What is periodontal disease?
Periodontal disease or periodontitis is a very common condition in which the gums and deeper periodontal structures surrounding the teeth become irritated and/or inflamed. Many adults have some form of periodontal disease but they don’t realize it because in the beginning stages it is relatively painless. As the disease progresses, this inflammation, which usually takes the form of redness, swelling and a tendency to bleed during tooth brushing, is the body’s response to certain disease-causing bacteria that have been allowed to accumulate on the teeth in the form of dental plaque. Although part of the body’s defence system, this inflammatory response can eventually cause serious damage. If left unchecked, the inflammation can spread down below the gums and along the roots of the teeth, causing destruction of the periodontal ligament and the supporting bone. This ultimately leads to the formation of gum abscesses, loosening of the teeth and, eventually, tooth loss. The inflammation caused by periodontal disease can also have implications for general non-dental health.
Do I have periodontal disease? What are the signs?
- Bleeding from the gums during brushing or flossing
- Shredding of the dental floss when flossing
- Bad breath
- Receding gums
- Gaps appearing in between the teeth at the gum line
- Tenderness in the gums when touching
- Swollen gums
- Loose teeth
- Drifting teeth
- Abscesses in the gums.
Generally, it is not always possible for a patient to determine the extent or severity of periodontal disease that they are suffering from. For this reason, a consultation with your dentist is highly recommended if you suspect that you have periodontal disease. Once the dentist performs a thorough check on you gums they can determine if the severity of periodontal disease is severe enough to warrant a referral to a periodontist. Alternatively, you may wish to directly see a periodontist if you are concerned about the health of your gums.
Are there any risk factors for periodontal disease?
Are all types of periodontal disease the same?
No. It is recognized that there are several different sub-types of periodontal disease such as aggressive periodontitis which demonstrates rapid progression and periodontitis associated with systemic diseases such as immune deficits. However, most periodontal disease in the community may be classified as chronic periodontitis. It is important for the subtype of periodontal disease to be diagnosed accurately in order for treatment to be effective.
Does periodontal disease have any implications for health outside the mouth?
A large body of recent research has revealed that having untreated periodontal disease can have effects on general health. For example, it poses an increased risk for complications during pregnancy (pre-eclampsia, premature birth and low birth weight) and also an increased risk for heart disease, diabetes and numerous other chronic conditions. Thus, whilst treating and eliminating periodontal disease is essential in ensuring the longevity of the teeth, it is also important for a patient’s general health.
Can periodontal disease be transmitted from one person to another?
The technical answer for this question is yes. Periodontal disease can be passed from parents to children and between intimate partners. Molecular genetic techniques have shown that the specific types of bacteria that a parent has can be identical genetically to that possessed by their children. This is also true in 20% to 30% of married couples. Bacteria can be transferred from one person to another through saliva. Intimate kissing and sharing of food, utensils or toothbrushes can result in exposure to saliva that contains the bacteria that cause periodontal disease. However, although bacteria can be spread by kissing, the bacteria by themselves are not enough to cause the disease. You would also have to neglect your teeth and not practice good oral hygiene to become infected with periodontal disease.
What does treatment of periodontal disease involve?
Oral hygiene instruction and advice
The aim of the oral hygiene phase of treatment is to reduce the number of bacteria in the mouth and therefore reduce the level of inflammation. Your periodontist will first explain the causes of your periodontitis and explain exactly how to keep your teeth and gums clean. You will be given individual advice on how to use the various cleaning aids most effectively; for example, the most appropriate tooth brushing type and technique and the correct use of dental floss and interdental brushes.
All soft and hard deposits will be removed from the tooth and root surfaces by the periodontist. This will involve cleaning deep in the diseased pockets that exist in between the tooth and the gums. The cleaning will be done to a specialist level and is usually performed over two appointments. Local anaesthetic will generally be required to completely numb the gums and teeth to facilitate this deep cleaning. Some mild discomfort may be experienced when receiving the local anaesthetic but once the areas have been completely numbed there is no discomfort whatsoever during the treatment.
In some cases, antibiotics may be prescribed in conjunction with periodontal treatment to deal with active or persistent gum infections. The decision whether to prescribe antibiotics or not is made clinically by the periodontist and will vary from patient to patient depending on their individual case. It is important to note that provision of antibiotics alone in the absence of root cleaning is ineffective in treating periodontal disease. This is because once the antibiotics have been ceased the bacteria merely re-populate the periodontal tissues from the root surfaces and disease progression continues.
After about three months, the periodontist will make a full reassessment of your gums to check the progress of your treatment. Periodontal pockets and bleeding on probing scores will be assessed and compared to that of the initial appointment. If deep periodontal pockets are still present, further treatment options may be suggested, including surgical corrective therapy.
Corrective (surgical) treatment
Sometimes, a surgical procedure is carried out to clean away plaque bacteria and deposits that are under the gum within deep periodontal pockets and on the root surfaces at the furcations (where the roots diverge). These areas are inaccessible to brushes and floss and inflammation will persist in these sites as long as bacteria are allowed to colonize them. Under local anaesthesia, the gum is lifted away and the root surfaces are cleaned under direct vision to ensure that all bacteria are removed. The surrounding bone may also be recontoured in order to ensure that the deep pockets are eliminated. Sometimes, it is possible to perform special regenerative treatment which can gain back some of the lost bone. At the end of the procedure, the gums are sutured back into place around the teeth.
Aftercare – supportive periodontal therapy
The long-term success of periodontal treatment depends both on your own efforts with oral hygiene and those of the practice team who provide your regular care and ongoing assessment. After the first phase of treatment has been completed, the periodontist will need to review the condition of your gums to check that the inflammation has been halted. If the disease has been stabilised then you will be placed on regular recall for periodontal maintenance. This recall is usually with your own dentist or hygienist. However, if the periodontist feels that you may be at risk of disease recurrence or that you may be highly susceptible to periodontal disease then you may be placed on recall appointments alternating between your dentist/hygienist and the periodontal practice or even exclusively at the periodontal practice. The frequency of your follow-up appointments will depend on the severity of disease and your individual risk of disease progression. Usually, follow-up visits are scheduled for every three to six months.
Regular follow-up appointments are critically important to ensure that the disease process does not recur, causing further destruction of the gums and supporting bone. If there are signs of continuing disease, your dental practitioner will be able to identify new or recurring sites of inflammation and treat them at an early stage. You will also be given advice on how to modify your oral hygiene practices to tackle the inflammation.
All periodontal research is conclusive in determining that periodontal treatment requires your full co-operation in regard to daily oral hygiene practices and attendance at regular follow-up appointments in the long-term.
What can I expect immediately following periodontal treatment?
There will often be increased sensitivity to hot and cold on most of the teeth. This is because as the gums heal and the inflammation subsides there will be some tightening and shrinkage of the gums. This will expose the root surfaces which do not have the enamel protection that the teeth do. This increased thermal sensitivity takes longer to die down but can suitably be managed in the interim period with the use of desensitising toothpastes.