Patient Guide To Periodontal Disease

Periodontal disease affects millions of people and it is the main cause of tooth loss.

In the early stages Periodontal Disease is a ‘silent’ condition and you may not be aware that a problem exists until the disease is quite advanced, which is why it is very important to have regular check ups so that we can detect any problems in the early stages of the disease.

What is Periodontal Disease?

Each tooth consists of two parts namely the crown, which is visible in the mouth and the root, which anchors the tooth into the bone. Each front tooth has one root whilst the back teeth have one, two or three roots.

The gums are a specialised type of skin that surrounds the teeth and covers the bone holding in the teeth. Often the gums will look essentially normal even though a gum condition is present and this is why a thorough examination by a dental professional is required to detect a gum problem.

Gingivitis is a superficial infection that is limited to the gum tissue and does not affect the underlying bone. The gums may look normal but may have some of the following signs – redness and puffiness, bleeding when brushing and bad oral odour (Halitosis).

When the infection advances and affects the supporting ligament and underlying bone, it is termed Periodontitis (once called Pyorrhoea).

Periodontitis ‘eats away’ at the bone that supports the teeth and if untreated can lead to tooth loss. The gums may appear red and swollen, spaces may begin to appear between the teeth, there may be loosening of the teeth, signs of receding gums an vague aching, itching or other discomfort of the gums.

The good news is that most periodontal diseases can be treated.

What causes Periodontal Disease?

Plaque is a primary cause of Periodontal Disease. It is a sticky, almost invisible film that forms daily on our teeth. Plaque is a continually spreading mass of disease-causing bacteria and their waste products, which grow on the teeth and down in the crevice between the gum and tooth. The bacteria produce toxins (poisons) that damage the gums and underlying bone.

Plaque build-up irritates the gums, and they become inflamed. In time the periodontal fibres that attach the teeth to the bone are destroyed and the underlying bone is lost, the crevice deepens which creates a ‘pocket’ which then fills with more plaque. In large amounts plaque can be seen and can be felt with tongue as a fuzzy, unclean coating on the teeth. If you do not completely remove all the plaque every day by tooth brushing and cleaning in between the teeth, it leads to the formation of calculus (tartar), a stony crust with a pitted, rough surface. You cannot remove calculus yourself- it clings to the teeth with such force that only a dentist or hygienist can remove it.

As the gum disease continues so does the bone destruction. When sufficient bone has been lost the tooth loosens. Finally, deprived of most of the supporting bone, the tooth becomes so loose that is either falls out or must be extracted. As the pockets get deeper, and the plaque hardens into tartar more plaque accumulates on top.

Tartar moves down to the root of the tooth It is possible to see the calculus that forms above the gum margin however it is the hidden calculus under the gums that does the harm. Calculus greatly complicates the problem of preventing the progression of Periodontal Disease. The toxins produced by the bacteria in plaque not only affect the gum but also destroy the periodontal fibres and will eventually destroy the bone supporting the tooth.

As the gum disease continues so does the bone destruction. When sufficient bone has been lost the tooth loosens. Finally, deprived of most of the supporting bone, the tooth becomes so loose that is either falls out or must be extracted.

In recent studies, health problems have been linked with people who have Periodontal Disease. Studies have shown that bacteria from the mouth can enter the bloodstream which is being increasingly associated with:

  • The increased risk of heart disease, fatal heart attacks and strokes
  • Make it more difficult for diabetic patients to control their blood sugar
  • Lead to reduced birth weight and premature babies for pregnant women

Other factors that contribute to an increased risk of developing Periodontal Disease include:

  • Smoking
  • Systemic diseases e.g. diabetes
  • Many medications e.g. steroids, blood pressure medications
  • Pregnancy
  • Plaque retention factors e.g. crowns and bridges that no longer fit and overcrowding of the teeth

A periodontist is one of the nine specialties recognized by the General Dental Council. From the Greek word “peri” meaning “around” and odons signifying “tooth,” a periodontist deals with the gums and supporting structures around your teeth. A periodontist can be seen in conjunction with your regular dentist for the treatment and maintenance of gum disease. A periodontist has many treatment options to restore gum disease to health. Typically, the initial treatment may include a non-surgical method of scaling and root planning. Plaque , tartar, rough cementum and diseased tissue is removed from the surrounding tooth and root surface. This method is called NSPT (Non-Surgical Periodontal Therapy) in which the bacterial viruses are eradicated to promote healthy re-growth.

If the disease is in an advanced stage, periodontal surgery can be employed. Some commonly prescribed surgeries include: pocket reduction (also known as gingival flap surgery), regeneration, crown lengthening, bone graft or soft tissue graft. In these procedures your periodontist will either fold back your gums to remove infection-causing bacteria, eliminate an overgrowth of gum tissue, replace lost bone or cut off tissue from elsewhere in your mouth and attach it to your gumline.

BPE (Basic Periodontal Examination) – The standard World Health Organisation screening process for gum condition is known as the BPE (Basic Periodontal Examination).

The mouth is divided into six sections referred to as sextants. (Upper and lower: front, right back and left back.)

A blunt probe with a 0.5mm ball at the end is carefully and gently placed in the space between the tooth and gum at 4-6 points round each tooth and the deepest pocket in that section of the mouth is noted in a 6 part grid (see example below). The other factors noted are the presence of plaque or calculus above and below the gum margin, and whether the gum bleeds at the slightest touch.

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