Chronic Periodontitis (Gum Disease)

A healthy tooth. Plaque builds up … … gum and bone may begin to recede. Sometimes the gum recedes with the bone and sometimes it doesn’t. Either way the tooth may become mobile.

About gum disease

There are two main types of gum disease: gingivitis and periodontitis.

Gingivitis

In gingivitis, your gums become irritated by plaque – a mixture of food, bacteria and bacterial waste products that builds up on your teeth after eating. If plaque isn’t cleaned off your teeth regularly, your gums will become red, swollen and shiny, and they may bleed.

Gingivitis is completely reversible. If the plaque is removed, the gums will recover. If the plaque is not cleaned off the teeth, the gingivitis will remain, and may progress to periodontitis.

Periodontitis

If gingivitis is not treated, the gums begin to pull away from your teeth, leaving a little pocket around the tooth. This pocket traps plaque that you can’t reach with a toothbrush. Over time, plaque hardens to tartar (calculus). Plaque and tartar build up, causing further irritation.

The irritation gradually spreads to the bone structures around your teeth. As time goes on, the pockets get deeper and more difficult to clean, and the gum and bone may shrink. This is called periodontitis. The shrinking gums may expose some of the roots of your teeth, making them wobbly and sensitive. If left untreated over a number of years, your teeth may fall out, or need to be taken out by a dentist.

It’s rarely possible to make the bone structures grow back, so periodontal pockets are not reversible. However, if you get the appropriate treatment and make sure you floss and brush your teeth well, the progress of the disease can be halted.

Symptoms of gum disease

You may not know that you have gum disease. Often it’s not painful and some people with gum disease have no symptoms. This is one of the reasons why it’s important that you attend regular check-ups with your dentist, as your dentist will be able to see the early signs of gum disease.

Usually the first sign of gingivitis is bleeding from the gums when you brush your teeth. Your gums may also be red and swollen.

If gingivitis has progressed to periodontitis, your teeth may be wobbly and you may get gum abscesses (pus collecting under the gum).

If you have any of these symptoms, your gum disease may already be quite advanced. You should see your dentist straight away.

Causes of gum disease

Gum disease happens when plaque builds up around teeth that are not cleaned properly. This is more likely to happen if you find it difficult to clean your teeth well, for example if you wear braces or dentures, or have irregularities in your teeth that you can’t reach with a toothbrush.

There are other factors that can make you more likely to get gum disease. These include:

smoking
diabetes
hormonal changes, for example during pregnancy or puberty

In all of these cases though, the main cause of the gum disease is the build up of plaque.

Treatment of gum disease

Your dentist will ask about your symptoms (if you have any) and examine your gums. He or she may also ask you about your medical history. The type of treatment you will receive depends on how severe your gum disease has become. Your dentist may provide any treatment you need, or he or she may refer you for treatment with a dental hygienist – a health professional specialising in the prevention and treatment of dental conditions such as periodontal disease.

Scaling

If you have gingivitis, your dentist or hygienist will clean your teeth thoroughly with gritty toothpaste using an electric toothbrush and special instruments called scalers. This type of thorough cleaning is called scaling. He or she may also recommend an antiseptic mouthwash that helps prevent plaque forming. He or she will also teach you how to brush and floss your teeth properly. If gum disease has progressed to periodontitis, you may need more extensive scaling to remove plaque and tartar from the periodontal pockets. This can take several appointments. You may need to have your gums numbed with an injection of local anaesthetic before the scaling. This completely blocks the feeling from your gums, and you remain awake during the treatment. Your dentist or hygienist will monitor the size of the pockets during the following months to make sure the treatment has been successful and the periodontitis is not getting any worse.

Prevention of gum disease

Preventing gum disease involves controlling the amount of plaque and tartar that builds up on your teeth. Regular visits to your dentist or hygienist, brushing and flossing your teeth properly and stopping smoking will help to do this. Your dentist or hygienist can show you the correct way to brush, floss and use inter-dental brushes. Dental floss or inter-dental brushes are used to remove plaque and particles of food from between the teeth and under the gum line. These are areas that a toothbrush can’t reach. Even thorough brushing and flossing can’t remove every trace of plaque. Most people have irregularities in their teeth where plaque can build up out of reach and harden into tartar. This can only be removed by your dentist or hygienist during scaling.