Gum disease is inflammation of the gums and supporting structures of the teeth caused by bacteria that is not effectively removed from the gumline. There are two main stages of gum disease:
Gingivitis – inflammation of the gums alone. This can include swelling, bad breath, redness, bleeding, and discomfort. If treated and maintained, gingivitis can be reversible, meaning full healthy gums can be achieved.
Periodontitis – inflammation and destruction of the gums and supporting structures of the teeth. The supporting structures include the gums or gingiva, periodontal ligament, cementum, and alveolar bone. Once the supporting structures are affected the condition becomes irreversible. Bone lost due to periodontal disease cannot grow back, but it may be replaced with surgery.
There have been many studies, research, and advances in the treatment of periodontal disease. Part of this has seen detailed grading tools used by dental professionals to determine the severity and appropriate treatment protocols.
Within these grading tools periodontitis is divided into categories:
Stable – no periodontal pockets above 4mm in depth, less than 10% bleeding but no bleeding from pockets
In remission – no periodontal pockets above 4mm in depth, more than 10% bleeding but no bleeding from pockets
Unstable – periodontal pockets above 5mm in depth with more than 10% bleeding including bleeding from pockets
When diagnosing periodontal disease there can be localised areas or the disease can be more widespread throughout the mouth. There can also be periods of stability, remission and instability depending on the oral health routine, lifestyle of the patient and various risk factors. It is important once a diagnosis has been made to visit the dentist, hygienist or therapist regularly for treatment and close monitoring. This way regression of the disease can be caught early and treated appropriately.
Advanced periodontal disease can be aggressive but the aim of treatment is always to halt and slow down the progression and maintain the teeth for as long as possible. Various treatments are available.
Non-surgical periodontal treatment (NSPT)
Sometimes known as root planning or root surface debridement, non-surgical treatment is usually the first option. This involves removing bacterial plaque and calculus from below the gum line, from the root surfaces and within any pockets. This removes factors that might attract more plaque below the gumline and above, such as overhangs from restorations, to allow the gums to reattach and heal. The number of visits would be determined by your dental professional and would require follow up reviews.
If a course of NSPT is not successful then other options would be considered such as laser treatment and surgery. These options are usually carried out by a specialist periodontist.
Laser therapy is a new, breakthrough technology which uses a specific wavelength to target diseased gum tissue, plaque retentive factors and bacteria that cause the disease. Alongside this, laser therapy also helps speed up healing while reducing bleeding and pain associated with periodontal disease.
Flap surgery involves exposing the root surface of the teeth in order to remove bacteria and calculus from those surfaces. The soft tissues are then stitched back into place over the cleaned hard tissues. Once healing takes place, the gums are maintained with a good oral hygiene routine at home and regular follow up visits with a dental professional.
A gingivectomy involves removing diseased soft tissue and reattaching the remaining healthy tissue back to the root surface.
In cases of severe gum recession, a procedure called a gingivoplasty can be performed. This involves reshaping and contouring the gum margins to create a more pleasing aesthetic. Tissue is sometimes taken from the palate to achieve this.
In very severe cases of periodontal disease, the extent of bone loss is so severe that teeth may not be saved. In this case a cosmetic dentist can advise on the best options for replacement, such as bridges, dentures or implants. If caught early enough, periodontal disease can be treated successfully using some of the techniques above, thus saving the teeth.
In the first instance any concerns should be raised with your dentist who will examine and plan a course of treatment tailored to your needs. A referral to a specialist periodontist may be required for cases that are unresponsive to treatment or more advanced cases.
If you’re concerned about gum disease or would like more information, please call us on 020 3411 7735 to speak with our friendly team or fill out our contact form.