Gum Disease

What is Gum Disease?

Gum disease, also known as periodontal disease or periodontitis, is an inflammatory condition caused by bacterial infection of the gums, ligaments, and bones supporting the teeth. The word periodontal means “around the tooth”. 

The bacteria in dental plaque can cause inflammation of the gums, leading to symptoms such as redness, swelling, and bleeding. Plaque is a sticky film of food debris, bacteria, and saliva. If plaque is not removed, it turns into calculus (tartar). When plaque and calculus are not removed, they destroy the gums and bone. 

Gum disease is a progressive disease that attacks the gums' supporting and surrounding tissue and the underlying jawbone. 

Risk Factors and Causes of Gum Disease?

The primary cause of gum disease is bacterial plaque. However, several factors can contribute to its development, including:

• Poor oral hygiene: Failing to brush and floss regularly can allow plaque to build up on teeth and gums, leading to gum disease.
• Tobacco use: Smoking and other forms of tobacco use are significant risk factors for gum disease.
• Genetics: Some people may be more genetically susceptible to developing gum disease.
• Medications: Certain medications can contribute to dry mouth, increasing the risk of gum disease.
• Diabetes: Individuals with diabetes are at an increased risk of developing gum disease, as high blood sugar levels can increase the risk of bacterial infection.

Symptoms of Gum Disease

Gum disease symptoms can vary from mild to severe. However, the most common symptoms of gum disease include the following:

• Red, swollen, and tender gums
• Bleeding gums during brushing or flossing
• Persistent bad breath or a bad taste in the mouth
• Receding gums or teeth appearing longer than usual
• Loose teeth or changes in the bite
• Pus or drainage from the gums

Types of Periodontal Disease

There are many varieties of periodontal disease and how these variations manifest themselves. All require immediate treatment by a dentist to halt the progression and save the gum tissue and bone.

Chronic Periodontal Disease

This is the most common form of periodontal disease and is characterised by inflammation of the gums and the formation of pockets between the gums and teeth. Chronic periodontitis progresses slowly over time and can lead to tooth loss if left untreated.

Necrotizing Periodontal Disease

This is a rare form of the periodontal disease characterised by the death of gum tissue, bone, and ligaments. Necrotising periodontal disease is usually accompanied by pain, bleeding, and bad breath.

Periodontitis as a Manifestation of Systemic Diseases

Some systemic diseases, such as diabetes, can increase the risk of periodontal disease. This type of periodontal disease is more severe and difficult to manage than other types of periodontal disease.

Stages of Periodontal Disease

Periodontal disease progresses as the sulcus (pocket or space) between the tooth and gums gets filled with bacteria, plaque, and tartar, irritating the surrounding tissues.  When these irritants remain in the pocket space, they can cause damage to the gums and, eventually, the bone that supports the teeth.

Stage 1: Gingivitis

Gingivitis is the earliest stage of gum disease, and it is characterised by inflammation of the gums caused by bacterial plaque buildup. Symptoms include redness, swelling, and bleeding of the gums. Gingivitis is reversible with professional dental cleanings and improved oral hygiene practices, such as regular brushing and flossing.

Stage 2: Early Periodontitis

Early periodontitis is characterised by the formation of pockets between the gums and teeth due to the progression of gingivitis. Bacteria and plaque can accumulate in these pockets, leading to further inflammation and damage to the gums and supporting structures of the teeth. Early periodontitis can be treated with scaling and root planing, which removes plaque and tartar from the teeth and gums.

Stage 3: Moderate Periodontitis

Moderate periodontitis occurs when the damage caused by early periodontitis is not treated, leading to further destruction of the gums and bone supporting the teeth. Symptoms include receding gums, loose teeth, and tooth sensitivity. Treatment may include more extensive scaling and root planing procedures and antibiotics.

Stage 4: Advanced Periodontitis

Advanced periodontitis is the most severe stage of gum disease, characterised by significant damage to the gums and supporting structures of the teeth. Tooth loss is common at this stage, and treatment may require surgical intervention, such as bone and tissue grafts, to regenerate lost bone and tissue.

