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Gum Disease - Periodontal Disease - Gingivitis - Periodontitis
Frequently Asked Questions.
Gum Disease - Periodontal Disease - Gingivitis - Periodontitis
Members of NobleDentist save hundreds and even thousands of dollars at participating dentists throughout Australia. Joining NobleDentist for 24 months is just $99.95. To learn more, click on dentist.
Frequently Asked Questions
What is gum disease (periodontal disease)?
How does gum disease get started?
What are the signs of gum disease?
What are the stages of gum disease?
How can I prevent gum disease?
How can I tell if I'm brushing and flossing properly?
What if I am already in the early stages of gum disease?
What does root planing accomplish?
Are there any other methods for treating gum disease?
Why can't I just clean my teeth?
Is there a link between gum disease and other health concerns?
What is gum disease (periodontal disease)?
In the broadest sense, the term gum disease, or periodontal disease, describes bacterial growth and production of factors that gradually destroy the tissue surrounding and supporting the teeth. "Periodontal" means "around the tooth."
Gum disease begins with plaque, which is always forming on your teeth, without you even knowing it. If the plaque is not removed on a daily basis it will form tartar (also called calculus) which is the breeding ground for the germs which cause gum disease.
Anyone at any age is susceptible to gum disease. You can lose your teeth from gum disease because this disease attacks the gums as well as the bone which are the foundation in which your teeth rest. Your teeth become loose and eventually fall out as the bone literally dissolves away from around your teeth.
Gum diseases are classified according to the severity of the disease. The two major stages are gingivitis and periodontitis. Gingivitis is a milder and reversible form of gum disease that only affects the gums. Gingivitis may lead to more serious destructive forms of gum disease called periodontitis
What is gingivitis?
Gingivitis is inflammation of the gum tissue. The gums are irritated and swollen due to a plaque or calculus (tartar) buildup along the gum-line. The gums may be sore, bleed easily and appear puffy, soft and swollen. No bone structure is lost around the teeth at this stage of gum disease.
Blood on the toothbrush or dental floss is one of the earliest and most common signs of gingivitis. Your gums should never bleed while brushing or flossing. The good news about gingivitis is that it is preventable and reversible through good brushing and flossing techniques (or other dental tooth cleansing). On the other hand, if oral hygiene habits are poor, gingivitis may progress to periodontitis.
What is periodontitis?
Periodontitis results from the progression of gingivitis, involving inflammation and infection of the ligaments and bones that support the teeth. Periodontitis occurs when inflammation or infection of the gums is untreated or treatment is delayed. Infection and inflammation spreads from the gums to the ligaments and bone that support the teeth. Loss of support causes the teeth to become loose and eventually fall out. Periodontitis is irreversible but you can stop its progression through good oral hygiene and visiting your dentist.
How does gum disease get started?
Gum disease begins when plaque adheres at and below the visible edge of your gums. If plaque is not removed every day by brushing and flossing, it hardens into tartar. Tartar promotes a bacterial infection at the point of attachment. In these early stages, gum disease is called gingivitis.
Your gums may be a bit red but you may not notice anything. As gingivitis gets more serious, tiny pockets of infection form. Your gums may be puffy and may bleed a little when you brush but it is not painful. Over time, the infection destroys the gum tissue. Eventually, you may be at risk of losing one or more teeth.
What are the signs of gum disease?
Gum disease may progress painlessly, producing few obvious signs, even in the late stages of the disease. Then one day, on a visit to your dentist, you might be told that you have chronic gum disease and that you may be at increased risk of losing your teeth. That is one reason why regular dental check ups and periodontal examinations are very important.
Although the symptoms of gum disease often are subtle, the condition is not entirely without warning signs. Certain symptoms may point to some form of the disease. Visit our participating dentists immediately if you notice any of the following signs of gum disease:
- gums that bleed when you brush your teeth
- red, swollen or tender gums
- gums that have pulled away from the teeth
- bad breath that doesn't go away
- pus between your teeth and gums
- loose teeth
- a change in the way your teeth fit together when you bite
- a change in the fit of partial dentures
Even if you don't notice any symptoms, you may still have some degree of gum disease. Some people have gum disease only around certain teeth, such as those in the back of the mouth, which they cannot see. Only a dentist can recognise and determine the progression of gum disease.
