Gum Disease FAQ's


Frequently asked questions about gum disease:

What are the symptoms and signs of gum disease?

Most people do not know they have gum disease, until their dentist brings it to their attention. One of the reasons it comes as a surprise is that gum disease is a silent disease, with few obvious symptoms in its early stages.

One of the first warning signs is when the rim of the gum next to your teeth becomes red and swollen, and bleeds easily when touched. Most often, there is no discomfort at this stage, yet the disease has gained a foothold and is now known as "gingivitis."

Gingivitis is reversible with improved oral home care and a professional cleaning. However, if left untreated, the danger exists that it will progress into an irreversible gum disease that damages the gums and bone surrounding the teeth.

Gum disease is a more advanced disease than gingivitis. Gum disease destroys jawbone and tissues supporting the teeth. Yet still, an individual may be unaware of the problem existing in their mouth.

The signs are subtle at first, and often only your dentist or hygienist can detect it.

Dental professionals are trained to look for:

  1. Pockets - Pockets occur when the collar of gum becomes infected, and separates from the tooth creating a space. This space is a "pocket." A pocket is not necessarily formed when food gets stuck between teeth.
  2. Bleeding - In spite of its common occurrence, gums are not supposed to bleed any more than fingers, ears, or noses do on their own. If any of those starts bleeding, everyone knows to stop the bleeding, and look into it if it recurs. However, when gums continue to bleed, many simply ignore it, as if it were "normal". Bleeding gums are not normal. When gums bleed, at the very least, a minor, reversible problem exists. Sometimes the bleeding is a sign that there are deeper problems, and without some kind of treatment pockets and bone loss will continue to occur.
  3. Bone loss - Dental x-rays, taken at regular intervals, chronicle the bone levels surrounding the teeth. Subtle changes in the bone levels are definite markers that periodontal breakdown is occurring. If these changes are ignored, bone loss will progress and compromise teeth. Fact: 70% of all teeth removed from adults are due to bone loss from gum disease…not decay.
  4. Loose teeth - Dentist or hygienist, not the person, is often the first to notice early signs of loose teeth. Something is wrong if your teeth are loose. Investigate the cause and seek treatment.
  5. Spaces - Spaces are forming between front teeth: In general, teeth do not shift their position, though crowding of the lower (mandibular) front incisors does occur as we age. However, when spaces appear between some of the upper (maxillary) front teeth, it is time to figure out why. The most common reason for front teeth to flare out is advanced bone loss and lack of tooth support due to progressive gum disease.
  6. Halitosis - Bad breath may be a sign that significant periodontal problems exist in someone's mouth. Once the periodontal problems are under control, bad breath often goes away.
  7. Abscess - Occasionally, the first time a person knows they have a gum problem is when they get a periodontal abscess. An abscess occurs when bacteria are trapped in a gum pocket. They have no way of escaping and the pocket expands, forming an abscess. If treated in time, little damage occurs to the surrounding bone and tooth. Not treating an abscess in time, can lead to rapid and severe bone loss. When this happens, you require additional periodontal treatment.

It is important to note you may have gum disease and not experience any of these symptoms. Gum disease is silent and chronic, rarely giving an advanced warning that tissue destruction is taking place. That is why it is important to have regular dental checkups.

Gum disease is usually a slow, painless, progressive disease. Most adults with gum disease are unaware they have it. If diagnosed and treated early, however, the teeth can be saved.

How is gum disease diagnosed?

During an examination, the dentist or hygienist inspects the colour and firmness of the gums. They test teeth for looseness. The bite is checked. At some point, they insert a small measuring instrument (actually it is a millimetre ruler) between the tooth and gum to measure the depth of the pockets. If the depths are greater than the norm of 1-3 millimetres, they may suggest improved oral hygiene measures and/or more deliberate therapy.

This "periodontal" examination is essential at frequent intervals for all adults, especially when there is a history of periodontitis in the immediate family (like a parent needing dentures by age forty) and/or if they smoke.

X-ray photos should be taken at appropriate times to evaluate changes in the bone supporting the teeth. X-ray photos also reveal dental decay and can be useful in detecting a variety of abnormalities.

How is gum disease treated?

Once a diagnosis has been made and a treatment plan formulated the active periodontal treatment is often performed in two phases, although a third phase (surgery) is sometimes required.

