Gum disease (gingivitis/periodontitis) often occurs as a result of poor oral hygiene. Gum disease is a common condition that results in the gums being red, swollen and sometimes infected. Also, in the UK, nine out of every ten people have gum disease, even if it’s only a small amount.
Periodontal diseases are infections that affect the structures around the teeth, which include your gums, bone and the periodontal ligament (this holds your tooth in). Periodontal disease is mainly caused by the build-up of various bacteria in dental plaque, but it can also be linked to genetics, smoking, medications, stress and poor nutrition.
Periodontitis is a more advanced gum disease where the inner layer of the patients gum pulls away from the tooth and the bone shrinks, causing pockets to form. These pockets can collect debris and become infected. Toxins in the bacteria found in plaque, therefore they begin to break down the bone and surrounding connective tissues, which can lead to permanent loss of teeth.
Gingivitis is the first stage of gum disease where bacteria in plaque builds up and causes gums to become swollen and inflamed. They may also bleed during tooth brushing. Therefore, left untreated, some cases may lead to Periodontitis. Therefore, left untreated, some cases may lead to Periodontitis.
In the early stages of gum disease, you can often improve the symptoms with regular brushing, flossing and using an antibacterial mouthwash. If you are suffering with a more severe case of gum disease such as periodontitis, you will need to see care from a dentist /hygienist or a Periodontist.
Most importantly, if gum disease is left untreated, the chances are that it could lead to more complicated dental problems further down the line, including permanent tooth loss. Also, it is best to consult your Dentist who can create a personalised treatment plan.
Antibacterial mouthwash can ease mild cases of gum disease. Many people use mouthwash to freshen their breath and help fight bacteria. Above all, it is important to note that using mouthwash alone can’t prevent gingivitis.
The first visit
The aim of the initial visit is to understand your problems and concerns and carry out a detailed examination.
At this visit a general assessment of the oral cavity with particular focus on the periodontal condition will be carried out. This will include a comprehensive examination of your dentition, gums and oral tissues. A considerable amount of clinical data will be collected.
Furthermore, the status of your dentition and the tissues supporting the teeth will be evaluated on radiographs (x-ray). Following these investigations, the diagnosis, prognosis and all treatment options will be discussed with you.
What can be done about it?
Diagnosis of the problem is an important first step and early diagnosis can lead to the best treatment outcome. Clinical examination can reveal whether the gums are healthy or diseased by their appearance, whether they bleed easily on gentle probing and if there are any periodontal pockets, indicating that the gums have become detached from their normal position against the tooth and bone had been lost. X-rays are a useful tool and can show more clearly the amount and pattern of bone loss around a tooth or teeth.
Treatment of gingivitis
If the gums are inflamed but there has been no loss of the supporting bone i.e. the condition is gingivitis only, this can usually be easily treated by careful removal of plaque and calculus by the dentist or dental hygienist, followed by regular and thorough plaque removal at home by brushing and flossing. The gums would then normally be expected to be back to good health after a couple of weeks. Thereafter it is important that good oral hygiene is maintained together with regular visits to the dental hygienist (the frequency tailored to suit your individual requirements) to maintain the health of the gums and prevent future problems.
Treatment of periodontitis – Pocket Depth Reduction
If there has been loss of the supporting bone around teeth, a careful record should be made of the extent of this – usually by measuring the depths of pockets with a measuring probe. This will help determine the extent of the problem and hence the treatment needed, and give a baseline record for later comparison to check the response to treatment. Treatment is again aimed at thorough removal of plaque and calculus, though this may be more difficult where pockets are present as the deposits will be on the root surface underneath the gum. A local anaesthetic is sometimes needed for this procedure. If there is generalised periodontitis throughout the mouth, a number of treatment sessions may be required to make sure treatment is thorough and the best conditions are in place for good healing. For advanced forms of periodontitis, gum surgery may be needed to obtain sufficient access to clean the roots of the teeth. The goals of treatment are to arrest the progression of the disease and create a stable gum situation which is easily maintained, though it is unusual for new bone to grow back around teeth. Maintenance of good health of the gums is again of great importance following treatment to prevent relapse.
There are two kinds of crown lengthening procedures. The first is Aesthetic to improve or enhance the appearance, the second is functional in order to increase a tooth’s structural integrity to support a crown.
Aesthetic Crown Lengthening
You may have asked your dentist about procedures to improve a “gummy” smile because your teeth appear short. Your teeth may actually be the proper lengths, but they’re covered with too much gum tissue. To correct this, your dentist ; performs a dental crown lengthening procedure.
During the dental crown lengthening procedure, excess gum and possible bone tissue is reshaped to expose more of the natural tooth. This can be done to one tooth, to even your gum line, or to several teeth to expose a natural, broad smile.
Functional Crown Lengthening
Your dentist or periodontist may also recommend crown lengthening to make a restorative or cosmetic dental procedure possible. Perhaps your tooth is decayed, broken below the gum line, or has insufficient tooth structure for a restoration, such as a crown or bridge. Crown lengthening adjusts the gum and bone level to expose more of the tooth so it can be restored.
Sometime the teeth can become so damaged that they can not be repaired and will need extraction. The removal of the tooth is done under local anaesthesia that makes the area numb and you will not feel any pain.
Wisdom Tooth Extraction
Wisdom teeth are hidden at the back of the mouth and they can easily became infected and will require extraction. When the first episode of pain and infection happened, we will normally look at ways of keeping future infection away. If it happens again and you feel ready to have the wisdom tooth removed, we will proceed with the extraction.
Many of the patients visiting us for a dental implant replacement will be suitable for the procedure straight away and won’t need to do any preparation. However, in some cases a patient may need a bone graft or sinus lift before the procedure in order to create the best possible chance of the new dental implants bonding securely to the jaw.
When a patient has had a tooth missing for a long time, the jawbone related to that tooth may naturally degrade and waste away. This may cause some aesthetic issues like a change in face shape around the jawbone. It will also mean that there isn’t enough jaw-bone available to support a dental implant. When this is found to be the case, a bone graft is used to restore the jawbone.
Tiny pieces of bone are placed in a precise area, based on where the implant is due to take place. Over time the bone graft and bone existing in the area will fuse together, creating a stable and secure base in which to place the implant.