These pockets collect debris and bacteria, the more bacteria present, the worse the infection is. The body’s immune system will attempt to defend itself against the infection and as a result, your gums will recede further. You will suffer from further bleeding of your gums when brushing and flossing.

Moderate periodontitis

If periodontitis is left untreated and progresses past the initial phase to moderate periodontitis or periodontal disease, you may start to experience some pain and bleeding around your gums and teeth. Your teeth may also start to lose their bone support and loosen gradually. This stage of the infection is also able to cause inflammation (an inflammatory response) throughout your body.

Advanced periodontitis

During the advanced stage of the infection, connective tissue holding the teeth in place will start to deteriorate and break down. The bones, gums and surrounding oral tissue will be destroyed as a result.

If you suffer from advanced periodontitis, then you may have symptoms of pain when chewing, halitosis (bad breath), as well as an unpleasant taste in your mouth. You are likely to suffer from tooth loss at this stage and will require immediate professional attention and treatment so as to prevent further loss.

 Stages of gum disease

What are the symptoms of periodontitis?

As noted above, periodontitis will always start with the inflammation of your gums (gingivitis). The initial inflammation is not always obvious, but you may start to notice your gums are redder in colour than usual and bleed easily when brushing or flossing. You may also notice that your teeth have a layer of bacterial plaque that is discoloured.

When gingivitis progresses to periodontitis, this progression may occur without any evident symptoms to warn you.

However, there may be some more evident changes present which include bleeding from your gums or spontaneous changes in the positions of your teeth, they may appear more lengthened as the gums recede due to the infection, and you may also suffer from pain in your gums and bad breath.

Smokers may not notice any bleeding in their gums as the nicotine found in cigarettes reduces blood flow to the mouth and can, therefore, mask the infection and prevent early symptoms of bleeding.

It is often the case that periodontitis is not recognised by the affected individual until they reach between 40 and 50 years of age, by this time a large amount of damage may have already occurred. It is therefore advised that you ensure that you attend regular check-ups with your dentist as he or she will be able to detect traces of an infection before it progresses to an irreversible state. The symptoms are explained in the section below.

When your gums are healthy, they will be pale pink in colour and firm as they fit tightly around your teeth. Some symptoms and signs of periodontitis may include the following:

  • Swelling and puffiness of the gums
  • Gums changing colour to dusky or bright red or purple-like in colour
  • Gums feeling tender when brushing or touching them
  • Gums bleeding easily
  • Gums beginning to recede from your teeth (teeth appear longer)
  • New pockets/spaces developing between the teeth
  • Pus forming between the teeth and gums
  • Having bad breath (halitosis)
  • Loosening of teeth
  • Feeling pain when chewing
  • Your teeth changing the way they fit together when biting down

When to see a dentist

It is advised that you follow your dentist’s suggestions on when you should attend regular check-ups. Should you detect any of the above-mentioned symptoms, then schedule an appointment as soon as you can. The sooner diagnosis is confirmed and treatment begins, the more likely you are to reverse the damage (if you have gingivitis) or treat it if it has advanced to periodontitis, preventing it from further progression. 

What are the different types of periodontitis?

We have previously explained what periodontitis is, but to further explain the process of the development of infection, it may help to read the following:

Periodontitis begins when the toxins from plaque start to attack and damage the soft gum tissues that surround your teeth. The bacteria implants itself in the gingival tissue (gums) and then breeds at a rapid pace, causing a bacterial infection.

If the infection progresses, the bacteria burrows even deeper into the gum tissue and results in irritation and inflammation of the gums and teeth. Due to the body’s immune response which attempts to destroy bacterial invader, the infected tissues are targeted, which is why your gums recede. This results in the pockets becoming larger and eventually, the jawbone can also recede, leading to your teeth becoming unstable and loosening.