On completion of active periodontal treatment it is essential that all patients enter a strict periodontal maintenance programme to maintain their periodontal health.

Phase 1 – Conservative periodontal treatment

The first phase is the initial preparation. All our patients need to complete this initial phase. This is when you learn which tools to use, and how to properly brush your teeth and clean in between your teeth.

In addition, during these visits, the dental hygienist and periodontist performs multiple scalings (cleanings) of the teeth, attempting to remove all the plaque and tartar (calculus) stuck to the teeth. Often, changes can be seen right away. Bleeding reduces and the pockets get smaller.

Phase 2 - Re-evaluation & possible further scalings

The second phase of periodontal treatment consists of re-evaluating the pocket depths and seeing if gums still bleed after the initial scalings. The better you clean at home, the better you will respond to conservative gum treatment.

There are times when additional scalings help attain the goal of smaller pockets. However, if the pockets are still too deep at the time of re-evaluation, you will need more treatment before returning to periodontal health.

Phase 3 - Gum surgery

Periodontal surgery is indicated when non-surgical methods are not enough to stop the disease process. Surgery helps to save teeth.

During surgery the periodontist gently pulls the gums away from the teeth and meticulously cleans teeth and supporting tissues.

Sometimes it is possible to regain lost tissues with "guided tissue regeneration (GTR)" or "periodontal regeneration" procedures. This involves the use of biocompatible materials (like Emdogain®), which promotes the growth of lost tissue and bone around your tooth. These biocompatible materials are placed during surgery. Not every case is suitable for regeneration.

Phase 4 – Periodontal maintenance

Once you have made the investment in periodontal treatment, it is important that you protect it. Without careful, ongoing monitoring and treatment, gum disease can recur. Periodontal maintenance enables you to gain control of the disease and increases your chances of keeping your natural teeth. Periodontal maintenance is specialized treatment and is different from ordinary cleanings with your dentist.

Periodontal maintenance entails you visiting the oral hygienist every 3 to 6 month (depending on your specific needs), and seeing your Periodontist for a re-examination every 9, 12, 15 or 18 months (depending on your specific needs). During this re-examination your Periodontist reviews your medical and dental histories to note any factors that may influence your periodontal health and treatment effectiveness. In addition, your Periodontist performs a thorough periodontal evaluation including: plaque control evaluation (effectiveness of your home-care), periodontal charting (probing depth etc.), oral cancer screening and take x-ray photos as indicated.

If new or recurrent gum disease is identified during your periodontal maintenance visit, then additional periodontal treatment may be recommended.

Periodontal maintenance is a way for you to protect your oral health. This regular treatment helps to prevent and minimize the recurrence and progression of gum disease. If the disease returns, careful monitoring increases the likelihood of locating and treating it in a timely manner, before tooth-threatening bone loss becomes uncontrollable.

Protecting your periodontal health brings a lifetime of benefits. You keep dental costs down by preventing future problems. You smile, speak and eat with comfort and confidence!

What causes gum disease (periodontitis)?

The main cause of periodontitis is plaque that constantly forms and accumulates in our mouths. Plaque is an often-colourless mass of bacteria that sticks to teeth, crowns and bridges, and other tissues in the mouth. Plaque irritates the gums, i.e. causes an infection.

If not removed daily, plaque becomes the hard material known as tartar or calculus. Brushing and flossing alone cannot remove calculus. A hygienist, dentist or periodontist must remove it manually to stop it becoming worse.

With time, plaque and its by-products destroy the tissues that attach the gums to the teeth. The gums "pull away" from the teeth and pockets begin to form between the teeth and gums.

Plaque and calculus continues to fill these pockets. Unfortunately for us, the mouth is a perfect incubator. It is warm, dark, and moist, with tons of "food" for the bacteria to metabolise. The net result is that the bacterial plaque thrives, matures and eventually destroys the jawbone supporting the teeth.

Bacteria in plaque initiate the early changes to the gums. As the plaque matures on the teeth, the disease becomes more established to the point where it becomes irreversible.

What makes gum disease (periodontitis) worse?

The main cause of periodontal (gum) disease is plaque, but other factors affect the health of your gums. A variety of factors can affect periodontitis. Other factors can modify how your gums react to plaque or calculus, thereby altering your body's response to the disease and affecting your overall health.

