Gum Disease (periodontitis)
What is a gum disease?
Gum disease is a very common dental problem that affects the bone supporting your teeth.
Unlike gingivitis (a reversible swelling of your gums), gum disease or periodontitis (as it’s known to us), involves the irreversible loss of the bone that holds your teeth in.
If it’s left untreated and allowed to progress, your teeth will become loose, painful and eventually be lost.
Why choose Dr Workman to look after you?
Not only is Dr Workman a very good dentist, he has genuine caring nature and always makes sure you feel truly looked after. This is why he has such a loyal following of, families, young professionals right through to our older generation. With over 12 years experience, he is young, passionate, great at what he does and has an excellent aesthetic eye. If you would like a dental professional you can really trust, who places your health, happiness and comfort as an absolute priority, then you would be hard pushed to look any further. If you have typed ‘dentist near me’ then our state of the art Maroubra dental practice won’t be far away.
Why is it so important to treat it early?
Gum disease is a slow burner.
It really is a tale of two mouths… get on top of it early with effective treatment, excellent hygiene and regular maintenance and you add many years to the life and function of your teeth… if you don’t see a dentist regularly, only have moderate hygiene, then your dental destiny is far more bleak…. you will encounter pain, abscesses and lose teeth early.
Gum disease is not fully preventable, but we can considerably slow its progress through tried and tested treatments and great hygiene. It takes on-going effort and dedication, but once your susceptibility is identified, you acknowledge the consequences and take responsibility for them, good progress can be made.
“ In my ‘day to day’ general practice- teaching and educating patients regarding dental decay and gum disease are two of the most important roles I play.
I know how important this is because I see people throughout all the stages of gum disease, and have observed huge difference in the health and happiness of their teeth… and their life!” [Dr Jamie}
There are a number of studies which have proved a link between gum disease and heart disease: Inflammation is a key risk for heart disease and there is evidence that periodontal disease can cause increase inflammation throughout the body.
We can’t yet say that gum disease ’causes’ heart disease or vice versa, but you are 50% more likely to have gum disease if you have chronic heart problems, and you are 50% more likely to suffer heart trouble if you have periodontitis…if that doesn’t make you sit up in your chair, I’m not sure what will.
It has been recommended by both the Journal of Periodontology and the American Journal of Cardiology that both medical and dental professionals join forces in assessing and treating those that are at risk. For us, as dentists to do that, we need to see you regularly to start with and we also need you to take on board the advice we give you.
How do you know if you’ve got gum disease?
Gum disease has certain signs and symptoms that indicate you have the disease, or are susceptible to the disease, but since the cardinal sign is bone loss around the teeth, it requires a dentist to perform a periodontal or gum examination and take x-rays to assess your relative bone levels.
The gum examination involves looking at the height of the gums, the level of recession, the amount of bleeding, the looseness of the teeth, and a checking of the ‘tooth pockets’ with a blunt little probe.
Normal probing depth around your gums is 1-3mm. if the probe slides down 4mm or more then there is an area you can’t keep clean under the gum and professional cleaning will be required.
X-rays are needed, to know if this pocket is caused by the loss of bone, and not just by your gums being swollen due to poor oral hygiene.
Symptoms of gingivitis include:
• Bleeding gums (especially on brushing or flossing)
• Swollen, inflamed or red gums; they may or may not be sore
• Bad breath is often present
Symptoms of periodontitis include:
• Loose or moving teeth (late stage)- which may cause pain on chewing.
• Sensitive teeth- this occurs from the recession of the gum, since the gum follows the loss of jawbone and exposes the root surface of the tooth.
• Receding gums- your teeth start to look longer and dark triangles open up between them as the gums shrink down.
• A change in your bite.
• A gap begins to open up, and the teeth may start to drift.
• Abscesses in the gums may cause teeth to be painful to touch, feel swollen and taste foul… if they discharge pus.
• Symptoms of gingivitis.
What happens in gum disease?
We know there are certain bacteria that cause gum disease and if this builds up in and around your teeth and you are susceptible (not everybody is), the inflammation that results can eat away at the bone which supports your teeth.
Initially this may go un-noticed as it is a chronic condition and not accompanied by pain, bone is lost and periodontal or gum pockets begin to form, shielding the plaque, calcus and bacteria from your hygiene efforts, thus allowing it to multiple and the bone loss to continue.