What are the stages of gum disease?
Gingivitis and periodontitis are the two main stages of gum disease. Each stage is characterised by what a dentist sees and feels in your mouth, and by what's happening under your gum line. Although gingivitis usually precedes periodontitis, it's important to know that not all gingivitis progresses to periodontitis.
In the early stage of gingivitis, the gums can become red and swollen and bleed easily, often during tooth brushing. Bleeding, although not always a symptom of gingivitis, is a signal that your mouth is unhealthy and needs attention. The gums may be irritated, but the teeth are still firmly planted in their sockets. No bone or other tissue damage has occurred at this stage. Whilst gum disease in Australia remains a serious public health concern, it is a situation that is far from hopeless.
When gingivitis is left untreated, it can advance to periodontitis. At this point, the inner layer of the gum and bone pull away from the teeth (recede) and form pockets. These small spaces between teeth and gums may collect debris and can 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 enzymes fighting the infection actually start to break down the bone and connective tissue that hold teeth in place. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed.
At this point, because there is no longer an anchor for the teeth, they become progressively looser, and the ultimate outcome is tooth loss.
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| Normal, healthy gums Healthy gums and bone anchor teeth firmly in place. |
Periodontitis Unremoved, plaque hardens into tartar (calculus). As plaque and tartar continue to build up, the gums begin to recede (pull away) from the teeth, and pockets form between the teeth and gums. |
Advanced periodontitis The gums recede farther, destroying more bone and the periodontal ligament. Even healthy teeth may become loose and need to be extracted. |
What causes gum disease?
The main cause of gum disease is bacterial plaque, a sticky, colorless film that constantly forms on your teeth. However, factors like the following also affect the health of your gums.
- Tobacco smoking or tobacco chewing
- Systemic diseases such as diabetes
- Some types of medication such as steroids, some types of anti-epilepsy drugs, cancer therapy drugs, some calcium channel blockers and oral contraceptives
- Bridges that no longer fit properly
- Crooked teeth
- Fillings that have become defective
- Pregnancy or use of oral contraceptives
- Clenching or grinding your teeth
- Poor nutrition
How is gum disease diagnosed?
During a periodontal exam, your gums are checked for bleeding, swelling, and firmness. The teeth are checked for movement and sensitivity. Your bite is assessed. Full-mouth X-rays can help detect breakdown of bone surrounding your teeth.
Periodontal probing determines the severity of your disease. A probe is like a tiny ruler that is gently inserted into pockets around teeth. The deeper the pocket, the more severe the disease.
In healthy gums, the pockets measure less than 3 millimetres and no bone loss appears on X-rays. Gums are tight against the teeth and have pink tips. Pockets that measure 3 millimetres to 5 millimetres indicate signs of disease. Tartar may be progressing below the gum line and some bone loss could be evident. Pockets that are 5 millimetres or deeper indicate a serious condition that usually includes receding gums and a greater degree of bone loss.
Following the evaluation, your dentist or periodontist will recommend treatment options. Methods used to treat gum disease vary and are based on the stage of the disease.
How common is gum disease?
Very. According to Dr Peter Lavelle of the ABC, gum disease is the fifth most common health condition in Australia. Gum disease can progress quite painlessly until you have a real problem. That's why it is so important to prevent gum disease before it becomes serious. Chairman of the ADA's Oral Health Education Committee, Dr Don Wilson said that 90% of tooth loss could be attributed to tooth decay or gum disease which meant it was preventable.
How can I prevent gum disease?
Gum disease is usually preventable. Just take care of your teeth starting now - don't wait!
- Brush twice a day for at least 3 minutes each time and floss daily. If you're not sure whether you're brushing or flossing properly, your dentist or dental hygienist can show you the best techniques.
- Always brush with toothpaste that contains fluoride. Daily mouth rinses containing fluoride are also recommended.
- Use a toothbrush with soft, polished bristles, as these are less likely to irritate or injure gum tissue. Be sure to replace your toothbrush at least every 3 to 4 months - a worn-out toothbrush can injure your gums.
- Eat a healthy diet - avoid snacks and junk foods packed with sugar that plaque-causing bacteria love to feed on.
