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Dental Factfiles

Periodontitis (Advanced Gum Disease)

Periodontitis is the inflammation of the tissues that hold the tooth in its socket. If left untreated it can result in the destruction of the tooth attachment as well as the destruction of the bone itself.

Healthy gums are pale pink and firm. If the gums are red and swollen, there is probably gum disease or gingivitis present. One of the commonest signs is blood on the toothbrush after brushing and often there is bad breath (halitosis) as well. Flossing may also cause bleeding.

The accumulation of a surface film of dental plaque (a sticky layer of germs) starts the inflammatory process. Tiny ulcers appear which penetrate the soft gum tissues and cause the immune system to respond. Large numbers of white blood cells appear on the scene to fight the bacterial invasion and the gums begin to swell. However, if it is left untreated, it gradually progresses resulting in the destruction of the tooth attachment and bone around the teeth (periodontitis). This causes the affected teeth to become loose and in some cases move. The depth of the space between the neck of the tooth (where the tooth meets the gum) and the gum indicates if there is a gum problem or not. These spaces are known as ‘pockets’. The measurements, taken by a dentist or hygienist also show how severe any existing gum problem is. Healthy gums have small pocket measurements (2-3mm), but in where there is disease these pockets can be very deep (5-10mm or more) and means that special treatment is needed.

Periodontitis and gingivitis can affect anyone at any age. The milder form, gingivitis, is more common. Gingivitis causes bleeding gums and, if left untreated, may progress to periodontitis.

Gingivitis can be treated by visiting a dentist or hygienist who will clean the teeth professionally and advise on how to improve tooth cleaning at home. The patient may be unaware that there is a problem, as gingivitis can be painless during the early stages of the disease. Basic periodontal treatment involves cleaning out the deposits of plaque and hardened plaque (tartar) from above and below the gums. The treatment is usually done by cleaning the affected areas, sometimes after making them numb with a local anaesthetic. In most cases the gum problems resolve after this type of treatment when accompanied by an effective oral hygiene routine at home Gum problems are also made worse by smoking and any dental professional will encourage users to stop.

Sometimes basic treatment is not successful at getting the gum disease under control. This is because the pockets in severe periodontitis are so deep that it is not possible to fully clean the roots without actually looking at them. The dentist may then suggest gum (periodontal) surgery. This treatment involves pushing the gums away from the teeth so that the roots can be seen. It is only by doing this that the dentist can be sure that the roots are clean.

Two types of gum surgery are available:-

1. Surgery to clean the roots of the teeth - root planing.
2. Surgery to replace the lost bone and soft tissues as well as clean the roots of the teeth

Those who need surgery include:

• Patients who have deep periodontal pockets and gum disease
• Patients who have short teeth which need crowns. The teeth can be made longer so that crowns can be fitted
• Patients who have a high lip line, show a lot of gum and need their smile improved.

The dentist will usually refer to a periodontist who is a specialist in gum diseases and its treatment.

Prevention of this condition can be done by visiting a dentist or hygienist for advice on brushing and flossing techniques and the use of special brushes, together with regular cleaning and dental appointments. Maintaining good oral hygiene will help to prevent gum conditions from worsening.

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