The soft tissue surrounding the base of your teeth are known as gums, or in medical terms, gingiva (plural gingivae). When the gingivae of your mouth become infected, this is known as gum disease. It can lead to swollen, inflamed or bleeding gums, as well as tooth decay.
How Common Is Gum Disease?
Gum disease, also called periodontitis or periodontal disease, is quite common - affecting almost half of adults living in the UK. The World Health Organization (WHO) estimates that there are approximately 1 billion cases of severe periodontal disease worldwide.
What Factors Increase The Risk For Periodontal Disease?
- Age - periodontal disease is prevalent amongst the elderly population.
- Sex - more men are affected than women.
- Lifestyle habits - smoking and poor dental hygiene is a major contributor.
- Disease - having diabetes, autoimmune diseases, cancer or HIV/AIDS.
- Genetics - certain genetic factors create a predisposition to periodontal disease.
Symptoms Of Gum Disease
Gum disease might cause persistent bad breath, loose or shifting teeth, sore, red or swollen gums and sensitive and painful teeth. You might also notice your gums receding or pulling away from your teeth, or bleeding when you brush your teeth.
Stages Of Periodontal Disease
Periodontal disease progresses in different stages as the condition gets worse.
Stage 1: Gingivitis
Plaque is a film of bacteria and leftover food particles that get stuck to your teeth. The acid produced by plaque eats away at the protective layer of your teeth, known as the enamel. When plaque is not removed within 72 hours, it solidifies into what is known as tartar. The build-up of plaque or tartar at the gumline of the teeth leads to gingivitis, which is an inflammation of the gums. Gingivitis can cause swollen, red and tender gums which are prone to bleeding easily, especially when brushed. If treated promptly, this condition is reversible.
Stage 2: Mild Periodontitis
Once gingivitis progresses to periodontitis, the gums begin to recede. Pockets develop below the gumline of the teeth. These pockets fill with plaque, food particles and bacteria. The bacterial infection of the gums begins to eat away at the tooth and bone. While the bone loss is not reversible, mild periodontitis can be managed to prevent the progression of the disease.
Stage 3: Moderate Periodontitis
At this stage of progression, the pockets below the gumline deepens. Consequently, more bacteria and debris get trapped deeper below the gumline. This leads to the spread of infection to the jawbone, and even the bloodstream.
Stage 4: Severe Periodontitis
In advanced periodontitis, the infection of the gums has spread to such a large extent that teeth can be lost. The gum line has receded and there isn’t enough bone to support the teeth, causing them to loosen. There can also be pain and difficulty when chewing, bad breath, and abscess or pus formation.
What Can Cause Periodontitis?
Plaque build-up is the main cause of periodontitis. It causes gingivitis and if not cleared, can further the progression of gum disease.
A lack of oral hygiene practices such as tooth brushing and flossing, causes plaque to harden into tartar against the tooth gum line.
Medicines which cause dry mouth and affect the flow of saliva can cause bacteria to overgrow in the mouth. Anticonvulsants such as phenytoin, and calcium channel blockers such as nifedipine cause the gingiva to enlarge.
Diseases that cause the immune system to attack its own tissues, like cancer and HIV/AIDS can lead to gum inflammation and progression of periodontitis. Due to the lack of blood sugar control, diabetics are more prone to bacterial infections, including gum disease and tooth cavities.
A family history of gum disease and certain genetic variations can contribute to the development of gum disease.
How Can Gum Disease Be Treated?
Your dentist will have to do a full oral examination, including an X-ray to ascertain the extent of bone loss. Your medical history will also be taken into account.
The goal of treatment is to prevent further progression of gum disease and improve dental health. The type of treatment depends on the stage of the gum disease.
The first step would be to do a deep cleaning of gums and teeth. Plaque and tartar may have to be cleaned out from the pockets which have developed below the gum line. Your dentist may use techniques such as root planing and scaling.
This involves local anaesthetic application as plaque and tartar is removed from the pockets. In the process of dental planing, the roots of your teeth are made smooth to allow for the gums to reattach to them. Scaling involves filing or scraping away plaque and tartar from the surface of the teeth to make them clean. This may cause tooth sensitivity.
Your dentist can also prescribe medication or surgical interventions to treat gum disease and its associated complications.
What Medication Is Used To Treat Gum Disease?
Antibiotics, such as metronidazole and tetracycline, can treat infections and abscesses caused due to gum disease. It’s important to avoid the consumption of alcohol when taking metronidazole.
After deep cleaning, an antibiotic or chlorhexidine chip may be placed into the pockets of the gums to be released slowly over time. An antibiotic gel can also be prescribed to spread over the gums to prevent infection.
Mouthwashes containing chlorhexidine or hydrogen peroxide are advised to help prevent infection. Fluoride or triclosan-containing toothpastes are also recommended.
Based on your dentist’s evaluation, laser therapy can be a suitable option to treat later stages of gum disease. It’s non-invasive and reduces the chances of tooth sensitivity as compared to other treatments.
How Can Surgery Help With Gum Disease?
Where your gums have receded, a soft tissue graft can be done. This involves taking tissue from elsewhere in your mouth, such as your palate and stitching it to affected areas that require coverage. A bone graft can also be done to replace bone loss due to advanced gum disease. Tissue engineering solutions can stimulate bone to regenerate faster.
Flap and bone surgery is another option that involves lifting the gums back and removing plaque and tartar. Bone below the gum line is resurfaced and smoothened to allow the gums to adhere better and prevent bacterial growth.
Book a consultation with your dentist to get an evaluation and decide on the best treatment options for you.