What is periodontal (gum) disease?
Gum disease is caused by plaque, which is the film of bacteria (germs) that builds up naturally on the teeth. The average mouth may have 200-300 different sorts of bacteria living together – the mix contains harmless or protective bacteria and harmful ones too.
If the film of plaque is allowed to build up over a few days, it becomes quite organised and the more harmful types of bacteria start to predominate. As a reaction to this, the body builds up defences in the gums and the gums become inflamed.
The part of the gum located most closely to the plaque changes from pink to red in colour, and may swell a little. You may also start noticing some bleeding of the gums after brushing teeth or eating hard food.
This stage of the disease is called gingivitis and if the plaque is removed over a period of time, the reaction settles down and everything returns to normal.
In some people, if the plaque is allowed to stay, this can lead to further problems. Any plaque which is left on the tooth surface for some days may pick up minerals from the saliva and become hard and scaly – what is commonly known as calculus (tartar). This acts as a porous structure in which the bacteria can live.
In some individuals, this may progress to the gum disease called periodontitis.
The gums are usually (but not always) red, inflamed and can bleed, but in addition there is breakage of the attachment between the gums and the teeth, producing a defect called a periodontal pocket.
A vicious circle is established because the plaque bacteria can grow down into the gap that has appeared between the gum and the tooth, in a place where it is harder to remove them.
Periodontitis can progress down the full length of the roots of the teeth causing them to first become loose and then fall out. The bone supporting the teeth dissolves and is lost in parallel with the loss of attachment. Other signs of disease may include receding gums, making the teeth look longer.
First and foremost is the effect of smoking. It is well known that smoking, in any amount, will aggravate the disease process so smokers will experience disease which is significantly worse than if they were not a smoker.
Severe gum disease at an early age tends to run in families and we therefore understand that there is a certain degree of influence of the genetics of the individual which has a role.
The medical condition of the individual, especially if they have poorly controlled diabetes, or if they are on certain medications, is also a factor which can worsen their gum disease.
What is a periodontist?
A periodontist is a specialist dentist who has additional training and qualifications to diagnose and treat gum problems.
The bulk of the work of a periodontist is the management of gum disease, but may also include periodontal plastic surgery (surgery to change the appearance of the gums) and the surgical placement of dental implants.
Can periodontitis be treated?
By and large it is not generally possible to replace the missing gum attachment and bone which was lost through the process of gum disease.
The goal of treatment is to establish the right conditions so that the remaining bone and attachment is preserved. Teeth with a reduced but healthy attachment may continue to function for several years.
Having periodontitis is similar to having diabetes or other chronic medical condition, in that the problem is never fully fixed but is instead managed to reduce its effects on the patient.
How to prevent periodontal disease
Periodontal disease can be prevented by adopting several simple daily habits that help improve oral health and maintain strong teeth and healthy gums.
- Brush your teeth after meals. Brushing helps dislodge food debris and any plaque that may become trapped between the teeth and gums. Remember to brush your tongue well too.
- Floss more regularly. Flossing at least once daily will help remove bits of food and plaque in places that are hard to reach with a toothbrush.
- Use mouthwash. Swishing mouthwash will help reduce plaque further and eliminate any food particles remaining.
- Learn about risk factors. Certain things like age, smoking, diet and a genetic predisposition may all increase your risk for gum disease.
- Book a dental checkup. Periodic visits to your dentist will help catch periodontal disease at the earliest stages and prevent further spread and damage.