What is gum disease?
Periodontal disease (gum disease) is a chronic bacterial infection of the gums and bone supporting the teeth. It is a major cause of tooth loss in adults.
However, because gum disease is usually painless, you may not even know you have it. Gum disease is caused by plaque bacteria which form a sticky film on the tooth surface. These plaque bacteria release toxins that can damage the gums. As the amount of plaque increases the saliva in your mouth can begin to mineralise the plaque to form tartar (calculus). These hard deposits on the roots of the teeth only serve to promote more plaque formation and further damage to the gums.
Types of Gum disease
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There are two main types of gum disease- gingivitis and periodontitis. Gingivitis is very common and may affect up to 70% of the population. Periodontitis affects around 30% of adults over age of 30. Both these infections can be treated and controlled, but the earlier they are diagnosed and managed, generally the better the prognosis for your teeth.
This is the primary reason that you need to stay regular with your dental visits, so that a dental hygienist can keep your teeth clean and monitor the health of your gums. Most people who lose their teeth lose them to periodontal disease. Take it seriously!
The warning signs of gum disease
If you notice any of the following signs, you probably have gum disease and need treatment:
Gums (gingiva) that bleed easily.
Red, swollen or tender gingiva.
Gums that have pulled away from the teeth.
Pus between the teeth and gingiva when the gingiva are pressed.
Persistent bad breath or bad taste.
Permanent teeth that are loose or separating.
Any change in the way your teeth fit together when you bite.
Any change in the fit of partial dentures.
Risk Factors for Gum Disease
The main cause of periodontal disease is bacterial plaque. Oral bacteria form a sticky, colourless film on your teeth. These bacteria release various toxic by-products which irritate your gum tissues. While plaque bacteria are the main cause of periodontal disease there are other factors, such as those outlined below, that can also affect the health of your gums.
Other Risk Factors
Smoking and Tobacco Use
Pregnancy & Puberty
Grinding or Clenching your Teeth
Medications e.g. antidepressants, oral contraceptives
Other Systemic Diseases . e.g. uncontrolled diabetes, corticosteroid use
Periodontal Gum Treatment
A patient with generalised gingivitis. Note the red, swollen, inflammed gum tissues around the teeth. These gums bleed easily on brushing.
A case of advanced Periodontitis. Very swollen gums, loose teeth, staining and heavy plaque and calculus deposits on all the teeth.
Periodontal (Gum) Treatment
Scaling & Root Planing
Scaling refers to the professional removal of soft plaque and hard calculus (tartar) deposits from the teeth and around the gum line. It is undertaken using hand instruments (scalers or curettes) and/or sonic/ultrasonic instruments which use high frequency vibrations to help remove these deposits from the tooth surface.
Root planing is really an extension of scaling which involves getting down further under the gum line to remove plaque and calculus from the tooth root surface. This is usually undertaken while the gum tissues are numb with dental anesthetic so that the treatment can be performed painlessly. Scaling and root planing aim to provide a clean smooth tooth and root surface in order that the gum tissue/ attachment has a chance to heal around the tooth. Both scaling and root planing are non-surgical treatments. Scaling and root planing may sometimes be combined with antibiotic treatment to assist in the management of the gum infection.
Pocket Elimination & Periodontal Flap Surgery
In certain circumstances, scaling and root planing alone may not be sufficient to deal with the periodontal disease, especially in patients who present with more severe periodontitis. Such patients will normally require further treatment in the form of periodontal surgery. Modern surgical treatments are generally minimally invasive and generally well tolerated by patients. There are a variety of surgical techniques used in the management of severe periodontitis each having their specific indications. Only a qualified periodontist such as Dr. Mehta has the specialist surgical skills to recommend and provide the periodontal surgery required for your specific circumstances.
Performing Proper Oral Hygiene
Being able to clean your teeth properly is not necessarily as easy as it sounds. Being able to removal plaque from certain areas in you mouth can be challenging. Professional advice and the right tools for the job can go a long way to ensuring that the time you do spend cleaning your teeth and gums is time well spent. Here are some preliminary suggestions to get you started.
Tooth brushing-twice daily.
Brushing removes the sticky film of bacteria from the teeth and from around the gum line. A soft-bristled toothbrush that is in good condition is recommended. Electric toothbrushes can also be of tremendous benefit for many patients providing they are used appropriately. The use of toothpastes containing fluoride helps to strengthen the teeth and prevent decay. Certain toothpastes can also help reduce tooth sensitivity.
Cleaning between teeth daily.
