Gingivitis is an infection affecting the superficial gum tissues. Your gums (latin – “gingiva”) may be inflamed (latin – “itis”), or bleed easily. Provided the correct and optimal treatment is undertaken, the effects of gingivitis are largely reversible.
Periodontitis is an infection causing damage to the deeper supporting structures; the ligament and bone that supports and holds your teeth (periodontal tissues). If left untreated it can lead to progressive bone loss, tooth mobility (loose teeth) and eventual tooth loss. Periodontitis is common, with the mild to moderate forms affecting over 30% of the adult population and more severe generalized form affecting approximately 15% of all adults in the USA. The incidence does vary between populations. There are well established guidelines that classify the severity of periodontal disease and who you should see to treat it appropriately. In the first instance you should ask your dentist whether you have a problem and how severe it is.
Periodontal diseases are diseases that are generally caused by bacterial plaque. This bacterial plaque produces toxins and enzymes that destroy the attachment of the gum to the tooth, and the supporting bone. Daily oral hygiene with effective brushing, and flossing can help prevent periodontal disease. Although, if the bacterial plaque is not removed, it can then calcify, (“calculus”) making it difficult to be removed without specialised tools and techniques. The severity of your individual response to plaque build-up on your teeth dictates whether you get the more early form, gingivitis, or with a more aggressive response, periodontitis.
There are several risk factors that predispose people to gum disease. Genetic, systemic and environmental. There is a genetic basis for the disease and you may inherit susceptibility to gum disease from your parents. The incidence of gum disease is significantly higher in smokers than non-smokers, and is harder to treat in smokers than non-smokers. Other factors that can affect the periodontal tissues are stress, various medications, pregnancy, medical conditions such as diabetes among others. You may have one or more of the risk factors that predispose you to periodontal disease – this is normally identified at your initial consultation appointment.
Bleeding and swollen gums are common to both forms of periodontal disease, gingivitis the minor form; periodontitis the severe form.
With periodontitis, you may also see one or more of the following:
Gingivitis can be treated by your general dentist, but advanced disease (periodontitis) should be treated by a specialist periodontist. If the disease is diagnosed early and the supporting bone is not significantly involved, non-surgical treatment by a dentist or periodontist is often enough. In most cases the initial phase treatment will be what is referred to as non-surgical scaling and root planing. If there is significant gum or bone loss, surgical treatment may also be required. The specific treatment varies between individuals, and the treatment you require will be discussed at your initial consultation appointment. If the bone loss is too advanced to save the tooth, implants can be used to replace missing teeth.
Once your gum disease has been stabilised, you enter what is referred to as the maintenance phase – stopping it from coming back. Normally you would see one of our hygienists for this part of treatment. We offer homecare instruction to optimise your homecare regime. Generally, the better your homecare, the less need you have for hygienist maintenance care. The frequency of this care will be 3, 4 or 6 monthly.
SCALING AND ROOT PLANING
Scaling and root planing, also referred to as non-surgical treatment, involves careful cleaning of the root surfaces to remove plaque and calculus (tartar) from deep periodontal pockets and to smooth the tooth root. This creates an environment where the gum can heal back against the tooth.
Scaling and root planing is performed under local anaesthetic with specialised ultrasonic cleaners as well as scaling instruments.
In most cases, the early stages of periodontal disease are best treated with non surgical periodontal therapy.
Even in severe cases, non-surgical periodontal therapy often precedes surgical therapy. This is done to improve the overall tissue quality prior to surgery and also to help limit the areas requiring surgery.
PERIODONTAL SURGERY
In cases where significant bony changes have accompanied periodontal disease or where pockets remain even after scaling and root planing, periodontal surgery is done to reduce pockets and improve the contour of the bone and gums around the teeth. Periodontal surgery involves reflecting (folding back) the gum line to create access to adequately treat the root surfaces and the supporting bone. The goal is to reduce pockets and improve the attachment level to the teeth so that you are you can maintain your teeth at home (with the help of a visit to a hygienist). Periodontal surgery is typically done under local anaesthesia and sometimes together with conscious sedation.
Treating periodontal disease is a partnership between you and your professional team – your dentist, periodontist, and hygienist.
We ask that you:
Periodontal disease should not be taken lightly and cannot, in general, be self treated. Most of the wonder cures sold over the counter are ineffective for anything but the mildest form of the disease. Frequently, these self-treatments only treat the symptoms while the disease progresses in the deeper tissues.
If left untreated, gum disease progresses in the deeper tissues leading to destruction of the supporting tissues around the teeth. As the supporting tissues are progressively lost, tooth mobility increased, pain increases and if the infection progresses too far, the teeth may be lost.
There is also strong evidence linking untreated gum disease to poor cardiovascular health, poorer blood glucose control in type II diabetics, pre-term babies and development of Alzheimer’s.