Types of periodontitis

Earlier in the article, we mentioned the stages of periodontitis. However, there are a number of different ways in which periodontal infections can manifest. All of these infections will require immediate treatment and action by you and a dentist, or a periodontist (specialist in periodontal diseases and infections) in order for the progression of the infection to be halted and bone and gum tissue to be saved.

The following are some of the most prevalent forms of periodontitis (periodontal disease), as well as a brief overview of the treatments needed for each one:

Gingivitis

By now you should already have a clear understanding that gingivitis is the predecessor of periodontitis and is a result of the toxins found in plaque and the bacteria that if left unchecked can also lead to periodontitis.

Those with an increased risk of gingivitis developing are those who:

  • Take birth control tablets
  • Are pregnant
  • Have uncontrolled diabetes
  • Take medication to control blood pressure and seizures
  • Are taking steroids

The above list involves those who may experience hormonal fluctuations or imbalances due to certain medications or conditions, which can disrupt the natural level of bacteria in their mouths.

The treatment for gingivitis typically involves a combination of professional cleaning and person oral hygiene and care. Gingivitis is a mild form of gum disease and is easily preventable. Your dentist or an oral hygienist may also perform deep scaling and root planing to cleanse the pockets that are full of bacteria and debris. A mouthwash and antibiotics can also be used to eliminate any of the remaining bacteria and allow for the pockets to heal.

Chronic periodontitis

This is the most prevalent form of gum disease and occurs commonly amongst those over the age of 45. Chronic periodontitis is marked by the gum line being inflamed which leads to the progressive destruction of both the bone and gum tissue. It often seems as though the teeth are growing in length, however, this elongation is actually due to the recession of the gums.

The treatment for chronic periodontitis typically involves antibiotics coupled with root planing and scaling. Unfortunately, the damage done to supportive tissues cannot be reversed, however, the progression of the infection can be halted and further damage prevented.

It may sometimes be necessary for a dentist or periodontist to perform a surgical treatment such as a pocket reduction. Tissue and bone grafts are also used to improve the appearance of your oral cavity and strengthen the supporting bone where necessary.

Aggressive periodontitis

When periodontal disease is aggressive, it is characterised by a rapid loss of bone and gum tissue and attachment. The infection is similar to that of chronic periodontitis, however, the progression takes place more rapidly. Those who have a genetic predisposition (family history) of the disease or are smokers have a higher risk of developing this type of infection.

The treatment for aggressive periodontitis is similar to that of chronic periodontitis, however, those with this condition are more likely to need surgery of some kind. This infection is also harder to eliminate and treat.

Dentists will opt for scaling procedures, antibiotic administration and surgery as a combination treatment approach. A laser procedure may also be performed to try and save the valuable bone and tissue. A dental laser will be used to remove the bacteria and inflamed gum tissue surrounding the roots of the teeth.

Periodontitis and systemic conditions

In some cases, periodontitis may be the result of a certain condition or disease that is affecting your body. The characteristics and behaviour of periodontitis will be dependent on the underlying disease or condition.

Diabetes, heart disease and respiratory disease are common co-factors for gum disease.  Bear in mind, however, that there are a number of other conditions that may also play a role in its development.

**My Med Memo – The term ‘systemic’ refers to the body’s entire system. A systemic disease is, therefore, one that has an impact on several of your organs and tissues or affects your body as a whole. Therefore, the above-mentioned conditions affect a number of organs and tissues (not just one) and thus the entire body, meaning their influence on your oral health may be severe and play a role in the development and/or progression of gum disease.

Certain medical conditions can accelerate and intensify the progression of gum disease even where there is very little plaque coating the teeth.

The relationship between systemic and periodontal disease is one that could be a pivotal factor when conducting further research into the cause of periodontal infections.

The treatment for situations such as these will begin with treating and controlling the systemic condition responsible for gum disease first and then addressing the resulting secondary conditions.

Your dentist will attempt to stop or slow down the progression of the gum disease through the use of treatments similar to those used to control chronic and aggressive periodontal disease.