Dental floss or interdental brushes can be used to remove bacteria and food particles from between the teeth where a toothbrush can’t reach. The early signs of gum disease (gingivitis) may be reversed by careful daily brushing and flossing. The use of interdental brushes requires instruction by a trained professional to prevent injury to the gum tissues and to ensure effective plaque removal.
Regular Dental Visits
Visiting your dentist or hygienist and having professional cleaning is important in the prevention of both tooth decay and periodontal diseases.
Exposed tooth roots are the result of gum recession. Gum recession may lead to exposure of a darker, yellow root surface and may also result in an uneven gum line. Perhaps you wish to enhance your smile by covering one or more of these roots that make your teeth appear too long. Or maybe you’re not bothered by the appearance of these areas, but your exposed roots are sensitive to hot or cold foods and drinks.
Your gums may have receded for a variety of reasons, including aggressive tooth brushing or periodontal disease. Drs’ Darfoor and Mehta can help you identify the factors contributing to the problem. Once these contributing factors are controlled, a delicate gum grafting procedure can be used to repair the area of recession and help to prevent further gum recession and subsequent bone loss.
Gum grafts can be used to cover roots or develop gum tissue where it is missing due to gum recession. Gum grafting involves a procedure known as a connective tissue graft which is a delicate procedure where a small piece of gum tissue is taken from the palate or another donor site and transplanted to cover the exposed root.
This can be done for one or more teeth to even up your gum line and/or reduce root surface sensitivity. The benefits of gum grafting include: reducing
further recession and bone loss, cover exposed roots to protect them from decay, reduce tooth sensitivity and improve the esthetics of your smile.
Case 1: Treatment of Gum Recession localised to a Canine tooth
Gum Recession Treatment
Case 2: Upper Incisor teeth with recession. A gum graft was used to repair this recession
Guided Tissue Regeneration (GTR)
Periodontal disease (periodontitis) is an infection which can result in damage to the normal gum attachment and bony support around your teeth. Loss of gum attachment and bony support around teeth can result in teeth becoming loose and ultimately being lost.
In certain situations it may be possible to regenerate damaged bone and gum attachment around teeth by undertaking guided tissue regeneration. By regenerating gum attachment and bony support around the roots of teeth, the prognosis for the teeth may be improved.
Guided tissue regeneration is an intricate procedure which involves carefully teasing back a small area of gum next to the tooth, while the gum is numb with dental anesthetic.
This allows for careful cleaning of the tooth root surface to remove any calculus (tartar) and plaque bacteria. Once the root surface of the tooth is clean, the damaged area of bone is bone grafted to assist with the bony healing.
A small barrier membrane (resorbable) is then placed over the bone-grafted area and the gum tissue gently stitched over the top. This procedure creates an ideal healing environment around the tooth to optimize healing of the bony support and the gum attachment to the tooth root.
The results of this state-of-the-art reconstructive surgery are demonstrated in the diagrams and x-rays below.
Guided Tissue Regeneration (GTR)
Guided Bone Regeneration.
Loss of jaw bone following the loss of teeth or traumatic injury may result in a number of different problems. Most commonly, areas of bone loss may result in difficulties in dental implant treatment due to a lack of bone into which to place a dental implant.
Bony defects elsewhere may be unsightly and compromise other dental treatments such as a dental crown and bridgework. Guided bone regeneration (GBR) is a surgical procedure which involves carefully lifting a small area of the gum overlying the bony defect. The area is then bone grafted with either bone taken from elsewhere in the mouth or with synthetic bone graft.
The bone graft particles placed into the bony defect act as scaffolding into which the bone cells can grow. The bone graft is then covered with a very thin barrier membrane prior to repositioning the gum tissue over the top and gently stitching it back into place. This regenerative procedure helps to promote bone growth in areas previously devoid of bone. Developing bone in this way can help to increase the amount of bone for subsequent dental implant treatment.
Gum Lift & Crown Lengthening
Do you have a ‘Gummy Smile’ ?
Do you have a gummy smile? Excessive gum and short teeth can often be corrected by undertaking crown lengthening. The procedure involves gently adjusting the gumline around the teeth. This delicate and precise surgery can result in a much fuller smile and reduce that ‘gummy smile’
Short upper front teeth with excess gum (Image1).Final result following gum lift procedure (Image 2).
Gum Lift & Crown Lengthening
Dr. Simon Darfoor is a cosmetic and implant dentist, is the lead clinician at the Darfoor Dental
Practice at No.1 Harley Street in London.
Periodontal (Gum) Disease