What is Periodontal Disease?
Periodontal tissues are the tissues that support your teeth. They consist of the gum (gingiva), bone and related fine tissues. Hence, inflammatory diseases involving these tissues are called periodontal diseases. The most common forms are induced by bacterial plaque, which builds up rapidly in our mouth unless meticulous brushing and flossing is instituted daily. The two main broad groups of periodontal disease are gingivitis and periodontitis. Gingivitis is the early, reversible and less serious, form of periodontal disease. It is also the precursor of periodontitis, where the permanent loss of supporting bone starts to take place.
Bacterial toxins found in plaque may cause the gums to become red, inflamed, swollen and to bleed easily (e.g. on tooth brushing). If left untreated, the gums can become permanently detached from the teeth resulting in spaces (called pockets). Further deterioration will result in progressive bone loss, leading to spaces between teeth and even eventual tooth loss.
Periodontal disease can often go unnoticed for years as it is mostly painless and symptomless. It is estimated that 4 out of 5 patients remain unaware of their periodontal condition. Naturally the best preventative measures are thorough daily brushing and flossing and/or use of interdental brushes. These measures can be checked and monitored by your dentist and hygienist. Preventive prophylactic cleaning (also called scaling or prophylaxis) is also hugely beneficial and, together with regular visits to your dentist and hygienist, can help detect and/or prevent the progression of periodontal disease. This support from a dental professional is important, as even the most diligent dental patient can still develop some form of periodontal disease. Early intervention by your dentist/hygienist can prevent its progression. During your regular ‘check up’ sessions with your dentist/hygienist, he/she will also carry out an oral cancer screening.
Periodontal treatment is recommended when your gums and the supporting tissues of your teeth are under threat. Retaining your teeth requires continuous health of these tissues. Untreated periodontal disease can lead to swollen and reddened gums and, when the supporting bone is irreversibly destroyed, your teeth may drift, become loose and fall out. Your ability to chew properly, to speak and to smile fully may then be compromised.
Periodontal disease and tobacco
Research has established a strong link between periodontal disease and tobacco usage. Signs and symptoms of periodontal disease are also masked by the dampening effect of nicotine on the inflammatory status of the gums, further delaying timely diagnosis and appropriate treatment. Periodontal disease also tends to be more severe in smokers, with deeper gum pockets and greater bone loss. Delayed healing and a poorer response to periodontal treatment are often seen in smokers. Therefore, quitting smoking is essential to restoring your periodontal health and also reduces your chance of oral cancer. Other modifying risk factors include diabetes, stress, certain medications or medical conditions. We can work with your doctor to help moderate some of these periodontal-medical associative effects.
The warning signs
These are usually quite mild and inconspicuous. Pain or obvious visible changes in the mouth are rare. You or your partner may notice persistent bad breath or shrinkage of your gums. When brushing and flossing, there may be some gum bleeding. Your gums may also feel tender or look swollen or feel spongy. Your teeth can also become looser and start to drift from their original position. However, it is more common to have no noticeable symptoms, which explains why many people with periodontal disease are not aware of it.
Diagnosis and treatments
Diagnosis is made after a thorough history is taken and an extensive oral examination is carried out when you visit us. We map out the surrounding tissue support of each tooth gently and carefully with the use of a periodontal probe. This is combined with a thorough examination of x-ray pictures of the affected teeth.
Loss of periodontal support is reflected in a higher number from the measurements with the probe, so called periodontal (gum) pockets. Pocket depths of more than 3mm are suggestive of varying levels of periodontal disease. During probing, any tenderness or bleeding are also signs of inflammation and unhealthy gum tissues.
The X-ray images can show us the two-dimensional levels of the bone around your teeth, the presence of local features that promote the buildup of bacteria plaque e.g. tartar, faulty fillings and adverse tooth surface anatomy.
Treatment options to arrest the bone loss and re-establish healthy gum support can then be discussed in detail with you.
As with all of our services, periodontal treatment is individually tailored to meet your specific needs. We always aim to begin with the least invasive approach using non-surgical means. This involves decontamination and thorough professional cleaning of the root surfaces, under the deep periodontal pockets. This is the fundamental cornerstone of periodontal therapy and, in many cases will be the only treatment you require, supplemented by a good home maintenance routine and supportive therapy. Non-surgical management can include any of the following:
- Scaling and root surface debridement
- Bacterial analysis and antimicrobial therapy
- Occlusal analysis and adjustment
- Splinting of teeth and instruction about plaque control
In some, more advanced, periodontal cases, problems may persist despite non-surgical treatment and your best efforts at home. A range of minor periodontal surgical procedures are used to smooth or correct defects and irregularities in the bone and soft tissue surrounding the diseased teeth, with the ultimate aim of re-establishing periodontal health. These include:
- Pocket Reduction Procedures
- Regenerative Procedures
- Crown Lengthening
- Soft Tissue Grafting
- Cosmetic Procedures