Gum disease

"Gum disease begins with plaque depositing on your teeth, without you being aware of it."

Our mouth is full of bacteria. These bacteria, along with saliva and other food particles, constantly form a sticky, colorless "plaque" on teeth. Proper brushing and flossing can remove plaque. When it accumulates to excessive levels and is not removed, it can harden into a substance called tartar (calculus) in as little as few days. Only a professional cleaning by a dentist or dental hygienist can remove tartar.

"Gingivitis and periodontitis are the two main stages of gum disease."

Gingivitis

Inflammation of the gums caused by bacteria is called as ‘gingivitis’. In this condition the gums become red, swollen and can bleed easily, often during tooth brushing.

Daily brushing and flossing, and regular cleaning by a dentist or dental hygienist, could be all that is needed to prevent gum disease and can actually reverse the early stages of the disease and help you keep your teeth for a lifetime. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.

Periodontitis

If gingivitis is left untreated, it can lead to inflammation around the tooth and is called ‘Periodontitis’. In Periodontitis, the inner layer of the gum and bone pull away from the teeth (recede) and form ‘pockets’ that are infected. Periodontal diseases range from simple gum inflammation to serious disease that result in major damage to the bones, gums, and connective tissue that support the teeth. In advanced cases the teeth eventually become loose and have to be removed.

If gingivitis is left untreated, it can lead to inflammation around the tooth and is called ‘Periodontitis’. In Periodontitis, the inner layer of the gum and bone pull away from the teeth (recede) and form ‘pockets’ that are infected. Periodontal diseases range from simple gum inflammation to serious disease that result in major damage to the bones, gums, and connective tissue that support the teeth. In advanced cases the teeth eventually become loose and have to be removed.

Who can get Gum Disease (Risk Factors)?

Plaque is the primary cause of periodontal disease, but some other factors can increase the risk and severity of gum disease. They are:

Smoking It is one of the most significant risk factors associated with the development of gum diseases. Smoking can lower the chances of success in some treatments. The percentage of periodontitis in smokers is seven times more than in nonsmokers.

Hormonal changes in girls/women. Hormonal changes make gums sensitive and easier for gum diseases to develop.

Grinding teeth -- Due to excess force on the teeth, the rate of destruction of the supporting tissues of the teeth increases.

Diabetes Diabetic patients are at higher risk for developing periodontal disease because they are more prone to get infections.

Stress Stress can lower down your body’s immune system to fight infection, including gum disease.

Medications Some drugs like anti-depressants, anti-convulsion and some anti-angina medicines, reduces the amount of saliva flow and this can affect your oral health as saliva plays a protective role on teeth and gums.

Illnesses Diseases that interfere with your immune system such as AIDS or cancer can also affect the oral health.

Genetic factor Some individuals are more prone to get severe gum disease than others.

Periodontal disease can cause health problems:

There is a cause-and-effect relationship between periodontal disease and general health:

• An increased risk of heart attack,

• An increased risk of stroke,

• An increased risk of low birth-weight and premature babies,

• An increased difficulty in controlling diabetes.

Signs and Symptoms:

The symptoms of periodontal disease often are not obvious; but the condition is not entirely without warning signs. Few symptoms include:

• Tender, swollen, or red gums

• Gums bleed during and after tooth brushing

• Gum recession

• Bad odor / halitosis or bad taste in the mouth

• Deep pockets are formed between teeth and gums

• Loosening and shifting of teeth

• Abscesses (pus oozing from the gums)

• Tender, swollen, or red gums

• Gums bleed during and after tooth brushing

• Gum recession

• Bad odor / halitosis or bad taste in the mouth

• Food impaction in areas of deep pockets formed between teeth and gums

• Loosening and shifting of teeth, or increase in spacing between teeth.

• Abscesses (pus oozing from the gums)

• Sensitivity or Pain in teeth due to exposure of the roots by gum disease

Some degree of gum diseases persists without any symptoms and some individuals have gum disease only around few teeth such as the back teeth, which they can't see. Only a dentist or a periodontist can recognize and determine the sequence of gum disease.