Eventually the gum has no support, since the bone underneath has disappeared and the gum then begins to follow the bone down- exposing the root surface of the tooth.
The tooth becomes sensitive and more and more difficult to keep clean.
Eventually the teeth start to move a little more, until the amount of bone holding them is so small and the teeth so loose that they becomes painful and need to be removed.
What are the causes of gum disease?
The primary cause is the bacteria in plaque and so the role of good oral hygiene is once again critical.
There are three known anaerobic bacterium that have been isolated and implicated in causing the disease.
In addition there are a number of risk factors that we know contribute to a patient’s susceptibility.
However, some patients with shocking hygiene do not get gum disease and some patients with perfectly healthy teeth do!
The key, wherever possible, is managing the risk factors and eliminating them, thus reducing the risk and/or the severity of the disease.
The four main risk factors are:
2. Diabetes (the more poorly controlled your condition, the worse the effect)
3. Genetic (yes… gum disease has a hereditary component, so if it runs in the family you need for regular dental care and excellent hygiene)
4. Presence of known causative bacteria
Other contributory risk factors include:
• Age (>55 years)
• Men > Women
• Poor immune system
• Hormonal changes
• Cardiovascular disease
• Rheumatoid arthritis
• Poor nutrition
• Certain medications (oral contraceptives, anti-depressants, anti-seizure)
• Clenching or grinding teeth
• Misaligned teeth.
How is gum disease treated?
Since the main cause of gum disease is bacterial plaque, the aim of treatment is to remove this and prevent it from building up.
Your ultimate prognosis and treatment success will depend on your ability to do this at home once all the professional gum disease treatment has been completed.
You are responsible for removing plaque above, at or just under the gum- line with toothbrushing, flossing and interproximal brushes.
Dr Jamie has three main roles:
1. Diagnosing and monitoring the progress of your condition.
2. Reducing the factors that increase plaque build up (such as poorly contoured fillings, crowns, veneers).
3. Teaching you how to effectively clean your teeth.
4. Performing professional cleaning at and below the gum line in those hard to reach areas. This could be general scaling or root planning under local anaesthetic to target further down the root. Sometimes antiseptics, antibiotics and other medicines will be prescribed.
Depending on the severity of the disease, treatment may vary but the ultimate goal is to slow the progress so you can keep the teeth for as long as possible…and in the event that teeth are lost, talk you through the options and perform the necessary treatment to replace them.
Do you need to see a periodontist?
Dr Jamie will identify and initially treat the disease.
If it is particularly severe, rapidly progressing or not responding to conventional treatments, he may refer you to his periodontist; a dental specialist for gums.
The periodontist has a few additional treatments that they can perform such as guided tissue regeneration, laser periodontal cleaning, gum surgery and grafting, pocket reduction and regenerative procedures.
Can you prevent gum disease?
The longer you leave gum disease untreated, the more irreversible damage that will occur in the bone supporting your teeth; so the best time to get on top of it, is as early as possible.
It can take many years to get signs and symptoms but we check for gum disease at every single check up, so you just need to come in for an examination.
It is not a fully preventable disease but the treatments will considerably slow its progression.
Prevention comes from eliminating as many of the risk factors as you can: such as ensuring your diabetes is controlled (if you have it), stopping smoking, taking care of yourself through diet and exercise and critically, maintaining excellent oral hygiene.
‘Good’ won’t cut it: you need to be flossing and using appropriate sized interproximal brushes in every space, before carefully brushing your teeth for two minutes.
Although we do a check and clean every 6 months, due to the nature of the disease, it’s adviseable to put in place an additional gum disease maintenance program and have an additional clean every 3 months in between your standard check ups.
There are some good antiseptic products out there that contain chlorhexidine gluconate, which can be a useful addition to your hygiene regime e.g. Savacol (Colgate) or Curasept – note prolonged use can cause brown staining. Dr Jamie will advise you on its appropriate use.
|Treatments||Oral hygiene instruction | Professional cleaning|Root planning |Subgingival debridement|
|Cost||See treatment page for details|
- Dr Jamie’s education site; Jamiethedentist.com where you can hear him speak and read about TOPIC in a lot more detail.
- These other excellent resources: