What is gingivitis?
Gingivitis literally means inflammation (-itis) of the gums (gingivae).
Bleeding gums is common but it is not normal.
Bleeding is an early sign of gingivitis and/or periodontitis. If treated early this may not result in any further progression or problems. Bleeding will usually also present where the disease has already progressed to the stage where loss of bone around the teeth has occurred. At this stage the disease process can accelerate with development of "pockets" where the gum becomes loose and detached from the tooth and areas of plaque and food accumulation occur more easily, which in turn leads to further tissue damage and loss. It is important to monitor and treat signs of periodontal disease when they first develop.
The most important factor in any treatment is to remove the cause! In this case it is as simple as cleaning your teeth well and regularly. Use a toothbrush twice daily and floss once a day.
For acute infections sometimes we might recommend adjunct therapies in addition such as chlorhexidine mouthwash or possibly treatment with an antibiotic.
What is periodontal disease or gum disease?
“Perio” means around and “odont” means tooth so periodontal disease literally translates as “disease around the tooth”. Periodontal disease is more commonly known as gum disease and is an infection of the tissues surrounding and supporting the teeth. The tissues around the teeth are gingivae (gum), bone and connective tissue. Periodontal disease is usually painless (although acute presentations can arise) and most often occurs over long periods of time. The consequence of long-standing undiagnosed and/or untreated periodontal disease can be tooth mobility or loss due to the destruction of the tissues supporting the otherwise healthy tooth/teeth.
What causes periodontal disease?
Periodontal disease is caused by dental plaque, a sticky film of bacteria that constantly forms on the teeth. The bacteria slowly produce and release toxins that damage the gums, bone and connective tissue. Over long periods, this results in a reaction by the body leading to loss of bone and these supporting tissue of the teeth. Periodontics is an area that is still subject to ongoing and intense research. Research is looking at ways to eliminate the most pathogenic bacteria and how to make our bodies reactions to these toxins less severe.
What are the indications of periodontal disease?
Periodontal disease can be indicated by one of, or a combination of the following symptoms :
- Very red, bleeding and/or swollen gums
- Changes in the colour of the gums
- Bad breath
- Increased tooth mobility
- A dentist may diagnose this at a check-up by “probing” your periodontal tissues
- Radiographs taken by your dentist
Treating periodontal diseas.
Again the most important factor is to remove the cause. As for gingivitis this means cleaning your teeth well and regularly. As periodontal disease is a more advanced problem than mild gingivitis it may require additional treatment such as:
- Replacement of defective plaque retentive restorations
- Removal of calculus (calcified plaque) through a professional scale and clean.
- Possible root planning – for badly affected teeth
We will happily discuss your condition, prognosis and explain any beneficial treatments that may be available to you.
Dental plaque is an example of what is known medically as a “biofilm”. A biofilm, is a group of microorganisms (in this case bacteria) in which cells stick to each other. Most often these cells adhere to a surface, in the case of dental plaque, the surface is the enamel of your teeth. The furry feeling you get when you run your tongue over your teeth a matter of hours after eating or not cleaning is the beginnings of this bacterial biofilm/plaque.
The inside of your mouth is colonised by millions and millions of bacteria that in normal circumstances remain in balance and live happily. Environmental factors such as a poor diet (high in refined sugars), lack of adequate cleaning or unfluoridated water, can lead to an imbalance in these bacterial colonies. In this sort of environment, the bad bacteria will multiply and throw out the natural balance. This is when problems such as decay and/or periodontal disease can start.
Calculus is a branch of mathematics at university. It is also more importantly another substance that can be harmful to our teeth and gums.
Calculus is a calcified version of plaque. Over time, if dental plaque is allowed to sit on or around a tooth surface, enzymes present in our saliva will begin to calcify these plaques. When this happens the plaque is converted from soft plaque into hard calculus. You may be able to see calculus forming as a yellowy-orange hard band around the hard-to-clean spots of your teeth near the gums.
As the dental biofilm in your mouth are impossible to remove, the resulting calculus is unfortunately going to be a fact of life for all of us. This means that a professional scale and clean is necessary to avoid excessive build-up at certain time intervals. This will depend on your risk. Please ask us about your individual periodontal risk assessment and we will happily discuss this with you.
Effect of Calculus.
Periodontal disease is usually developed over long periods and can be avoided with good diet, regular effective oral-hygiene and annual check-ups to assess your risk and condition. It will also mean a scale and clean at a time interval that is indicated by your individual periodontal risk assessment.
If left unchecked and untreated for periods of time your periodontal condition will slowly deteriorate. When left undisturbed by brushing, flossing and professional cleaning, the bacteria that make up these biofilms will continually metabolise the residual sugars in your mouth for hours and hours after meals. The result of this metabolism is the production of low levels of acids and toxins that begin to irritate and inflame the gums and other tooth supporting tissues. Over longer periods this will result in the breakdown of these tissues altogether often resulting in the symptoms mentioned above associated with gingivitis and/or periodontitis. Chronic periodontitis will most often result in increased tooth mobility and the loss of teeth.
Scaling and Cleaning.
From a dentist’s perspective, a thorough scale and clean is doing much more than making your teeth look and feel clean. The major long term benefit is the prevention of periodontal disease. The aesthetic benefit is simply a nice by-product of the procedure.
Scaling involves cleaning the root surface of your teeth to remove plaque and calculus deposits. The instruments used to perform a scale and clean are "scalers" or “curettes”. Usually these days ultrasonic scalers are used. Ultrasonic scalers vibrate at a speed in excess of 20,000 cycles/second. This vibration is what allows the scaler to remove the hardened calculus from the enamel where flossing and tooth-brushing have failed.
When calculus deposits are located on the tooth roots or in deep pockets its removal and the subsequent cleaning of the root surfaces is referred to as "root planing". The treatment is similar to scaling and cleaning but is usually more difficult and time consuming because it is harder to access these deep areas below the gums. Root planning is indicated in a small percentage of patients usually with an acute localized presentation of periodontitis. This condition may or may not be associated with painful symptoms.
We are happy to consult with you and fully examine and discuss your periodontal condition. Should the need arise we will also happily offer you a referral to a specialist periodontist.