Diagnosis of Gum Disease

Diagnosing gum disease involves a comprehensive evaluation of the gums and supporting structures of the teeth. Here are the steps involved in the diagnosis of gum disease:

• Medical and Dental History: The first step in diagnosing gum disease is to take a medical and dental history. This includes asking about any medical conditions or medications contributing to gum disease.
• Clinical Examination: The next step is to perform a clinical examination of the gums and teeth. This includes checking for signs of inflammation, such as redness and swelling, and measuring the depth of gum pockets around the teeth.
• X-Rays: X-rays may be taken to assess the extent of bone loss and other damage to the teeth and gums.
• Periodontal Charting: Periodontal charting involves measuring the depth of gum pockets around the teeth and recording any signs of inflammation, bleeding, or recession of the gums.
• Classification and Staging: Based on the clinical examination, x-rays, and periodontal charting, the dentist or periodontist will classify and stage the gum disease. This helps determine the severity of the disease and the most appropriate treatment options.

In some cases, additional tests, such as bacterial or genetic testing, may be needed to diagnose gum diseases. It is important to schedule regular dental checkups and seek prompt treatment if any signs of gum disease are present to prevent further damage to the gums and supporting structures of the teeth.

Treatment of Gum Disease

Your dentist may choose to perform many surgical and nonsurgical treatments, depending upon the exact condition of the teeth, gums and jawbone. 

A complete periodontal exam of the mouth will be done before any treatment is performed or recommended.

Here are some of the more common treatments for periodontal disease:

• Scaling and root planing – To preserve the health of the gum tissue, the bacteria and calculus (tartar) which initially caused the infection must be removed.  The gum pockets will be cleaned and treated with antibiotics as necessary to help alleviate the infection.  A prescription mouthwash may be incorporated into daily cleaning routines,
• Tissue regeneration – When the bone and gum tissues have been destroyed, regrowth can be actively encouraged using grafting procedures.  A membrane may be inserted into the affected areas to assist regeneration.
• Pocket elimination surgery – Pocket elimination surgery (also known as flap surgery) is a surgical treatment that can reduce the pocket size between the teeth and gums.  Surgery on the jawbone is another option that eliminates bone indentations that foster bacteria colonisation.
• Dental implants – When teeth have been lost due to periodontal disease, the aesthetics and functionality of the mouth can be restored by implanting prosthetic teeth into the jawbone.  Tissue regeneration procedures may be required before the placement of a dental implant to strengthen the bone.
• Tissue Grafts - With tooth loss, your dentist can perform tissue grafts to promote natural tissue regeneration and insert dental implants if a tooth or several teeth are missing.  Where gum recession causes a “toothy” looking smile, your dentist can recontour the gingival tissue to create an even and aesthetically pleasing appearance.
• Laser treatment can reduce the size of the pockets between the teeth and the gums.

Conditions Related to Periodontal Disease

Recent research has shown that periodontal disease may be linked to systemic diseases and health conditions. Here are some conditions that are related to gum disease:

Periodontal Disease and Diabetes

It is well-documented that people with diabetes are more susceptible to developing infections than non-diabetes sufferers.  It is not widely known that periodontal disease is often considered the sixth complication of diabetes, particularly when the diabetes is not under proper control.

Diabetes is characterised by too much blood glucose (or sugar).  People with type II diabetes cannot regulate insulin levels, meaning excess glucose stays in the blood.  Type I diabetics do not produce any insulin at all.  Diabetes is a serious condition that can lead to heart disease and stroke.

Experts suggest the relationship between diabetes and periodontal disease can worsen both conditions if either condition is not properly controlled.

Here are ways in which diabetes and periodontal disease are linked:

• Increased blood sugar 
• Blood vessel thickening 
• Smoking 
• Poor oral hygiene

Periodontal Disease, Heart Disease, and Stroke

Periodontal disease has been linked to an increased risk of heart disease and stroke. While the exact relationship between periodontal disease and these systemic conditions is still being studied, researchers believe that inflammation and infection caused by periodontal disease may contribute to the development of cardiovascular disease.

Periodontal Disease and Atherosclerosis

Atherosclerosis is a condition where plaque buildup in the arteries can lead to heart disease and stroke. Researchers believe that the inflammation caused by periodontal disease may contribute to the development of atherosclerosis.

Periodontal Disease and Bacterial Endocarditis

Bacterial endocarditis is an infection of the lining of the heart. Bacteria from the mouth can enter the bloodstream during dental procedures, and people with periodontal disease may be at a higher risk of developing this condition.

