Gum Disease (Periodontitis)

Symptoms

Healthy gums are firm and fit closely around the teeth. Depending on the individual, healthy gums can vary in colour from light pink to dark pink or brown.Symptoms of periodontitis may include the following:

• Enlarged or puffy gums.
• Gums that appear dark red, bright red, or dark purple.
• Tender gums when touched.
• Gums that bleed easily.
• A toothbrush that appears pink after brushing.
• Spitting out blood while brushing or flossing teeth.
• Persistent bad breath.
• Presence of pus between the gums and teeth.
• Loose teeth or tooth loss.
• Pain when chewing.
• New gaps forming between teeth that appear as black triangles.
• Gums pulling away from the teeth, making them appear longer than normal (receding gums).
• Changes in how the teeth fit together when biting.

Causes

Periodontitis usually begins with the formation of plaque, a sticky film that is typically composed of bacteria. If left untreated, plaque can progress to periodontitis over time through the following steps:

• Plaque formation on the teeth: This occurs when sugars and starches in food mix with bacteria commonly present in the mouth. Brushing teeth twice daily and flossing every day removes plaque, though it quickly reforms.
• Plaque hardening under the gumline to form tartar if it remains on the teeth. Tartar is usually difficult to remove and cannot be eliminated by brushing and flossing alone, necessitating professional dental cleaning. Since plaque and tartar harbour bacteria, their prolonged presence on the teeth increases the risk of damage.
• Plaque buildup can lead to gingivitis, which is a mild form of gum disease. Gingivitis involves inflammation and irritation of the gum tissue surrounding the base of the teeth. This condition can be reversed with professional dental treatment and proper oral hygiene at home if addressed promptly before bone loss occurs.
• Recurring gum irritation and swelling, known as inflammation, can lead to periodontitis. This condition creates deep pockets between the teeth and gums, which harbour plaque, tartar, and bacteria and can deepen over time. If left untreated, this could lead to bone and tissue loss. Additionally, persistent inflammation may strain the immune system, leading to other medical problems.

Risk Factors

Factors that are likely to increase the risk of developing periodontitis include:

• Poor oral hygiene.
• Smoking or chewing tobacco.
• Hormonal changes, such as those associated with pregnancy and menopause.
• Use of recreational drugs like marijuana or vaping.
• Poor nutrition, particularly low levels of vitamin C.
• Certain medications that cause changes to the gums or dry mouth.
• Conditions that weaken the immune system, such as HIV/AIDS, leukaemia, and cancer treatments.
• Certain health conditions, like rheumatoid arthritis, diabetes, and Crohn's disease.

Complications

Periodontitis can lead to tooth loss. The bacteria responsible for periodontitis can enter the bloodstream through gum tissue, potentially affecting other parts of the body. Periodontitis has been associated with rheumatoid arthritis, respiratory disease, coronary artery disease, low birth weight and preterm birth, as well as difficulties in regulating blood sugar levels in diabetes.

Diagnosis

To determine whether you have periodontitis and its severity, your dentist may do the following:

• Assess your medical history to identify any factors that might be related to your symptoms, such as smoking or using certain medications that cause dry mouth.
• Examine your mouth to check for the buildup of plaque and tartar and for gums that bleed easily.
• Measure the depth of the pockets between your gums and teeth using a small ruler, known as a dental probe, placed between the gumline and teeth. The depth of the pockets is measured at various locations in the upper and lower gums. In a healthy mouth, pocket depths typically range from 1 to 3 millimetres (mm). Depths over 4 mm may indicate periodontitis, while depths over 5 mm cannot be adequately cleaned with routine care.
• Take dental X-rays to detect bone loss in areas where the dentist observes deeper pockets.

The dentist may classify the stage and grade of gum disease depending on the severity of the condition, treatment complexity, individual risk factors, and overall health. A treatment plan will then be developed accordingly.

Treatment

Treatment for periodontitis may be provided by a periodontist or a dentist. A periodontist is a dental professional who specialises in gum disease. As part of the treatment plan, a dental hygienist may work with your dentist or periodontist.

