Periodontal disease, in other words, gum disease, has two common types: gingivitis and periodontitis.
Gingivitis
Gingivitis is the mildest and most common form of periodontal disease. Inadequate oral hygiene causes accumulation of dental plaque at the junction of the tooth and the gum. As a result, the gums become inflamed, with common visual signs being redness, swelling, and bleeding. There is usually little or no discomfort at this stage. However, bleeding gums are a sign of disease, as healthy gums do not bleed, and this can lead to more serious problems. Gingivitis is reversible with professional tooth cleaning and good regular oral care at home. It is important to seek professional assessment if gum bleeding is detected during brushing or eating.
Periodontitis
When gingivitis is unable to be controlled, the inflammation progresses to periodontitis, a common chronic disease that affects at least 25% of the adult population. Periodontitis is caused by dental plaque that contains destructive bacteria that result in the loss of the supporting structures around the teeth.
This causes the formation of ‘pockets’ around the teeth and/or recession of the gums. As is the case with gingivitis, inadequate oral hygiene is a risk factor for periodontitis, as are various systemic diseases (e.g., diabetes) and harmful habits (e.g., smoking). Genetic predisposition is a major contributor to the risk of developing periodontitis, and patients with a family history of periodontitis should have their gum health closely monitored.
Although periodontitis is not usually painful, common signs of the disease include gum recession (tooth getting long) and mobility (loosening) of the teeth. If untreated, periodontitis may result in the loss of teeth. With professional care the condition can usually be stabilised.
What is dental plaque?
Plaque is a sticky layer of bacteria that forms on the surface of the teeth, both above and below the gums. It can make the teeth ‘feel fuzzy’ when they have not been brushed. When plaque builds up on the teeth, it can lead to gum disease.
Treatment for periodontal diseases
Firstly, the dentist assesses the causes and grade in an examination. The goal is to inform you on treatments and desired outcomes.
There are many factors that influence the steps of your treatment and outcomes such as, dental plaque which is the cause of the disease, smoking, diabetes and others which need to be controlled.
Depending on your disease stage and grade, your dentist may increase “step up” or decrease “step down” your treatment until your gums are healthy.
Non-surgical periodontal Treatment
STEP 1 of periodontal treatment is to establish a good daily oral hygiene routine. Your periodontist will help you to fine tune your cleaning to ensure all plaque is removed from all tooth surfaces every day. They will provide pro-tips on the best ways to do this and the best tools to use for your mouth. Performing good oral hygiene every day is essential to ensure the disease is controlled and even prevented. In addition, other factors such as diabetes and smoking will be addressed.
STEP2 includes thorough cleaning the teeth, also known as deep cleaning. All plaque and tartar are removed from the teeth, often over several appointments using local anaesthetic to make the teeth and gums numb.
In some specific cases, antibiotics can also be given with this treatment. After these treatment steps, the gums are given time to heal.
In mild cases, no further treatment is needed. But in severe cases, bleeding gums and deep pockets might continue to be present. So further treatment is needed. This is STEP 3.
In STEP 3, step 1 & 2 can often be repeated. Or surgical periodontal treatment may be recommended. Common reasons for surgery include:
- To improve access to cleaning in difficult areas, such as the surfaces of the tooth roots.
- To make cleaning easier (pocket depth reduction).
- To reverse the damage (regenerative procedures).
- Graft tissue into areas where disease has caused the gum and bone tissues to be lost.