Smoking

The worst offender is smoking. Tobacco use is linked with many serious illnesses such as cancer, lung disease and heart disease, as well as numerous other health problems. Tobacco users also are at increased risk for periodontal disease. Studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease.

Genetic predisposition

Though nearly ¾ of the world's population has some form of periodontitis, a genetic predisposition is the single biggest determinant as to how serious each case gets. Some individuals are more prone to periodontitis than others. Some get a mild form, while others get a severe case. It is likely we inherit a genetic predisposition to periodontitis, and this influences how severely it will affect us.

Other Systemic Diseases

Other systemic diseases that interfere with the body's inflammatory system may worsen the condition of the gums. These include cardiovascular disease, diabetes, and rheumatoid arthritis.

Stress

Stress is linked to many serious conditions such as hypertension, cancer, and numerous other health problems. Stress also is a risk factor for periodontal disease. Research demonstrates that stress can make it more difficult for the body to fight off infection, including periodontal diseases.

Poor Nutrition and Obesity

A diet low in important nutrients can compromise the body's immune system and make it harder for the body to fight off infection. Because periodontal disease begins as an infection, poor nutrition can worsen the condition of your gums. In addition, research has shown that obesity may increase the risk of periodontal disease.

Medications

Some drugs, such as oral contraceptives, anti-depressants, and certain heart medicines, can affect your oral health. Just as you notify your pharmacist and other health care providers of all medicines you are taking and any changes in your overall health, you should also inform your dental care provider.

Be aware of another common side effect of many medications: dry mouth. When the salivary flow decreases, you need better oral hygiene since decay and inflammation may increase. If you sense your mouth is dry, clean your mouth frequently, and rinse often with water.

Hormonal changes - Gum Disease and Women

A woman's periodontal health may be impacted by a variety of factors.

Puberty

During puberty, an increased level of sex hormones, such as progesterone and possibly estrogen, causes increased blood circulation to the gums. This may cause an increase in the gum's sensitivity and lead to a greater reaction to any irritation, including food particles and plaque. During this time, the gums may become swollen, turn red and feel tender.

Menstruation

Occasionally, some women experience menstruation gingivitis. Women with this condition may experience bleeding gums, bright red and swollen gums and sores on the inside of the cheek. Menstruation gingivitis typically occurs right before a woman's period and clears up once her period has started.

Pregnancy

Some studies have suggested the possibility of an additional risk factor – periodontal disease. Pregnant women who have periodontal disease may be more likely to have a baby that is born too early and too small. However, more research is needed to confirm how periodontal disease may affect pregnancy outcomes.

All infections are cause for concern among pregnant women because they pose a risk to the health of the baby.

Menopause and Post-Menopause

Women who are menopausal or post-menopausal may experience changes in their mouths. They may notice discomfort in the mouth, including dry mouth, pain and burning sensations in the gum tissue and altered taste, especially salty, peppery or sour.

In addition, menopausal gingivostomatitis affects a small percentage of women. Gums that look dry or shiny, bleed easily and range from abnormally pale to deep red mark this condition. Most women find that estrogen supplements help to relieve these symptoms.

Who treats gum disease (periodontitis)?

Your dentist should be the first line of defense in treating your gum condition. Once he or she discovers that you have periodontitis, they should initiate a program to return your gums to good health.

Many dentists employ dental hygienists. Hygienists are specially trained to recognize and treat the early stages of periodontitis. (However, there are limits as to what hygienists can do for patients).

In advanced cases of periodontitis, improved oral home care and thorough dental cleanings are not enough. More has to be done to the pockets and bone.

Many dentists are comfortable performing these procedures, and can effectively treat your periodontal condition.

Most dentists prefer to recommend dental specialists to treat advanced periodontal cases. That is where periodontists enter the picture.

Most people do not know what periodontitis is or even that the specialty of Periodontics exists. In a sentence, periodontists are charged with saving teeth. That is their mission and goal for all patients. They utilize many types and techniques of treatment to achieve this goal. 

When teeth cannot be saved and need to be removed, they are often replaced with dental implants. These dental implants are as strong, and allow the patient to keep an intact set of teeth (dentition) without the need for removable bridges or dentures.

Is there a link between gum disease (periodontitis) and other illnesses?