Necrotising periodontitis

This is a form of gum disease that rapidly progresses and is commonly seen amongst those who suffer from immunosuppression (i.e. suppression of the immune system caused by diseases such as HIV/AIDS), malnutrition, chronic stress, smoke cigarettes and other tobacco products. Necrotising periodontitis is a very rare condition.

Necrosis refers to the death of tissues, this is often seen to affect the gingival (gum) tissues, the periodontal ligament, as well as the alveolar bone (bone holding the teeth in place).

The treatment process for necrotising periodontitis (gum disease that causes tissue death), will typically involve a dentist consulting with a doctor before treatment is commenced. Root planing, scaling, mouthwash (medicated), antibiotics, as well as fungicidal medications will generally be administered as the treatment for this condition.

What causes periodontitis?

The majority of cases of periodontitis begin with plaque (the sticky coating on your teeth that is mostly composed of bacteria). When plaque is not cleaned off the teeth through daily brushing and flossing, plaque build-up can advance, causing infection and ultimately periodontitis. The following explains this progression:

  1. Plaque will form on your teeth when the sugar and starch found in the food that you eat interacts with the bacteria that naturally reside in your mouth. Flossing daily (once a day is adequate) and brushing your teeth twice a day will aid in removing plaque. It is necessary to brush and floss your teeth daily as plaque re-forms at a rapid rate.
  2. Plaque may harden under the gum-line and form into tartar if it is not removed. Tartar, also known as calculus, has a higher quantity of bacteria and cannot be removed through brushing and flossing alone. An oral hygienist or dentist will have to professionally remove the tartar. The longer plaque and tartar remain, the more likely they are to do harm and damage to your gums and teeth.
  3. Plaque can lead to the mildest form of periodontitis, being gingivitis. This is the inflammation and irritation of the gums (gingiva). This condition can be reversed through sound oral hygiene practice and regular professional cleaning.
  4. When gum inflammation is not treated, it can result in periodontitis. Gum inflammation can cause pockets to develop and deepen between the teeth and gums when they fill with bacteria, plaque and tartar as the infection progresses. If this inflammation is left untreated and infection occurs, then these deep pocket formations can result in the loss of bone and tissue, and eventually the loss of teeth. This ongoing inflammation may also put strain on the immune system as it tries to defend itself and fight off the infection.

What are the risk and prevention factors for periodontitis?

The bacteria found in plaque are the most prominent cause of periodontitis. However, there are a number of other factors that may also have a role to play in the development of gum disease. These include medications, oral hygiene habits and some diseases. The factors that can increase the risk of gum disease developing can also worsen the infection should gum disease already be present.

These contributing/risk factors include:

  • Genetics – Some may be more susceptible to gum disease than others due to their genes. However, genes do not make gum disease an inevitable condition as those who have a higher chance of gum disease developing are able to control and even prevent periodontal disease through sound oral hygiene and care.
  • Smoking cigarettes and the use of tobacco products – Smoking will increase your risk of developing gum disease. It will also adversely impact the infection should you smoke when you have periodontitis, as smoking may increase your resistance to treatment. If you smoke, you may find that you have more tartar build-up on your teeth and develop deeper pockets between your teeth and gums due to gum disease. The nicotine found in cigarettes can result in less blood flow to your gums, thus masking the condition until it has reached a point of considerable severity. Stopping smoking can greatly increase your chances of undergoing successful treatment and recovery.
  • Crowded or misaligned teeth, bridgework or braces – If there is any kind of obstruction that makes it hard to floss and brush your teeth, your chances of infection are increased due to the formation of tartar and plaque in hard to reach areas. Your dentist or periodontist may be able to show you different techniques to apply in which you can slide the floss under your braces or clean around and between the crowded teeth. You may also be referred to an orthodontist. An orthodontist is a kind of dentist who specialises in the straightening of crooked teeth and misaligned jaws. Ultimately, any dental issue you have regarding crooked teeth, braces and bridgework should be corrected as further complications can arise because of these conditions.