Periodontal Disease and Stroke

Recent studies have suggested that periodontal disease may increase the risk of stroke. Researchers believe that the inflammation and infection caused by periodontal disease may contribute to the development of blood clots, which can lead to stroke.

Treating Periodontal Disease Can Improve Cardiovascular Health

Treating periodontal disease may help improve cardiovascular health. Studies have shown that treating Periodontal Disease can improve blood vessel function and reduce inflammation in the body, which may reduce the risk of heart disease and stroke.

Periodontal Disease and Pregnancy

Pregnant women with periodontal disease are at a higher risk of developing complications such as premature birth, low birth weight, and preeclampsia.

Hormonal Changes During Pregnancy Can Affect the Gums

During pregnancy, hormonal changes can make the gums more susceptible to inflammation and infection. This can increase the risk of developing periodontal disease.

Periodontal Disease Can Increase the Risk of Complications

Periodontal disease has been linked to pregnancy complications, including premature birth, low birth weight, and preeclampsia. The inflammation caused by Periodontal Disease may contribute to these complications.

Treating Periodontal Disease During Pregnancy is Safe

Treating periodontal disease during pregnancy is safe and can help reduce the risk of complications. Non-surgical treatments such as scaling and root planing can be performed during pregnancy, and antibiotics may be prescribed if necessary.

Good Oral Hygiene Practices are Essential During Pregnancy

Maintaining oral hygiene during pregnancy is essential to prevent and manage periodontal disease. Regular brushing and flossing and regular dental checkups can help prevent the buildup of plaque and bacteria in the mouth.

Periodontal Disease and Osteoporosis

Periodontal disease and osteoporosis are two conditions that may be linked. Osteoporosis is a condition in which the bones become weak and brittle, and studies have shown that people with osteoporosis may be at an increased risk of developing periodontal disease.

Osteoporosis Can Affect the Bones Supporting the Teeth

Osteoporosis can affect the bones that support the teeth, making them more susceptible to damage and infection. This can increase the risk of developing periodontal disease.

Periodontal Disease Can Accelerate Bone Loss

Periodontal disease can accelerate bone loss in people with osteoporosis, weakening the bones supporting the teeth and making them more susceptible to damage and infection.

Hormone Changes May Contribute to Both Conditions

Hormonal changes may contribute to the development of both periodontal disease and osteoporosis. For example, decreased oestrogen levels in postmenopausal women may increase the risk of developing both conditions.

Maintaining Good Oral Hygiene Practices is Essential

Maintaining good oral hygiene is essential for preventing and managing periodontal disease and osteoporosis. Regular brushing and flossing and regular dental checkups can help prevent the buildup of plaque and bacteria in the mouth.

Treating Periodontal Disease Can Help Improve Bone Health

Treating periodontal disease can help improve bone health in people with osteoporosis. By reducing inflammation and infection in the gums, treatment may help prevent further bone loss.

Periodontal Disease and Respiratory Disease

Periodontal disease has been linked to an increased risk of respiratory disease. The bacteria and inflammation caused by Periodontal Disease can enter the lungs through inhalation, increasing the risk of respiratory infections and diseases.

Bacteria From the Mouth Can Enter the Lungs

Bacteria from the mouth can be inhaled into the lungs, increasing the risk of respiratory infections and diseases. In people with periodontal disease, the levels of harmful bacteria in the mouth increase the risk of bacterial pneumonia and other respiratory diseases.

Periodontal Disease May Increase the Severity of Respiratory Infections

Periodontal Disease may make respiratory infections more severe. The inflammation caused by Periodontal Disease can weaken the immune system and make it more difficult for the body to fight infections.

Treating Periodontal Disease Can Help Improve Respiratory Health

Treating Periodontal Disease may help improve respiratory health. Treating harmful bacteria in the mouth may help prevent respiratory infections and diseases.

Good Oral Hygiene Practices are Essential

Maintaining good oral hygiene practices is essential for preventing and managing periodontal disease and reducing the risk of respiratory disease. Regular brushing and flossing and regular dental checkups can help prevent the buildup of plaque and bacteria in the mouth.

What if Gum Disease is Untreated?

If left untreated, gum disease can severely damage the gums, teeth, and supporting structures. Untreated gum disease can result in tooth loss and even affect your overall health. Recent studies have linked gum disease to an increased risk of several systemic diseases, including heart disease, stroke, and diabetes.