Until recently, periodontitis was considered a localized problem with little or no effect on our overall health and well-being. Continuing research, however, has shown that periodontitis may have powerful and multiple influences on the onset and severity of many systemic conditions and diseases.

Periodontitis is a serious infection caused by plaque bacteria. Although much of the bacteria are confined to the pockets around the teeth, the micro-organisms that make up the plaque can invade the gum tissue and enter the bloodstream, circulating throughout the body. 

Once inside, the bacteria are able to secrete destructive chemicals and virulence factors. These factors activate the body's immune system to respond much in the same way as the body responds to infected cuts or illnesses like pneumonia - with inflammation, pain, and destruction of the tissues. 

Women, in particular, have special health needs during certain periods of their lives. These come during periods of maturity and change in their bodies: puberty, menstruation, pregnancy and menopause. What is not so widely known is that women's oral health needs can also change during these times.

Cardiovascular disease

Heart Disease

Several studies have shown that periodontal disease is associated with heart disease. While a cause-and-effect relationship has not yet been proven, research has indicated that periodontal disease increases the risk of heart disease.

Scientists believe that inflammation caused by periodontal disease may be responsible for the association.

Stroke

Additional studies have pointed to a relationship between periodontal disease and stroke. In one study that looked at the causal relationship of oral infection as a risk factor for stroke, people diagnosed with acute cerebrovascular ischemia were found more likely to have an oral infection when compared to those in the control group.

Diabetes

Diabetic patients are more likely to develop periodontal disease, which in turn can increase blood sugar and diabetic complications.

People with diabetes are more likely to have periodontal disease than people without diabetes, probably because people with diabetes are more susceptible to contracting infections. In fact, periodontal disease is often considered a complication of diabetes. Those people who don't have their diabetes under control are especially at risk.

Research has suggested that the relationship between periodontal disease and diabetes goes both ways - periodontal disease may make it more difficult for people who have diabetes to control their blood sugar.

Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. This puts people with diabetes at increased risk for diabetic complications.

Gum Disease and Other Systemic Diseases

Osteoporosis

Researchers have suggested a link between osteoporosis and tooth loss. Studies suggest that osteoporosis may lead to tooth loss because the density of the bone that supports the teeth may be decreased, which means the teeth no longer have a solid foundation.

Respiratory Disease

Research has found that bacteria that grow in the oral cavity can be aspirated into the lungs to cause respiratory diseases such as pneumonia, especially in people with periodontal disease.

Cancer

Researchers found that men with gum disease were 49% more likely to develop kidney cancer, 54% more likely to develop pancreatic cancer, and 30% more likely to develop blood cancers.

What is the big deal if I lose a tooth?

Besides helping us look good, teeth are important for a host of other reasons.

For one, strong firm teeth enable us to chew our food more comfortably. Properly masticated food makes for better digestion.

Everyone likes a healthy, bright smile. First impressions count. Besides making you look and feel good, teeth help us to speak clearly. People, who have had the misfortune of losing all their teeth and wearing dentures, can have difficulty speaking. They also cannot eat all the things they want, are often self-conscious about their "choppers," complain that they cannot taste their food as well as they used to, and may even have trouble breathing when they sleep.

Losing a tooth or teeth has an effect on the remaining teeth. A full complement of teeth arranged in an arch is stable (teeth do not move). This stability is lost when you lose a tooth or teeth. Remaining teeth move, and interfere with others. The net result is losing more teeth.

Those are enough reasons to keep our teeth, and the best way to start is with good oral hygiene.

Is maintenance required after periodontal treatment?

Yes, in most cases. As mentioned earlier, periodontitis is a chronic condition that is not cured but can be stabilized and maintained. Periodontists have a great track record when it comes to getting periodontal conditions under control. Once the initial treatment has been completed, maintenance care is essential for future good oral health.

Periodontitis often follows certain patterns. Pockets and bone loss usually begin in the maxillary (upper) molars, followed by the mandibular (lower) molars. In time, it will involve other teeth as well.

Once formed, periodontal pockets do not get worse on a daily basis. Rather, pockets can remain stagnant for long periods of time, only to have short bursts of problems when they worsen, only to become stabilized again. We call this periodontal breakdown "episodic." Along the way, abscesses can occur, and pockets and bone loss can progress to the point that teeth need to be removed. Treatment retards and, in many instances, can even stop this progressive gum/bone deterioration.

 

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