Braces with plaque on teeth

  • Gritting, grinding and/or clenching your teeth – Habits such as these do not directly cause periodontitis, they do however, lead to a more severe form of the condition should you already have gum inflammation (gingivitis). The progression of the infection as a result of these actions is due to the excess force that is placed on the teeth, this pressure has been seen to speed up the rate at which the periodontal bone and ligament break down to occur. In the majority of cases, these actions are a result of stress or frustration. Recognising these behaviours and becoming conscious of when you are performing them can aid in stopping them entirely. Some people may battle to stop habits such as teeth grinding as these are actions that they perform in their sleep. If you are unable to stop one of these habits, despite applying breathing techniques and finding other ways through which tension can be relieved, then your dentist may create a custom mouth guard to protect your teeth from grinding and help relieve some of the pressure associated with gritting and clenching teeth. This device is often referred to as a night guard, occlusal guard, bite guard or mouth guard, and is typically worn at night whilst sleeping.
  • Stress – Elevated levels of stress can result in the rapid progression of periodontitis and contribute to the infection’s resistance to treatment. The extra hormones released during stress, cortisol being the main one, result in interference with memory and learning and lower the functioning ability of the immune system, which in turn results in a number of additional complications. When your immune system is compromised, this makes it difficult for your body to fight off an infection and heal adequately, this is seen particularly in the cases of infections related to gum disease.
  • Fluctuating hormones – If your hormone levels fluctuate, due to puberty, pregnancy or menopause, this may temporarily put you at risk of infection. Fluctuations in the female hormones progesterone and oestrogen can cause blood flow in the gums to be increased which may affect the way that the gum tissue reacts to certain irritants such as plaque and bacteria, thus, the gingiva become inflamed and tender, bleeding more easily.
  • Medications – There are several different kinds of medications that can result in dry mouth, also known as xerostomia. Certain drugs that are used for hypertension (high blood pressure) and depression are some examples of these medications. When you do not have an adequate amount of saliva, then the formation of plaque is more likely. Some other medications may result in the enlargement of the gingiva. This creates a more susceptible environment for bacteria and debris to be caught in. Some of the medications that have oral side effects include:
    • Phenytoin (Dilantin) – This is used for the treatment of seizures
    • Cyclosporine (Sandimmune, Neoral) – Used to control and supress the immune system during and after an organ transplant
    • Nifedipine (Cardizem, Adalat) – These are used for the treatment of high blood pressure, angina (chest pain), heart arrhythmias and are known as calcium channel blockers.
  • Diseases – Those who suffer from certain conditions and diseases are more likely to develop gum disease. One such example of this risk group includes those who suffer from systemic conditions such as diabetes. This same group is also more likely to have more severe cases of gum disease with additional complications and faster progression of the infection.
  • Poor nutrition – Having a healthy and balanced diet is a vital factor for overall health, this includes having an efficient immune system, a healthy mouth and gums (healthy gums are a light pink in colour). Certain deficiencies such as those of vitamin C, also known as scurvy, can result in bleeding gums as the immune system is negatively impacted by the deficiency of vitamin C which is vital in the strengthening and supporting thereof.

How is periodontitis diagnosed?

In order for your dentist to determine whether or not you have periodontal disease and the severity of the infection, your dentist is likely to:

  • Review your current medical status and medical history – This will help your dentist to identify any risk factors such as smoking or medications that may be causing your symptoms.
  • Examine your mouth – This will allow your dentist to check for plaque and tartar and determine if your gums bleed easily.
  • Measure the periodontal pocket depth – This is the measurement of the gap between your teeth and gums. This will be done by placing an instrument known as a dental probe beneath the gum line and next to a tooth, this is typically done at a number of different sites in your mouth. A healthy mouth will have a pocket depth of between one and three millimetres (0.03 to 0.11 inches). If your pocket depth is more than four millimetres (0.15 inches), this may indicate an infection associated with gum disease. If the pockets are deeper than six millimetres (0.23 inches), these are difficult to clean during a professional dental cleaning.
  • Take dental X-rays – Dental X-rays will help detect any bone loss in the infected areas that your dentist identified as having deep periodontal pockets.