- Don't smoke! Cigarettes and chewing tobacco cause mouth irritation and are very unhealthy for gums and teeth.
- Regular dental care is extremely important in helping to keep your mouth healthy. Visit participating dentists for routine care, especially cleaning, at least twice a year. Your dentist can remove hardened plaque and any tartar that you're not getting to with brushing or flossing.
Gum disease will not go away by itself or with improved home care. The only way of removing plaque deep under the gums is with professional cleanings. Once you have had a gum problem you will always be susceptible to recurring problems, so be sure to see your dentist on a regular basis - every three to four months, unless he or she recommends otherwise.
How can I tell if I'm brushing and flossing properly?
Brushing - Brush your teeth gently, paying special attention to the areas where your teeth and gums meet. Clean every surface of every tooth. Use the tip of your brush to clean behind your upper and lower front teeth.
Flossing - Take a piece of floss and wrap it around your middle fingers. Using a clean section of floss each time, wrap the floss into a C shape around a tooth. Wipe it over the tooth, from base to tip, a couple of times. Repeat on each tooth.
What if I am already in the early stages of gum disease?
If you have gum disease, getting rid of plaque and tartar gives your gums a chance to get better. That's why in the early stages of gum disease, the best treatment is:
- Cleaning by your dentist or dental hygienist to remove built-up tartar
- Brushing twice a day to remove plaque and
- Flossing once a day to remove plaque.
When gum disease is more serious, your dentist may refer you to a dental specialist called a periodontist. A periodontist has extra training in treating gum disease and in restoring (or regenerating) bone and gum tissue that have been lost because of gum disease.
A periodontist also treats serious forms of gum disease that do not get better with normal dental care. When serious gum disease is found, brushing and flossing become even more important.
What treatment is available?
The goal of periodontal treatment is to control any infection that exists and to halt progression of the disease. Treatment options involve home care that includes healthy eating and proper brushing and flossing, non-surgical therapy that controls the growth of harmful bacteria and, in more advanced cases of disease, surgery to restore supportive tissues.
- Although brushing and flossing are equally important, brushing eliminates only the plaque from the surfaces of the teeth that the brush can reach. Flossing, on the other hand, removes plaque from in between the teeth and under the gum line. Both should be used as part of a regular at-home, self-care treatment plan. Some dentists also recommend specialised toothbrushes, such as those that are motorised and have smaller heads, which may be a more effective method of removing plaque than a standard toothbrush.
- During a typical checkup your dentist or dental hygienist will remove the plaque and tartar from above and below the gum line of all your teeth. If you have some signs of gingivitis, your dentist may recommend that you return for future cleanings more often than twice a year. Your dentist may also recommend that you use a toothpaste or mouth rinse that is approved for fighting gingivitis.
- If your dentist determines that you have some bone loss or that the gums have receded from the teeth, the standard treatment is an intensive deep-cleaning, non-surgical method called scaling and root planing (SRP). Scaling scrapes the plaque and tartar from above and below the gum line. Root planing smoothes rough spots on the tooth root where germs collect and helps remove bacteria that can contribute to the disease. This smooth, clean surface helps allow the gums to reattach to the teeth.
Opinions about which treatment methods to use vary in the periodontal field. For some people, certain procedures may be safer, more effective, and more comfortable than others may be. Which treatment your dentist or periodontist chooses will most likely depend on how far your disease has progressed, how you may have responded to earlier treatments, or your overall health.
What is root planing?
Normal tooth cleanings remove plaque and calculus deposits from above the gum line. Root planing is necessary when these deposits extend below the gum line.
Root planing is performed with the same tools as normal cleanings but the procedure is more aggressive. Often it is necessary to numb the affected area before the procedure. Once the accumulated plaque and calculus have been removed, the gums will heal, tightening around the teeth.
Depending upon the extent of disease found in the examination, root planing may be done over several practice visits. In this way, your dentist can assess the progress of treatment and alter tactics if necessary.
Simply stated, root planing may be considered as an extension of a "routine cleaning". A "routine cleaning" is intended to clean harden deposits that form above the gums. Over time, these deposits often form below the gums, on the roots. It is at this point that we recommend root planing.