Diagnosis

• Your gums are checked for swelling, bleeding and firmness.

• The teeth are checked for mobility and sensitivity.

• Assessment of your bite is done.

• Full-mouth X-rays (OPG) can help to detect bone loss surrounding your teeth.

• Periodontal probing determines the pocket depth.

• "The deeper the pocket, the more severe the disease."

Prevention of gum diseases

Some of the things you can do to prevent periodontal diseases:

• Brush your teeth twice a day

• Floss every day

• Visit your dentist regularly for a check-up and professional cleaning

• Eat a well balanced diet

Gum disease Treatment

• Oral Hygiene Instructions - proper brushing, flossing, inter-dental brushing.
• Medications - are used to destroy the microbes that cause Periodontitis or hold back the destruction of the tooth's attachment to the bone. In some cases, a dentist will recommend a mouth rinse containing a chemical called chlorhexidine to help control plaque deposition. There are also antibiotic gels, fibers or chips, which are directly applied to the infected pocket.
• Splinting – for mobile teeth
• Coronoplasty – for correcting any traumatic bite

• Curettage - Scraping away of the diseased gum tissue in the infected pocket, this allows the infected area to heal and gums to become firmer.
• Periodontal flap surgery - Surgery might be needed if inflammation and deep pockets remain after treatment with deep cleaning and medications. The flap surgery involves lifting back the gums and removing the tartar deposited in deep pockets. The gums are then sewn back in place so that the tissue fits snugly around the tooth. This method reduces the pocket and areas where bacteria grow and make it easier for the patient to keep the area clean.
• Bone grafts - used to restore bone lost due to Periodontitis. Small fragments of your own bone, synthetic bone, or donated bone are placed where bone was lost. These grafts serve as a platform for the re-growth of bone, which stabilizes the teeth.
• GTR (Guided Tissue Regeneration) - It stimulates bone and gum tissue growth. In combination with flap surgery, a small piece of mesh-like fabric is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to re-grow and support the teeth. Bone grafts may or may not be used in combination.
• Soft tissue grafts - reinforce thin gums to fill the space where the gums have receded.
• Bone (Osseous) Surgery - it is smoothening of shallow craters in the bone due to moderate or severe bone loss. During the flap surgery, the bone around the tooth is reshaped to decrease the craters, this makes it difficult for bacteria to gather and grow.
• Gingivectomy/Gingivoplasty – To correct gum contour

• Scaling and Root Planing Professional cleaning means scraping off the tartar from above and below the gum line of teeth, and Root planing gets rid of irregular spots on the tooth root where the germs collect, and helps remove bacteria that contribute to the gum diseases.
• Curettage Scraping away of the diseased gum tissue in the infected pocket, which allows the infected area to heal.
• Medications are used to destroy the microbes that cause periodontitis or hold back the destruction of the tooth's attachment to the bone. In some cases, a dentist will recommend a mouth rinse containing a chemical called chlorhexidine to help control plaque deposition. There are also antibiotic gels, fibers or chips, which are directly applied to the infected pocket.

• Bone grafts used to restore bone resorbed due to periodontitis. Small fragments of your own bone, synthetic bone, or donated bone are placed where bone was lost. These grafts serve as a platform for the re-growth of bone, which stabilizes the teeth.
• Soft tissue grafts reinforce thin gums to fill the space where the gums have receded.
• Guided tissue regeneration It stimulates bone and gum tissue growth. In combination with flap surgery, a small piece of mesh-like fabric is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to re-grow and support the teeth.
• Bone (osseous) surgery it is smoothening of shallow craters in the bone due to moderate or severe bone loss. During the flap surgery, the bone around the tooth is reshaped to decrease the craters, this makes it difficult for bacteria to gather and grow.
• Flap Surgery might be needed if inflammation and deep pockets remain after treatment with deep cleaning and medications. The flap surgery involves lifting back the gums and removing the tartar deposited in deep pockets. The gums are then sewn back in place so that the tissue fits snugly around the tooth. This method reduces the pocket and areas where bacteria grow and make it easier for the patient to keep the area clean.