 Dentist checking teeth and gums for infection

How is periodontitis treated?

The initial aim of your dentist, periodontist or dental hygienist in treating gum disease is to rid your mouth and periodontal pockets of any bacteria that have accumulated in order to prevent any further damage to tissue and bone.

To ensure that you achieve the best possible results, you will also need to maintain sound dental hygiene. This will involve brushing your teeth when you wake up and before going to bed as well as flossing once a day. In some cases, if your teeth have enough space in-between them, your dentist may suggest you use a Proxi-brush, also known as an interdental toothbrush. These are brushes that are designed to reach between the gaps in your teeth and the name is derived from inter-proximal which means “between your teeth”.

Soft-picks can also be used if the space between your teeth is smaller. Those who have arthritis, or others who suffer from issues with dexterity (issues in performing skills with their hands), may benefit from the use of an electric toothbrush as this will perform most of the movement needed to clean the teeth thoroughly.

It is vital that you understand what gum disease is and that it is a long-term (chronic) inflammatory infection, meaning that thorough oral hygiene will need to be maintained for your entire life. This will involve regular check-ups with your dentist.

The following information explains the different means of treatment for periodontitis:

Initial treatment

Nonsurgical treatments

If your gum disease has not yet advanced, then your treatment plan may involve some less invasive options, these include:

  • Root planing – This procedure will involve smoothing out the root surfaces and cleaning them meticulously in order to prevent the accumulation of bacteria and tartar. The debris and bacteria will be removed from the root surface inside the periodontal pockets. This will also prevent further attachment of bacteria as the surfaces are smoother.
  • Scaling – This procedure involves removing any bacteria and tartar from the surfaces of your teeth and beneath the gum line. Scaling can be performed through the use of dental instruments, an ultrasonic device or a laser.
  • Antibiotics – Oral or topical (applied directly to the site of infection) antibiotics are administered to control the infection. Some topical antibiotics may include gels or mouth rinses. The gel will be applied to the pockets after they have been cleaned. Oral antibiotics are also sometimes necessary in order to completely rid the site of bacteria.

**My Med Memo – The difference between scaling and root planing is as follows:

  • Both procedures will remove the calculus (tartar) and bacteria that are involved in causing the infection.
  • Root planing focuses specifically on the root surfaces and will remove the soft and hard deposits from these surfaces through the use of a curette (a small dental hand tool in the shape of a small hook or scoop).
  • The goal of root planing is to achieve smoother and glassy root surfaces in order to decrease the inflammation associated with the infection.
  • Scaling, also known as debridement involves more than simply smoothing the root surfaces and will also include examining and treating the pocket wall, pocket space, the surfaces of the teeth and the underlying tissues.
  • The focus of scaling is to control the infection caused by bacteria as opposed to only removing the bacterial deposits from the root surfaces.
  • Scaling is normally conducted through the use of an ultrasonic scaling device to remove tartar from the surface of the teeth and beneath the gum line. Following this, a handheld instrument may also be used manually to remove any remaining debris.

