Gum disease

You may not know that you have gum disease. Often it's not painful and some people with gum disease have no symptoms. This is one of the reasons why it's important that you have regular check-ups with your dentist. They are trained to detect the early signs and advise you about what you can do in your day-to-day life to help keep your gums healthy. If you catch gum disease in the early stages, it can be treated by your dentist and its effects may be reversed.

About gum disease

Gum disease is caused by the same bacteria that cause dental caries (decay). It begins when bacteria in your mouth consume the sugary carbohydrates in the food you eat to produce plaque – a sticky, colourless film. If plaque isn't removed with thorough cleaning, eventually the damage goes beyond the tooth and progresses to the structures that support the teeth, including your gums.

This gradual destruction can result in tooth loss.

There are two type of gum disease: gingivitis and periodontitis.

Gingivitis

If plaque is not cleaned off regularly, it irritates and inflames the gums so that they become red, swollen and shiny and may bleed on brushing — this is gingivitis. The condition is completely reversible; if the plaque is removed, with effective twice-daily brushing using fluoride toothpaste and daily flossing, the gums will recover.

Periodontitis

If the plaque is not cleaned off the teeth, gingivitis may progress to a condition called periodontitis. The gums begin to pull away from the teeth, leaving a little pocket around the tooth. This pocket traps even more plaque that can't be reached with a toothbrush. Over time, the plaque hardens to form tartar (calculus). Plaque and tartar builds up, causing further irritation.

Gradually, the irritation spreads to the bony structures around your teeth and as the pockets get deeper and more difficult to clean, the gum and bone may shrink. This is periodontitis. The shrinking or receding of gums may expose some of the roots of your teeth, making teeth wobbly and sensitive and you may get gum abscesses (where pus collects under the gum). The body's own immune system gets involved and starts to attack its own cells and tissues making the damage worse. If periodontitis is left untreated over a number of years, your teeth may fall out or may need to be extracted by a dentist.

Periodontal pockets are not reversible, but with the appropriate treatment by your dentist and regular flossing and brushing, you can stop it progressing. If left untreated, the destruction of the tooth's supporting tissues worsens over time and is often more severe in people aged 45 and older.

Are you at risk of gum disease?

If you find it difficult to clean your teeth well, for example if you wear braces or dentures, or if you have irregularities in your teeth that you can't reach with a toothbrush, seek the advice of your dentist. Keeping all the surfaces of your teeth and your gums clean is a must to prevent oral health problems including periodontal problems and your dentist can give you individual advice.

Other factors that raise your risk of gum disease include:

• Smoking. This reduces the amount of oxygen-carrying blood reaching the tissues. It also weakens the immune system making it harder for your body to fight infection. Smokers also have more dental plaque than non-smokers and this makes it easier and faster for gum disease to progress more rapidly. Around a third of gum disease in Australia is caused by smoking.
• Diabetes. Diabetes can reduce your body's resistance to all types of infection, including oral infections.
• Conditions and medications that suppress your immune system. Conditions such as cancer and HIV/AIDS and the medications used to treat them can suppress the immune system and increase your risk of gum disease. Some of these medications reduce saliva flow, which can also be a risk. Saliva helps protect your teeth and gums from the bacteria that cause dental decay and periodontal diseases.
• Genetic susceptibility and ethnic background. It seems that some people are more prone to developing the condition than others, particularly people from certain ethnic backgrounds. This may be down to differences in diet between cultures, or it could also be due to genetic susceptibility to oral bacteria.

In all of these cases though, the main cause of the gum disease is the build up of plaque.

What can you do to prevent gum disease?

To prevent gum disease, the build-up of plaque and tartar on your teeth needs to be controlled. Regular visits to your dentist, careful regular teeth brushing and flossing are effective. It's also important not to smoke.

Your dentist can show you the correct way to brush, floss and use inter-dental brushes. Dental floss or inter-dental brushes are used to remove plaque and particles of food from between the teeth and under the gum line. These are areas that a toothbrush can't reach.

