Understanding Periodontal Disease

From causes and symptoms to treatments and outcomes, this insightful Q&A will tell you everything you need to know about periodontal disease.

What is periodontal disease?

Periodontal disease, often known as gum disease, is an inflammatory condition, which affects the teeth and supporting structures (gums, bone and ligaments). This disease is highly prevalent within the UK, and statistics have shown around 60 percent of adults suffer from a form of periodontal disease within their lifetime.

What causes it?

There are a number of factors which contribute to the development and progression of periodontal disease; bacteria, the body’s response/genetics and also a mechanical element.

There are millions of bacteria within our mouths, some good and some bad. Bacteria thrive within a sticky film called plaque. When the balance shifts in favour of the bad bacteria, known as pathogenic bacteria, disease can occur. This is often the result of a poor oral hygiene routine. The bacteria thrive within the areas underneath the gumline, which can spread into the surrounding tissues and bone, causing destruction.

Genes also play a large role to play within the development and progression of periodontal disease. Individuals may have genes predisposing to the development of periodontal disease and may also have genes which restrict natural healing of the periodontal tissues. Medical conditions, for example diabetes, could have a predispose an individual to developing periodontal disease.

The number of teeth present in the mouth, and the way they bite together, is important for a stable mouth. This will help to distribute the biting load evenly throughout all the teeth, preventing weak areas within the mouth which may develop periodontal disease.

Furthermore, local factors such as poorly contoured fillings and crowns, can retain plaque in difficult to reach areas.

What are the symptoms?

The main symptoms associated with gum disease are:

  • Bleeding when brushing, cleaning in-between teeth or biting into food
  • Bad breath (halitosis)
  • Receding gums
  • Painful gums
  • Abscesses
  • Mobile teeth
  • Teeth drifting out of place

It is very important not to underestimate these symptoms as this may lead to an advanced stage of the disease with the subsequent loss of teeth. Tooth loss may occur both in the short term and the long term.

What is the most drastic outcome of the disease?

Tooth loss may be considered the most drastic outcome of gum disease, but there are further problems which may occur throughout the body. Recent evidence suggests the bacteria and/or the inflammation associated with periodontal disease could play both a direct and indirect role in the onset of numerous other associated diseases. In particular, cardiovascular disease (heart attack and stroke), diabetes, pregnancy complications and osteoporosis.

How can the disease be treated?

Prevention is always better than the cure. If you suspect disease, or have any one of the symptoms present, it is always better to seek a dental professional’s advice.

After a thorough assessment of medical/dental/social histories, a dental professional will perform a clinical examination to provide a diagnosis. A probe is inserted between the tooth and gum to assess gum health and levels of attachment. In many cases, X-rays are necessary to check bone health around each tooth. The main treatment involves removing tartar (hardened on plaque) from teeth surfaces, either through a scale and polish, or in more advanced stages, root surface debridement (RSD). RSD involves deeper cleaning under the gum of the root surface of the tooth. More than 1 session may be needed, depending on the severity of the tartar build up. These sessions are combined with patient education, to help maintain a clean mouth at home between appointments. Sometimes antibiotics are used alongside periodontal treatment for certain types of periodontal disease; options include local delivery of antibiotics (placed within the mouth) or systemic delivery (tablets). In sites which do not respond to non-surgical periodontal therapy, surgery may be required. An adjunct to scaling treatment, however, is laser therapy.

Is it important to detect early?

Detecting disease early may stop the progression of a mild case of periodontal disease to a severe case. It can also stop the disease from affecting all teeth within the mouth. Getting an early diagnosis means treatment can holt the disease where it is, to stop further destruction which can give teeth a good life long prognosis.

What are the different surgical and non-surgical treatments available?

Non-surgical treatments involve scaling and root surface debridement (cleaning under the gum). This is where hard deposits of tartar are removed using mechanical and powered instruments by a dental professional. 

On occasion, it may be necessary to perform surgery to treat periodontal disease in areas which have not responded to non-surgical periodontal treatment. This involves removing a flap of gum to expose the root surfaces of a tooth/teeth for cleaning. This flap is then sutured back into its original position where it will heal.

In special circumstances, antibiotics are prescribed to patients as an adjunct to the treatment.

How effective are these treatments?

The outcome of treatment is heavily determined by patient compliance during their home care routine which will have been tailor made for them by their dental professional. If patients maintain low plaque levels during active periodontal treatment and during maintenance phases, the condition can be stabilised and symptoms reduce or eliminated. 

What is the best way to prevent the disease from developing in the first place?

Maintaining good oral hygiene levels is the best way to prevent gum disease. Good oral hygiene prevents the build-up of plaque, therefore, preventing gum inflammation and disease. Techniques used to avoid gum disease include brushing twice per day with an electric toothbrush, ensuring spaces between the teeth are cleaned using floss or interdental brushes. Dental care professionals can tailor oral hygiene advice to best suit each individual. Other prevention methods include stopping smoking, reducing alcohol consumption to the recommended guidelines and maintaining a healthy diet.

How regularly should we visit the dentist?

Advice given on the regularity of appointments with a dentist or dental care professional should always be followed. They will be tailoring the recall period based on the risks for dental health problems. Every patient should attend their dentist at least twice a year for an examination and a professional clean.

IMI Clinics offer Perioblast™, a minimally-invasive approach, combining the use of the Nd:YAG laser and a surgical microscope. This precise approach has proven to be consistently effective in restoring long-term periodontal health, no matter the form of the disease (aggressive or chronic).

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