What is gum disease?

Gum disease is where the gums become red, swollen and sore, and can bleed. In the worst cases it can cause infection of the tissues supporting the teeth. Gum disease is very common and is likely to affect most adults at some point in their life. There are two main types of gum disease: ‘gingivitis’ and ‘periodontal disease’.

What is gingivitis?

Gingivitis is the most common form of gum disease and leads to the superficial inflammation of the gums. It causes the gums around the teeth become very red and swollen. Often the gums bleed when you brush them.

What is periodontal disease?

If gingivitis is left untreated, it can turn into periodontal disease. This affects the underlying bone which holds the teeth in place. If the periodontal disease is not managed, it can lead to tooth mobility, sensitivity, gum recession and eventual tooth loss. Severe gum disease affects approximately 10% of the population and is a major cause of tooth loss in adults.

How do I know if I have gum disease?

The first sign may be blood on your toothbrush when you clean your teeth. Your gums may also bleed when you are eating, leaving a bad taste in your mouth and your breath may become unpleasant. If you think you may have gum disease, the most important thing to do is visit your dentist for a full examination. The dentist will use a special probe to measure any space present between your tooth and gum, known as a pocket. This will also identify any sites which are bleeding. The increased pocket depths indicate a higher risk of gum disease. The dentist may take some xrays of your teeth to see the amount of bone that has been lost. This assessment is very important, so the correct treatment can be prescribed for you.

What are the causes of gum disease?

• Plaque – Gum disease is primarily caused by bacterial plaque. Plaque is a film of bacteria which forms on the surface of the teeth every day. Many of the bacteria in plaque are harmless, but there are some that have been shown to be the main cause of gum disease. In the most aggressive forms of gum disease, even the smallest amount of plaque is harmful. To prevent and treat gum disease, you need to make sure you remove all the plaque from your teeth every day. You can do this by brushing your teeth, and by cleaning in between the teeth with interdental brushes or floss.
• Smoking – People who smoke are more likely to have gum disease. Smoking may change the type of bacteria in dental plaque, increasing the number of bacteria that are more harmful. It also reduces the blood flow in the gums and supporting tissues of the teeth and makes them more likely to become inflamed. Gum disease in smokers progresses more quickly than in people who do not smoke and is more difficult to treat. Because of the reduced blood flow smokers may not get the warning signs of bleeding gums as much as non-smokers.
• Diabetes – Gum disease and periodontitis have a two-way relationship. Diabetics whose blood sugar is unstable have a higher risk of developing periodontitis, and those patients with unstable periodontitis, are more likely to develop diabetes. If your diabetes is well controlled, however, you are at no greater risk of periodontitis. If you treat one condition, it often has a positive effect on the other. If you are diabetic, it is very important to attend your dental examinations to ensure any signs of periodontal disease can be treated. If you have periodontal disease, a blood test is sometimes indicated to check for signs of diabetes.
• Genetic factors – Your genetics play an important role in your susceptibility to periodontal disease. While it is not possible to alter this, it can be helpful to understand why you can have severe disease after making significant efforts with your oral hygiene and dental attendance. The immune system can vary in its response to harmful bacteria; therefore, the condition can be different from person to person. In patients with aggressive types of disease they can react more unfavourably to even the smallest amount of plaque on their teeth. That is why if you are at particular risk of disease your oral hygiene practice may need to be more thorough to control gum disease. We may ask about your close family’s experience of gum disease to understand your individual risk.

What happens if gum disease is not treated?

Unfortunately, gum disease usually develops painlessly so you do not notice the damage it is doing. However, the bacteria are sometimes more active, and this is what makes your gums sore. This can lead to gum abscesses, and pus may ooze from around the teeth. Over a few years, the bone supporting the teeth can be lost, which can lead to teeth moving and gaps appearing between the teeth. If the disease is left untreated for a long time, treatment to save the teeth may not be possible.

What treatments are needed?

Your dentist or hygienist will usually clean your teeth thoroughly to remove the scale. You’ll also be shown how to remove plaque successfully yourself, cleaning all the surfaces of your teeth thoroughly and effectively. This may take several sessions with the dentist or hygienist. A good oral-care routine at home, with brushing and interdental cleaning, is the most important thing you can do to help prevent gum disease getting worse.

What else may be needed?

Once your teeth are clean, your dentist may decide to carry out further cleaning of the roots of the teeth, to make sure that the last pockets of bacteria are removed. This is known as root surface debridement. You may need the treatment area to be numbed before anything is done. Afterwards, you may feel some discomfort for up to 48 hours. Multiple sessions of this treatment may be required to gain stability.

If your gum disease treatment is not successful, we may recommend you attend to see a specialist in periodontal disease. Here at Church View Dental Care, we have a periodontal specialist called Dr James Chesterman. If you feel you would benefit from seeing Dr Chesterman, please speak to your dentist.

Once I have had periodontal disease, can I get it again?

Periodontal disease is never cured, but it can be controlled as long as you keep up the home care you have been taught. Any further loss of bone will be very slow and it may stop altogether. However, you must make sure you remove plaque every day, and go for regular check-ups by the dentist and hygienist.

I have heard gum disease is linked with other health conditions – is this true?

In recent years gum disease has been linked with general health conditions such as diabetes, strokes, cardiovascular (heart) disease, poor pregnancy outcomes and even dementia. While we need more research to understand how these links work, there is more and more evidence that having a healthy mouth and gums can help improve general health and reduce the costs of medical treatment.