Even thorough brushing and flossing can't remove every trace of plaque. Most people have irregularities in their teeth where plaque can build up out of reach and harden into tartar. This can only be removed by your dentist.

Treatment of gum disease

If you or your dentist notice signs of gum disease, your dentist may ask about any symptoms and examine your gums. You will also be asked about your medical history as some conditions impact on your oral health, and vice versa.

The type of treatment you will receive depends on how severe your gum disease has become.

Scaling and surgery

If you have gingivitis, your dentist will clean your teeth thoroughly with gritty toothpaste using an electric toothbrush and special instruments called scalers. This type of thorough cleaning is called scaling. Your dentist may also recommend an antiseptic mouthwash that helps prevent plaque formation and teach you how to brush and floss your teeth properly, especially in the areas that you're not reaching.

If gum disease has progressed to periodontitis, more extensive scaling will be needed to remove plaque and tartar from the periodontal pockets. This may need to be done over several appointments. You may need to have your gums numbed with an injection of local anaesthetic before the scaling. This completely blocks the feeling from your gums and you remain awake during the treatment. Your dentist or hygienist will monitor the size of the pockets during the following months to ensure the treatment has been successful and the periodontitis isn't getting any worse.

Gum surgery

If the pockets are too deep for a dentist to clean simply by scaling, you may need gum surgery. Your dentist will refer you to a periodontologist (a specialist in treating gum disease) for this. Typically, the surgery involves making some cuts in the gum tissue so that it can be pulled back. This allows the periodontologist to see into the bottom of very deep pockets and clean the area much more effectively. Once all the plaque and calculus has been removed, the flap of gum is replaced with sutures (stitches).

For any of the treatments to be successful you have to put time and effort into cleaning your gums and teeth. Follow your dentist's advice and make sure you remove plaque every day. If you smoke, it's likely that treatment will be less effective and it's another reason to quit. For more information about quitting smoking, click here

Further Information

Australian Dental Association

www.ada.org.au

Sources

American Academy of Periodontology. Fallacies about gum disease. [online] Chicago, IL: American Academy of Periodontology. [accessed 27 May 2011] Available from: http://www.perio.org/consumer/2a.html

American Academy of Periodontology. Gum disease and diabetes. [online] Chicago, IL: American Academy of Periodontology. [accessed 27 May 2011] Available from: http://www.perio.org/consumer/mbc.diabetes.htm

Australian Dental Association (ADA). Gum Disease (Periodontitis). [online] St Leonards, NSW: ADA. Jan 2002 [accessed 27 May 2011] Available from: http://www.ada.org.au/faqs/faq,documentid,26919,category,Gum_Disease.aspx

Do LG Slade GD Roberts-Thomson KF et al. Smoking-attributable periodontal disease in the Australian adult population. Journal of Clinical Periodontology. 2008; 35(5):398–404.

National Institute of Dental and Craniofacial Research (NIDCR). Periodontal (Gum) Disease: Causes, Symptoms, and Treatments. [online] Bethseda, MD: NIDCR. [last revised April 2010, accessed 27 May 2011] Available from: http://www.nidcr.nih.gov/OralHealth/Topics/GumDiseases/PeriodontalGumDisease.htm

Slade GD Spencer AJ Roberts-Thomson KF, eds. Australia's dental generations: the National Survey of Adult Oral Health 2004–06. AIHW cat. no. DEN 165. Canberra: Australian Institute of Health and Welfare (Dental Statistics and Research Series No. 34). 2007.

University of Maryland Medical Center (UMMC). Periodontal diseases – causes. [online] Baltimore, MD: UMMC. [last reviewed 22 Jan 2009, accessed 27 May 2011] Available from: http://www.umm.edu/patiented/articles/what_causes_periodontal_disease_000024_3.htm

Last published: 30 July 2011

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