What is Gum (Periodontal) Disease?
An Infection of the Gums and Surrounding Tissues
Gum (periodontal) disease is an infection of the gums and surrounding tissues that hold teeth in place. The two forms of gum disease are gingivitis, a mild form that is reversible with good oral hygiene, and periodontitis, a more severe form that can damage the soft tissues and bone that support teeth. If left untreated, periodontitis can lead to tooth loss.
In its early stages, gum disease is usually painless, and many people are not aware that they have it. In more advanced cases, gum disease can cause sore gums and pain when chewing.
Not a Normal Part of Aging
The good news is that gum disease can be prevented. It does not have to be a part of growing older. With thorough brushing and flossing and regular professional cleanings by your dentist, you can reduce your risk of developing gum disease, sticking to a proper oral hygiene routine and visiting your dentist for regular cleanings can minimize the chances that it will come back.
Plaque Buildup Can Form Tartar
Gum disease is typically caused by poor brushing and flossing habits that allow dental plaque – a sticky film of bacteria – to build up on the teeth. Plaque that is not removed can harden and form tartar that brushing doesn’t clean. Only a professional cleaning by a dentist or dental hygienist can remove tartar.
Gum disease can range from simple gum inflammation to serious disease. The two forms of gum disease are gingivitis and periodontitis.
Gingivitis and Periodontitis
In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.
When Gingivitis is not treated, it can advance to periodontitis. In periodontitis, gums pull away from the teeth and form spaces (called “pockets”) that become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and tissue that support the teeth are destroyed. The teeth may eventually become loose and may have to be removed.
Risk Factors and Prevention
There are a number of risk factors that can increase your chances of developing periodontal disease.
Smoking is one of the most significant risk factors associated with the development of gum disease. Smoking can also lower the chances for successful treatment.
Hormonal changes in women can make gums more sensitive and make it easier for gingivitis to develop.
People with diabetes are at higher risk for developing infections, including gum disease
Diseases like cancer or AIDS and their treatments can also negatively affect the health of gums.
There are hundreds of prescription and over-the-counter medications that can reduce the flow of saliva, which has a protective effect on the mouth. Without enough saliva, the mouth is vulnerable to infections such as gum disease. And some medicines can cause abnormal overgrowth of the gum tissue, this can make it difficult to keep teeth and gums clean.
Some people are more prone to severe gum disease because of their genetic makeup.
Here are some things you can do to prevent gum disease:
- Brush your teeth twice a day (with a fluoride toothpaste)
- Floss regularly to remove plaque from between teeth. Or use a device such as a special pick recommended by a dental professional. Visit the dentist routinely for a check-up and professional cleaning
- Visit the dentist routinely for a check-up and professional cleaning
- Don’t smoke
- Eat a well-balanced diet
Tips for Easier At-Home Care
- If your hands have become stiff because of arthritis of if you have a physical disability, you may find it difficult to use your toothbrush or dental floss. The following tips might make it easier for you to clean your teeth and gums.
- Make the toothbrush easier to hold. The same kind of Velcro strap used to hold food utensils is helpful for some people.
- Another way to make the toothbrush easier to hold is to attach the brush to the hand with a wide elastic or rubber band.
- Make the toothbrush handle bigger. You can cut a small slit in the side of a tennis ball and slide it onto the handle of the toothbrush.
- You can also buy a toothbrush with a large handle, or you can slide a bicycle grip onto the handle.
- Try other toothbrush options. A power toothbrush might make brushing easier.
- A floss holder can make it easier to hold the dental floss
- Also, talk with your dentist about whether an oral irrigation system, special small brushes, or other instruments that clean between teeth are right for you. Be sure to check with your dentist, though, before using any of these methods since they may injure the gums if used improperly.
Symptoms and Diagnosis
Symptoms of gum disease may include:
- Bad breath that won’t go away
- Red or swollen gums
- Tender or bleeding gums
- Painful chewing
- Loose teeth
- Sensitive teeth
- Receding gums or longer appearing teeth
If You Have Symptoms
Any of these symptoms may be a sign of a serious problem that should be checked by a dentist. Sometimes gum disease has no clear symptoms.
At your dental visit, the dentist or hygienist should:
- Ask about your medical history to identify any conditions or risk factors (such as smoking) that may contribute to gum disease
- Examine your gums and note any signs of inflammation
- Use a tiny ruler called a ‘probe’ to check for and measure any pockets. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimeters. This test for pocket depth is usually painless.
The dentist or hygienist may also:
- Take an X-ray to see whether there is any bone loss and to examine the condition of the teeth and supporting tissues
- Refer you to a periodontist. Periodontists are experts in the diagnosis and treatment of gum disease and may provide you with treatment options that are not offered by your dentist.
Controlling the Infection
The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on how far the disease has advanced. Any type of treatment requires the patient to keep up good daily care at home. The doctor may also suggest changing certain behaviors, such as quitting smoking, as a way to improve treatment outcome.
Treatments may include deep cleaning, medications, surgery, and bone and tissue grafts.
Deep Cleaning (Scaling and Planing)
In deep cleaning, the dentist, periodontist, or dental hygienist removes the plaque through a method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease.
In some cases, a laser may be used to remove plaque and tartar. This procedure can result in less bleeding, swelling, and discomfort compared to traditional deep cleaning methods.
Medication may be used with treatment that includes scaling and root planing, but they cannot always take the place of surgery. Depending on how far the disease has progressed, the dentist or periodontist may still suggest surgical treatment. Long-term studies are needed to find out if using medications reduces the need for surgery and whether they are effective over a long period of time.
Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications. A dentist or periodontist may perform flap surgery to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the patient, dentist, and hygienist to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again. After surgery, the gums will shrink to fit more tightly around the tooth. This sometimes results in the teeth appearing longer.
Bone and Tissue Grafts
In addition to flap surgery, your periodontist or dentist may suggest procedures to help regenerate any bone or gum tissue lost to periodontitis.
· Bone grafting, in which natural or synthetic bone is placed in the area of bone loss, can help promote bone growth. A technique that can be used with bone grafting is called guided tissue regeneration. In this procedure, a small piece of mesh-like material is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow.
· Growth factors – proteins that can help your body naturally regrow bone – may also be used. In cases where gum tissue has been lost, your dentist or periodontist may suggest a soft tissue graft, in which synthetic material or tissue taken from another area of your mouth is used to cover exposed tooth roots.
Since each case is different, it is not possible to predict with certainty which grafts will be successful over the long-term. Treatment results depend on many things, including how far the disease has progressed, how well the patient keeps up with oral care at home, and certain risk factors such as smoking, which may lower the chances of success. Ask your periodontist what the level of success might be in your particular case.
Treatment results depend on many things, including how far the disease has progressed, how well the patient keeps up with home care, and certain risk factors, such as smoking, which may lower the chances of success. Ask your periodontist what the likelihood of success might be in your particular case.
Consider Getting a Second Opinion
When considering any extensive dental or medical treatment options, you should think about getting a second opinion. To find a dentist or periodontist for a second opinion, call your local dental society. They can provide you with names of practitioners in your area. Also, dental schools may sometimes be able to offer a second opinion. Call the dental school in your area to find out whether it offers this service.