Healthy Gums

A healthy mouth is key to a healthy body. Periodontal disease and decay are both caused by bacterial plaque and can be accelerated by a number of different factors. Plaque is a colourless film that sticks to your teeth at the gum line. Plaque constantly forms on your teeth. If not carefully removed by daily brushing and flossing, plaque hardens into a rough, porous substance known as calculus (or tartar). Up to 80 percent of the population unknowingly has some form of gum infection. By thorough daily brushing, flossing and using mouthwash, you can remove these germs and help prevent gum disease.

What is Gum Disease?

Gum disease (or Periodontitis) is characterized by a persistent bacterial infection surrounding one tooth or several teeth; gum disease causes little discomfort and produces few obvious symptoms in the early stages. When periodontal disease is not treated, it will spread and compromise gums, teeth, bone, and it can lead to heart disease and strokes, as well as diabetes and pregnancy complications.

We can generally separate the disease into gingivitis or periodontitis. Gingivitis is seen as the early stages of gum infection where no long-term damage to the gums or deeper supporting structures has taken place. Generally gingivitis is considered reversible. However if gingivitis is allowed to continue, periodontal disease can develop. In periodontal disease there is destruction of the supporting tissues, including the gums, bone and periodontal ligaments (the fibers that hold the teeth in the jaw). Eventually the destruction could cause the teeth to become loose and even be lost.

More importantly, research has associated periodontal infection to several serious medical problems; including heart disease, diabetes and stroke. This underlines the need for a comprehensive approach to the treatment of gum disease, as the impact it has on general health can be significant. As ongoing research continues to define how periodontal disease is associated with these and other health problems, oral health maintenance is essential.

Traditionally dentists believed that all individuals with gingivitis would develop periodontitis if it were left untreated. The development was seen as an inevitable decline over many years caused by most bacteria that are commonly present in the mouth. While this progression is still widely accepted, the exact conditions for its progress have been extensively researched. Today it is commonly accepted that gingivitis affects the vast majority of people in some form or other. On the other hand aggressive periodontitis only affects 10 - 15% of the population. This seems to indicate that there are certain risk factors for the progression of the disease. The first of these is the type of bacteria present. Today we know that of the 300 species of bacteria in the mouth only a few are capable of causing advanced disease. Secondly, progress has also been made in identifying the role of the individual in the progression of disease. In the last decade epidemiologists have begun recognising risk factors (table 2) that could make an individual more susceptible to developing periodontal disease. With this knowledge it has become easier to identify individuals who are more at risk of developing advanced stages of periodontitis. This has led to exciting new strategies in the diagnosis, prevention and early intervention and treatment of gum disease.

What can cause infection to advance?

People with periodontal disease have low resistance to periodontal bacteria. This causes an ongoing gum infection that grows in "bursts" of activity. Each time it grows, more support for your teeth is lost. Some factors that can cause this to occur may include:

• Poor oral hygiene
• Dental plaque
• Genetic factors
• Stress or tension
• Diet
• Age
• Illness
• Bad bite
• Systemic Illness
• Smoking / Tobacco
• Grinding

Symptoms of Periodontal infection

Periodontal infection is usually painless until it reaches an advanced stage. However, there are some symptoms that can indicate the presence of periodontal infection. These may include:

• Red or swollen gums
• Bleeding when brushing (pink toothbrush), or at other times
• Aching, itchy, sore or tender gums
• Receding gums (teeth beginning to look longer)
• Pus between your teeth and gums when you press down on the gums
• Bad breath
• Any change in the way your teeth fit together when you bite
• Any change in the fit of partial dentures
• Loose, separating or protruding teeth
• Spaces between teeth

If you notice any of the above warning signs of periodontal infection, please contact your dentist and ask for a periodontal evaluation. Important Note: Your gums can look and feel quite normal and yet deep pockets of periodontal infection can still be present. To be certain about any periodontal disease, ask your dentist or periodontist to examine your gums for signs of infection. We work closely with periodontists and other specialists for optimal results.

Systemic factors that increase the risk of developing periodontal disease

Progress has been made in identifying systemic factors that could play a role in increasing an individual's chances of developing advanced gum disease. Some of the most prominent contributing factors are smoking, diabetes, HIV, stress and depression. Of these, smoking is probably the most important increasing your risk of developing advanced disease up to seven times. A second significant risk factor is both insulin and non-insulin dependent diabetes mellitus, particularly in patients who have been affected long term. This is possibly due to the increased susceptibility to infection and a weakened host response. With the increase in the prevalence of HIV in South Africa, its impact on dentistry has also become more significant. An estimated 5% of all HIV patients develop a form of necrotic periodontitis (ANUG) that can be extremely destructive and painful. With the degenerative nature of HIV/AIDS there are great challenges in effectively managing these patients. Preliminary studies have also suggested that chronic stress, depression and other angst-related psychological factors could increase your risk of developing disease. These stressors may decrease the body's immune response and thus increase the likelihood and severity of the infection.

How do I control periodontal disease?

Periodontology plays an increasingly important role in modern dental practices – that is why it is especially important to invest in a proper oral hygiene program. Calculus (plaque) should be removed every 6 months, and should be detected it without harming the healthy tooth structure, accurately and reliably, even in subgingival (below the gum level) regions. The risk of inadequate or excessive treatment is reduced considerably by using the correct equipment (we use an ultrasonic scaler). And it often may be possible to avoid having to conduct a flap surgery (soft tissue surgery)

How we can help you

The best way to prevent gum disease is effective daily brushing and flossing as well as regular professional examinations and cleaning. Unfortunately, even with the most diligent home dental care, people still can develop some form of periodontal disease. Once this disease starts, professional intervention is necessary to prevent its progress.

Early on, when redness, swelling, and bleeding are the only symptoms, we can treat and reverse gum disease non-surgically. Regular checkups greatly increase your potential for early detection and conservative treatment. Generally, treatment will include careful, individualized instruction regarding the most effective means of brushing and flossing at home. This strategy is usually accompanied by professional scaling or careful scraping of all affected tooth surfaces, gum pocket irrigation, and even local antibiotic placement in areas of significant irritation. Often, patients experience immediate improvement. If, however, symptoms don't improve significantly, you may require surgical treatment.

The right brush makes a difference. Philips Sonicare is endorsed by the Periodontal Association of South Africa. We sell them as well.

Surgical Treatments

If gum disease progresses without intervention, a patient may need surgery to remediate the disease and restore the mouth to good oral health. Some surgical treatments include: pocket depth reduction, bone or tissue regeneration, crown lengthening, and/or soft tissue grafts. All of these procedures may improve your chances of keeping your teeth for life. We refer patients to specialist for these procedures.