Medications

  • Prescription antimicrobial mouth wash – An example of this kind of mouth wash or rinse is chlorhexidine. This will aid in controlling bacteria and treating the infection, it can also be used after surgery to further promote healing. Prescription mouthwashes are used the same way as a regular mouthwash is.
  • Antiseptic chip – In some cases, your dentist may place a small chip that contains chlorhexidine in the form of a gel-like tablet. This will help to control the infection and reduce the size of the periodontal pocket. This chip will be inserted after you have undergone root planing and the medication will be released slowly over time.
  • Antibiotic microspheres – These medications are in the form of tiny particles that contain an antibiotic known as minocycline. These are used to reduce the size of the infected pockets and control bacteria. These will be placed in the periodontal pockets and are a slow-release form of medication.
  • Antibiotic gel – This is a very similar treatment method to antibiotic microspheres. This is a gel that contains an antibiotic known as doxycycline. This kind of medication will aid in halting the growth of the bacteria and in shrinking the size of the periodontal pocket. This gel will be placed into the periodontal pocket by your dentist or specialist after root planing or scaling.
  • Enzyme suppressant – This form of medication aids in controlling destructive enzymes through the use of doxycycline. Enzymes are known to accelerate chemical reactions and are substances produced by our bodies as a natural response of our immune system to infection, which can cause gum recession in the case of periodontitis. Some enzymes are responsible for breaking down the gingival tissue, an enzyme suppressant will control and halt the body’s response in creating enzymes to fight off the infection. These medications are administered orally and are used in conjunction with root planing and scaling.
  • Oral antibiotics – These will be taken orally in the form of a tablet or capsule. Oral antibiotics will be used for a short period of time to treat persistent or acute periodontitis.

Surgical treatments

Should you suffer from advanced periodontitis, then your dentist may suggest that you undergo dental surgery. Some of these include:

  • Pocket reduction (flap surgery) – This form of surgery will involve your periodontist making small incisions in the gingiva (gum tissue) in order for a section to be moved or lifted back so as to expose your roots to allow for more effective root planing and scaling. Due to gum disease often resulting in bone loss, your periodontist may re-contour underlying bone, so that the gum tissue can be sutured back into its original place. Once you have healed from this surgery, it will be easier for you to clean the infected areas and maintain a healthy mouth and gum tissue.
  • Soft tissue grafting – When gum tissue is lost due to bacterial infection, the gum line will recede. In these cases, your dentist may suggest that you have parts of the damaged tissue reinforced. In order for the soft tissue to be reinforced, your periodontist will remove a small part of tissue from your palate, or from another source and attach this to the infected site. This will aid in reducing future gum recession, give your teeth a more aesthetic appearance and also cover the exposed roots.
  • Bone grafting – In some cases, gum disease may have destroyed the bone that surrounds the root of your teeth, when this has occurred, your periodontist may perform a bone graft. This will aid in preventing the loss of the infected teeth and hold the teeth in place and will also serve as a means for regrowth of the natural bone. The bone graft may consist of small pieces of your own healthy bone, this is known as an autograft, or it may consist of donated bone that has been frozen, known as allograft or it can be man-made, known as a synthetic The procedure involves transplanting new bone tissue to the infected or damaged site in order to repair the existing bone.

    For the procedure to be conducted, you will be under local anaesthetic and will feel no pain. The bone graft will be shaped and placed into, as well as around the affected area and will be held in place with plates, pins, or screws. The recovery time will depend on your body’s unique healing ability and it may take up to three months or more to fully heal.
  • GBR (guided bone regeneration) or GTR (guided tissue regeneration) – This procedure will allow for the regrowth of bone that has been damaged and destroyed by a bacterial infection. The surgery will involve the use of a barrier membrane in order for new bone and gingival tissue growth to be directed to the affected sites that have insufficient dimensions or volumes of bone or gum tissue in order for their form and function to be restored. Simply put, your dentist or specialist will place a small piece of fabric that is biocompatible (not harmful to living tissue) between your tooth and the existing bone. This material will prevent any unwanted tissue from interfering with the area that is healing, thus, allowing for the bone to regenerate and grow back.
  • Other regenerative materials – Proteins to stimulate gingival tissue can be applied through the use of a specialised gel to the infected tooth’s root. The gel contains similar proteins that are found in developing tooth enamel and will aid in stimulating the growth and regeneration of healthy tissue and bone.

How is periodontitis treated at home?

