Periodontal Gum Disease Archway

What is periodontal disease?

Periodontal disease is a type of gum disease, it is an inflammatory disease. Inflammation is part of the body’s natural defence mechanism and in the gum tissue, it occurs in response to a build-up of plaque bacteria (now referred to as biofilm) on the teeth. In some patients, this natural inflammatory response is too severe or poorly controlled and the inflammation begins to damage the supporting structures of the teeth, namely gum, ligament and bone.

Who gets periodontal disease?

Approximately 10% of the population are severely affected by the periodontal disease but it is thought that milder forms of the disease affect around 80% of the population by the age of 60. The single biggest risk factor for developing gum disease is poor oral hygiene, so a build-up of plaque bacteria (biofilm). Allowing plaque biofilm to sit around your teeth and gums (particularly in between your teeth) for prolonged periods of time is what provokes the destructive inflammatory response. Other risk factors that will make it more likely you will have periodontal disease include tobacco use, diabetes, genetics/family history of disease, stress and poor diet/nutrition.

What are the signs of periodontal disease?

Healthy gums should be pink, firm and shouldn’t bleed. Periodontal disease will not always cause pain, however, some patients may notice pain with chewing, loose or sensitive teeth, receding gums or longer-looking teeth, bleeding on brushing, red, swollen gums, and bad breath (halitosis).

Can it be treated?

Periodontal disease can be treated successfully but it cannot be cured. By controlling the disease we aim to prevent further damage and prevent tooth loss. Failure to treat and stabilise the disease can lead to progression of the disease including further bone loss, recession and eventually tooth loss.

What can I do to help?

Your role in the management and control of the disease is crucial. The disease cannot be controlled without your home care efforts. You will need to make changes to your lifestyle and daily routines if you wish to keep your teeth. The initial aim of treatment is to reduce and eliminate individual risk factors.

• Plaque control: We will show you techniques to clean your teeth to a very high standard. This will mean plaque biofilm levels are below the levels that trigger inflammation.
• Tobacco use: If you smoke then stopping smoking will help. Smoking is the number one modifier of periodontal disease making the disease process more damaging and less responsive to treatment. Should you wish to stop smoking the best people to speak to are your GP or practice nurse, we can also offer advice or arrange a referral to your local NHS stop smoking initiative.
• Diabetes: Evidence shows that severe periodontal disease can increase blood sugar levels in people with diabetes and also in those that do not have diabetes. In other words, periodontal disease and diabetes are linked in both directions. If you have been diagnosed with periodontal disease it may be recommended that you have a diabetes check at your GP.
• Genetics/family history: Some people are genetically predisposed to periodontal disease and may find that they are prone to rapidly developing periodontitis. It is important if there is a family history of gum disease that any early signs of disease are managed quickly.
• Stress: Stress can suppress the body’s immune system which can lead to increased destruction of the supporting structures of the teeth.
• Nutrition: Periodontal disease is an inflammatory disease. Research has shown that diet can affect inflammation, therefore diet will also affect periodontal disease and its progression. A healthy balanced diet is important in the prevention and stabilisation of periodontal disease.
• General health: There is more and more evidence showing that periodontal disease can have potentially negative consequences for general health. If active periodontal disease is present in the mouth, this can be a significant source of inflammation. A high concentration of bacteria under the gums can lead to bacteria entering the bloodstream, and this can then directly or indirectly affect other parts of the body. At present, there are strong links to periodontal disease and adverse control of diabetes, an increased risk of cardiovascular disease, increased risk of chronic kidney disease, adverse pregnancy outcomes for pregnant women from some specific populations, and new evidence looking at the link to Alzheimer’s.

How is it treated?

Once you are adequately controlling the daily plaque biofilm build-up, we will help by removing the deposits that you cannot remove with a thorough cleaning of the biofilm and deposits of calculus that sticks to the teeth and root surfaces. This is sometimes referred to as deep cleaning or root surface debridement. The use of local anaesthetic avoids discomfort and allows thorough cleaning to be completed. Treatment is provided by a team of hygienists and your dentist. This treatment is only successful if an optimal level of oral hygiene is achieved at home, so the emphasis will be placed on this aspect of your treatment, and this will be regularly checked following the stabilisation of the disease.

Is treatment successful?

The success of periodontal treatment is multifactorial, but your role is central and crucial in maintaining low plaque levels in the mouth, as well as managing the other risk factors discussed above. In most cases, when the main risk factors such as smoking and uncontrolled diabetes are eliminated, and immaculate oral hygiene is maintained, periodontal disease will stabilise. This will work for the majority of cases, however, periodontal treatment does not guarantee to stabilise the condition. Once the disease is stable, supportive therapy and regular professional cleaning of your teeth are vital in making sure that it stays stable, your hygienist and dentist will discuss this as part of your treatment planning.

Despite controlling risk factors, stabilising the disease can be challenging, further treatment may be required, and referral to a specialist Periodontist may be needed. Further non-surgical, surgical therapy and/or drug therapy may be required.

Are there any side effects of treatment?

In health, the gums lie approximately 2-3mm above the bone of our jaw. When bone is destroyed during the disease process, the gum follows it. This isn’t always obvious when there is inflammation present, but as the inflammation subsides and resolves, the gum will ‘shrink’ back to where it should be, in close proximity to the bone. This should be seen as a sign of the guns returning to health.

However, as a result of periodontal treatment and therapy, you may notice the following:

Increased sensitivity of the exposed root surfaces to hot, cold or sweet foods and drinks.

• The recession of the gums and exposure of the root surfaces.
• Longer-looking teeth.
• Increasing gaps between your teeth are irreversible but can be masked if treatment is successful.
• Increased food trapping between teeth.
• Some temporary increase in tooth mobility.

What if I choose not to have treatment?

If you choose not to have treatment your teeth may become loose, gums may shrink further and teeth may be lost. In some cases, teeth will develop periodontal abscesses and this can cause significant pain.

What next?

If you are concerned that you have gum disease, please speak with your hygienist or dentist, an appointment will then be made for a periodontal consultation with the dentist. A full examination of your teeth and gums will be completed, including measuring your gums around the teeth, x-rays will be taken to check the bone levels around your teeth, a bleeding and plaque score will be taken, and mobility of the teeth will be assessed, and oral hygiene routines will be checked and discussed. A treatment plan can then be formulated and further information will be given to you to help you decide whether you would like to proceed with treatment. Treatment will most likely then involve appointments with both the hygienist and the dentist, this again will be discussed further at your consult and subsequent appointment.

Periodontal Consultation:

Includes:

• A full examination of your mouth, teeth and gums
• Measurement of your gums, pocket depths and recession
• Check for tooth mobility
• Check how your teeth bite together
• Checking plaque and bleeding scores
• X-rays to check bone levels around your teeth
• Discussion of oral hygiene routines and how to improve yours
• Provisional diagnosis, discussion and information related to periodontal disease and discussion of treatment planning

Further, discussion of treatment planning may be needed and this may require further appointments before treatment commences, this will be discussed in the initial consultation.