Healthy gums, healthy body
Gum Disease
About Gum Disease
Gum disease (periodontitis) is caused by bacteria (plaque/biofilm) and the body’s inflammatory/immune response to it. In a healthy mouth, gums are pink and tight around the teeth. Poor cleaning leads to plaque buildup, causing inflamed and bleeding gums (gingivitis) — the first, reversible sign of gum disease.
In susceptible patients, the increased inflammatory / immune response can cause irreversible damage, leading to bone loss, gum recession, and eventual tooth loss if untreated. Periodontitis doesn’t affect all teeth equally; some may have mild/moderate disease while others have severe disease, requiring different management.
A Patients view
The Sound of Periodontitis
Gum Disease FAQs
It is the 6th most common disease in humans! About 50% of all adults will suffer from gum disease at some point in their life and in most people, the disease is chronic (slowly progressing over many years). However, some people (approximately 15-20%) are susceptible to it and can suffer from more severe forms of disease which leads to more rapid bone loss and can lead to tooth loss earlier. Although caused by bacteria, it is not like a typical infection such as a lung infection where for example, antibiotics on its own might help. This is not the case.
Gum disease has been shown to contribute to the most years lost to disability (due to loss of teeth, lack of function) than any other human disease and severe disease affects almost 1 billion people worldwide.. Patients with gum disease are at risk of losing teeth which can affect chewing function, teeth can drift or become gappy affecting aesthetics and speech as well as cause discomfort and affect our confidence and quality of life.
Gum disease can be an innocuous disease, in the sense that it does not always cause symptoms until it progresses (a ‘silent disease’) and so you may be unaware of it until your dentist or hygienist identifies it. It is possible to have the disease and not be aware of these signs.. In addition, some people brush really well and are still susceptible to gum disease and others are not. In many ways it is therefore a bit of an unfair disease.
There are some ‘red flags’ (symptoms that you may notice that mean you should get your gums checked):
- Bleeding gums when brushing or even whilst eating
- Red or swollen gums
- Bad breath
- Spaces appearing between teeth
- Drifting teeth (teeth moving position in the mouth)
- Loose teeth
- Receding gums
- Sensitivity to cold or hot foods and drinks
Risk factors increase the chance of developing disease or increase the chances of it being more severe. There are a number of factors that increase your chance of developing periodontitis and make it more likely to progress. Research has shown that great gum health is important for your smile, comfort, confidence, and quality of life.
Smoking and diabetes have been shown to be the biggest risk factors for gum disease in addition to genetics, age and lifestyle factors. Stress also increases the risk of gum disease being more severe. Sometimes some medical conditions or deficiencies (such as Vitamin D deficiency) can also increase your risk of gum disease. In addition, there has been a great deal of research about possible effects of gum disease on your general health.
Gum Disease & General Health Links
There is growing evidence of the importance of the oral microbiome in gum disease entering the bloodstream and triggering low levels of inflammation and impacting our body in general. Gum disease has also been linked to several conditions: diabetes, heart disease, kidney disease, COPD, Rheumatoid Arthritis and Osteoporosis.
In particular, patients with gum disease are at a higher risk of developing Diabetes, and heart complications (including angina and strokes). Some studies have also shown links with Alzheimer’s, dementia, and adverse pregnancy outcomes.
The Mouth - A Reflection of Our Health
Treatment Of Gum Disease
Nearly all patients with gum disease will go through four steps of treatment depending on its severity. Depending on the severity of disease and your oral hygiene, our Specialist Periodontist will provide a treatment plan that is individual to you.
All patients will need Steps 1 and 2 of treatment (a non-surgical phase of treatment), and some patients will need some additional treatment like periodontal (gum) surgery. The most important final step is maintaining your gum health.
Step One
Oral Hygiene
At this stage we need to focus on your cleaning and things that make you more susceptible to gum disease (risk factors). This is about getting things clean on top and helping you to improve your brushing techniques and providing a personalised regime for you.
Step Two
Deep Cleaning
After reviewing how well you are improving your oral hygiene routine, a deep clean can be carried out. This involves cleaning below the gum line, removing the bacteria biofilm within the ‘pockets’ where you can’t reach with brushing. A local anaesthetic is used in the same way you would have for example for a simple filling, making it comfortable for you. The treatment is usually carried out over two visits, but can be carried out in a single session (Full Mouth Debridement).
After the procedure, we will go through simple aftercare instructions and how to keep things clean. You can go to work straight after, and carry out your normal day to day activities.
Periodontal Therapy
Step Three
Periodontal Surgery (If required)
This step is for any ‘residual pockets’ and may involve a further course of deep cleaning or periodontal (gum surgery) for residual areas of active gum disease. This step may not be required if everything has responded well following Step 2.
Step Four
Supportive Periodontal Care
Supportive Periodontal Care (maintenance, usually every 3 months with a hygienist, or your dentist). This is the most important step to keep your gum health in check. Maintaining gum disease is lifelong and requires long term maintenance for success.
re-assessments Between Steps
Our Periodontist will reassess your response to treatment 3 – 6 months later, to check if you are ready to move to the next step (Step 3 or 4). Another ‘Detailed Pocket Chart’ is carried out to check for pockets that are left, and whether you need any further treatment. We will also check how you are doing with your brushing.
Importance of Oral hygiene
As 80% of the management of gum disease is about how well you clean your teeth at home, on a day to day basis, developing a meticulous oral hygiene regime and maintaining it is the key to the success, otherwise treatment will only be partially successful.
If you are susceptible to gum disease, you need to be better than the average person in terms of brushing. This means that you will need to consider how you can set aside some dedicated time to meticulously clean your teeth on a daily basis for ‘biological reasons’ to fight disease and not just for ‘social reasons’.
The Bass Tooth Brushing technique
Lifestyle Considerations
Gum disease is a medical condition like diabetes and heart disease that is influenced by our lifestyle. This means making changes to your diet, improving sleep, exercising more and reducing stress levels can help. While stress doesn’t directly cause gum disease, it can make it worse.
Research suggests that a typical diverse Mediterranean-style diet rich in fresh fruits & colourful vegetables can boost antioxidants and reduce inflammation. Berries, and oily fish high in omega-3s, are great examples.
Sometimes supplements such as Vitamin D can also help if you are low (consult your doctor). If you smoke, quitting smoking is crucial for both gum and overall health. Smoking significantly increases the risk and severity of gum disease and reduces treatment response.
Success Rates of Gum Treatment
The success rates of gum treatment overall can be as high as 87-92% providing you follow a strict oral hygiene regime at home and visit the hygienist or therapist for regular maintenance every 3 months for as long as you can.
Successful treatment has been shown to retain teeth for 10-12 years longer (or more) than without treatment and patients who attend regularly for maintenance lose less teeth in the long term.
Side Effects of Gum Treatment
As your gum health improves, you will notice some differences that are part of the normal healing process. As the gums tighten up and the inflammation (bleeding) reduces, they shrink slightly. Most people notice some more gum recession and sensitivity as things heal.
The gum recession may not always be obvious but it may become a cosmetic concern for you if you show some gum when you smile. Once your periodontal health is stable, there may be options to improve this.