Periodontic Treatment (Gum Disease)

What is Periodontal Disease?

Periodontal disease, also known as gum disease, is a serious inflammatory disorder that, left untreated, can lead to tooth loss. The word periodontal literally means ‘around the tooth’. Periodontal disease is a chronic inflammatory disease that affects the gums and bone supporting the teeth. Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colourless film that constantly forms on your teeth) causes the gums to become inflamed.

Types of gum disease

Untreated gingivitis can advance to periodontitis and can eventually lead to tooth loss and other health problems.

Gingivitis

Gingivitis is the mildest form of periodontal disease. It causes the gums to become red, swollen and bleed easily. There is usually little or no discomfort at this stage. Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with professional treatment and good oral home care.

Factors that may contribute to gingivitis include diabetes, smoking, ageing, genetic predisposition, systemic diseases and conditions, stress, inadequate nutrition, puberty, hormonal fluctuations, pregnancy, substance abuse and certain medication use.

Periodontitis

Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body, in essence, turns on itself and the tissues and bone that support the teeth are broken down and destroyed.

Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.

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There are many forms of periodontitis. The most common ones include the following.

Aggressive periodontitis

Aggressive periodontitis occurs in patients who are otherwise clinically healthy. Common features include rapid attachment loss and bone destruction and familial aggregation.

Periodontitis

Periodontitis as a manifestation of systemic diseases often begins at a young age. Systemic conditions such as heart disease, respiratory disease, and diabetes are associated with this form of periodontitis.

Chronic periodontitis

Chronic periodontitis results in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss. This is the most frequently occurring form of periodontitis and is characterised by pocket formation and/or recession of the gingivae. It is prevalent in adults but can occur at any age. Progression of attachment loss usually occurs slowly, but periods of rapid progression can occur.

Necrotizing periodontal

Necrotizing periodontal disease is an infection characterised by necrosis of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions such as HIV infection, malnutrition and immunosuppression.

How is gum disease treated?

The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keeps up good daily care at home. This may also include changing certain behaviours, such as quitting smoking, as a way to improve treatment outcome.

Deep cleaning (scaling and root planning)

The dentist removes the plaque through a deep-cleaning method called scaling and root planning. Scaling means scraping off the tartar from above and below the gum line. Root planning gets rid of rough spots on the tooth root where the germs gather and helps remove bacteria that contribute to the disease.

Referral to a specialist periodontist may be necessary if the condition of the gums does not improve after having a deep clean.