The goal of periodontitis treatment is to entirely clean the spaces surrounding the teeth and avoid further damage to the surrounding gum tissue and bone. The chances of successful treatment are improved with a daily regimen of good oral care, managing medical conditions that may affect dental health, and quitting tobacco use.

Non-surgical Treatments

If periodontitis has not advanced, the treatment may include less invasive procedures such as:

• Scaling: This procedure eliminatesgerms and tartar from the tooth's outer layers and under the gumline. The specialists can perform scaling usingdevices, ultrasonic equipment, or a laser.
• Root planing: This procedure smooths the root surfaces to prevent further accumulation of tartar and bacteria, and helps the gums reattach to the teeth.
• Antibiotics: Oral or topical antibiotics may be recommended to treat bacterial infections. Topical antibiotics may consist of antibiotic mouthwashes or gels placed directly in the gum pockets. Oral antibiotics are sometimes required to eliminate the bacteria causing the infection.

Surgical Treatments

For advanced gum disease, dental surgery may be required, including:

• Flap surgery (pocket reduction surgery): During this procedure, small incisions are made in the gums to fold back the tissue, exposing the tooth roots for better root planning and scaling. Before stitching the gum tissue into position, the periodontist can reshape the underneath bone since gum disease often leads to bone loss. Maintaining healthy gum tissue and cleaning spaces surrounding teeth becomes simpler after recovery.
• Soft tissue grafts: When gum tissue is lost, the gumline recedes and can expose some tooth roots. Reinforcement of the affected tissues may be necessary. This often involves taking a small tissue from the upper part of the mouth or using tissue from a donor source, which is then attached to the damaged area. Soft tissue graft procedures can protect exposed roots, prevent additional gum loss, and improve the appearance of the teeth.
• Bone grafting: A bone graft, made from small pieces of your bone, donated bone, or synthetic material, is recommended when gum disease damages the bone near the tooth’s root. Bone grafting lowers the risk of tooth loss by keeping the tooth in position and provides a foundation for natural bone regrowth.
• Guided tissue regeneration: This procedure encourages new growth of bone damaged by bacteria. It involves placing a special type of fabric between existing bone and the tooth. This stimulates bone regeneration by preventing the growth of unwanted tissue into the healing area.
• Tissue-stimulating proteins: This involves applying a special gel to a diseased tooth root. The gel contains proteins found in developing tooth enamel and helps promote the growth of healthy bone and tissue.

Prevention

The most effective way to prevent periodontitis is to establish and maintain good oral hygiene habits. Start this practice early in life and continue it throughout your life.

• Good oral care: This involves brushing your teeth for at least two minutes twice daily (once in the morning and again before bed) and flossing every day. Flossing helps remove food particles and bacteria, especially before brushing. Good oral care not only keeps your teeth and gums clean but also removes the bacteria that cause periodontal disease.
• Regular dental visits: Visit your dentist regularly for cleanings, at least every 6 to 12 months. More frequent professional cleaning may be necessary for those with risk factors that increase the likelihood of periodontitis, such as smoking, having a dry mouth, or taking certain medications.

Lifestyle and Home Remedies

To minimise or prevent gum disease, consider the following measures:

• Clean your teeth at least twice daily or ideally after meals.
• Use an electric toothbrush to effectively remove tartar and plaque.
• Floss daily. If using traditional dental floss is difficult, consider a floss holder. Other alternatives include water flossers, interdental brushes, or interdental cleaners that are suitable for cleaning between teeth. Discuss with your dental hygienist or dentist what would work best for you.
• Schedule routine appointments for professional teeth cleanings as advised by the physician.
• Avoid smoking or chewing tobacco.

A Note from MD.co.uk

Periodontal disease is often painless, particularly in its early stages. Therefore, it is essential to recognise the warning signs to ensure prompt treatment before the condition worsens. If left untreated, gum disease can significantly impact oral and overall health. Moreover, the infection may spread to other parts of the mouth and body, increasing the risk of various health problems such as stroke, heart disease, and diabetes.

Consult your dentist immediately if you notice tender, swollen, or bleeding gums. They can help you address the infection and restore the health of your teeth and gums.