What does root planing accomplish?
During this procedure the root surfaces are literally planed. This accomplishes several things:
- Removes hard deposits and the bacteria they harbour.
- Creates a smooth root surface that is easier to keep clean.
- Reduces infection because the bacteria will not reattach to the smooth surface as readily.
Are there any other methods for treating gum disease?
- Curettage - a scraping away of the diseased gum tissue in the infected pocket which permits the infected area to heal.
- Flap surgery - involves lifting back the gums and removing the tartar. The gums are then sewn back in place so that the tissue fits snugly around the tooth. This method also reduces the pocket and areas where bacteria grow.
- Bone grafts - used to replace bone destroyed by periodontitis. Tiny fragments of your own bone, synthetic bone, or donated bone are placed where bone was lost. These grafts serve as a platform for the regrowth of bone which restores stability to teeth.
- Soft tissue grafts - reinforce thin gums or fill in places where gums have receded. Grafted tissue, most often taken from the roof of the mouth is stitched in place over the affected area.
- Guided tissue regeneration - stimulates bone and gum tissue growth. Done in combination with flap surgery, a small piece of mesh-like fabric 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 to better support the teeth. br>
- Bone (osseous) surgery - smoothes shallow craters in the bone due to moderate and advanced bone loss. Following flap surgery, the bone around the tooth is reshaped to decrease the craters. This makes it harder for bacteria to collect and grow.
- Medications - in pill form are used to help kill the germs that cause periodontitis or suppress the destruction of the tooth's attachment to the bone. There are also antibiotic gels, fibres or chips applied directly to the infected pocket. In some cases, a dentist will prescribe a special anti-germ mouth rinse containing a chemical called chlorhexidine to help control plaque and gingivitis. These are the only mouth rinses approved for treating gum disease.
Why can't I just clean my teeth?
Gum disease is a serious infection. Evidence now links gum disease to a variety of health concerns, including heart disease, stroke, diabetes, and other degenerative diseases that are life threatening. It's not just about your teeth anymore.
Gum disease can be a disfiguring disease. Your gums swell in size and become red. They may bleed very readily. Your teeth may shift and dark spaces between your teeth may start showing. The teeth then become loose and may need to be removed.
Early detection as with other diseases is the key to successful treatment. Your dentist or hygienist should routinely perform a gum disease screening exam. The results of this examination will determine your periodontal status. If you have gum disease, your treatment will be personalised for you and your level of infection. A routine cleaning is not enough by itself to treat gum disease.
Is there a link between gum disease and other health concerns?
The link between poor oral hygiene and poor overall health is well documented. The mouth is the gateway to the rest of the body and disease and infection can enter via the mouth. The oral bacteria found in patients with gum disease can enter into the blood stream. From here the bacteria can travel throughout the body. Inflammation sets in but your body's immune response sometime falls short. These bacterial colonies can cause serious problems such as:
- Lung Infections in people with chronic lung diseases.
- A weakened immune system that can slow wound healing and diminish a person's response to hepatitis B and flu vaccines.
- Stroke - a new study of fatty deposits lodged in carotid arteries of stroke sufferers shows that 70% contain bacteria and 40% of that bacteria comes from the mouth.
- Heart Disease - Studies have found the incidence of heart disease is about twice as high in people with gum disease. Bacteria get mixed up with blood-clotting cells called platelets forming a clump that travels through the blood vessels. These clumps of cells and bacteria irritate vessel walls and may promote formation of heart stopping blood clots. The inflammation also produces a protein that can irritate the interior of blood vessels creating sites where fatty deposits can form.
- Infective Endocarditis, a potentially fatal disease in which the inner lining of the heart becomes inflamed.
- Diabetes - Studies have shown that diabetics with gum disease were three times more likely to have heart attacks than those without gum disease.
- Spontaneous pre-term births - women with gum disease are 7 to 8 times more likely to give birth prematurely to low-birth-weight babies. Researchers believe that the low-grade infection causes damaged cells to release inflammation causing substances that have been linked with pre-term births.
Members of NobleDentist save hundreds and even thousands of dollars at participating dentists throughout Australia. Joining NobleDentist for 24 months is just $99.95. To learn more, click on dental.
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