The following measures can be put into place in order for periodontitis to be prevented:

  • Brushing your teeth twice a day, when you wake up in the morning and before you go to bed at night.
  • Using a soft toothbrush as this will prevent gum recession, hard-bristled toothbrushes can be hard on the gums. You should replace your toothbrush every three months or so.
  • Using an electric toothbrush (particularly if you battle with hand co-ordination caused by certain chronic conditions like arthritis or diabetes) can sometimes be more effective in the removal of plaque and debris.
  • Flossing once a day.
  • Using a mouth wash that will aid in reducing plaque build-up between the teeth.
  • Making use of a dental pick, dental stick or interdental brush that is specifically designed to reach between the smaller spaces of your teeth. Bear in mind, some people do not have big enough gaps for these sorts of devices.
  • Attending regular check-ups and cleanings with your dentist or oral hygienist. Depending on your own personal oral health, these cleanings should take place at least twice a year.
  • Not smoking or chewing tobacco as this can decrease blood flow to the gums, increase the plaque build-up in your mouth, prevent healing from infection and mask the symptoms of infection until it has reached a point of severity.

Prevention

Periodontitis can be prevented by following a routine of sound oral hygiene that is practised from a young age and continued consistently throughout your life. This routine, which was basically outlined above, should consist of the below:

  • Having good dental hygiene – This involves brushing your teeth at least twice a day for as long as two minutes. It is advised that you also floss before brushing to allow for food debris and bacteria to be loosened. Our article on gingivitis explains how to brush your teeth and floss correctly step-by-step.
  • Seeing your dentist regularly – Seeing your dentist or oral hygienist every six months to a year will aid in detecting any issues and infections before they develop into gum disease. If your risk factors for infection are higher, then speak to your dentist about making these visits more regular.

FAQ regarding gum disease

Is it possible to cure periodontal disease?

Periodontitis does not have a cure, but it is able to be controlled and treated through the correct treatment and sound personal oral hygiene. Gingivitis, the milder form of gum disease which refers to the inflammation of the gums, is able to be reversed and cured as inflammation will subside once the plaque and bacteria have been professionally removed. Periodontitis is a chronic and non-curable bacterial infection which results in permanent bone and tissue loss and may require surgery.

Is periodontal disease reversible?

The bacteria that cause gum disease produce toxins that may damage the bone, gums and surrounding teeth. When gingivitis is present, which results in red, swollen gums that bleed easily, this condition can be reversed. The more severe form of gum disease, periodontitis, as previously stated, cannot be reversed and requires immediate treatment so as to halt the progression of the damage.

What causes periodontal bone loss?

The bacteria present in gum disease will spread beneath the gum line and result in inflammation (gingivitis – this does not result in bone loss) when this is left untreated and progresses, the infection can spread deeper within in the gingiva tissue and affect the supporting bone surrounding the teeth. This can result in tooth loosening and bone loss.

Is gum disease contagious?

The infection itself is not contagious, however, the bacteria that causes gum disease is able to be transmitted via saliva.

Is gum disease hereditary?

There have been some studies conducted that have produced evidence suggesting that one’s risk factors for developing periodontal disease can be influenced by genetic makeup. If you have someone in your family with gum disease, then your chances of developing it can be elevated, but this does not guarantee that you will get the infection, especially if you practice good oral hygiene consistently.

Can gum disease cause jaw pain?

Severe gum disease is able to result in jaw pain due to the loss of bone from infection. If you grind your teeth or clench your jaw on a regular basis, this can also contribute to your jaw pain.

What kind of chewing gum cleans your teeth?

There have been some studies conducted that suggest that chewing gum, as long as it is sugar-free, after snacks and meals can aid in rinsing off food debris and neutralising the acids that are released by the bacteria found in plaque.  This is beneficial as these acids are harmful to the enamel of your teeth.

Chewing the gum can stimulate ten times more than the normal rate of saliva production which can also help to rid the mouth of bacteria, as saliva is a naturally occurring component that contributes to oral health and can help to wash away any harmful bacteria. However, chewing gum should not be used as a replacement for flossing and brushing.

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