Periodontal Disease

About Periodontal Diseases

Diagram representing probing depths around healthy and abnormal periodontium.

Approximately 80% of the population have some form of periodontal disease, also known as gum disease or pyorrhoea. These diseases are often painless until the much later stages, and therefore can go undetected until it is too late to save the teeth. If left untreated, gum disease can destroy the bone and tissues that surround and support the teeth, causing them to become loose and painful, and eventually be lost, even though the teeth themselves may be healthy. Other signs and symptoms of gum disease include bleeding gums, bad breath or a bad taste, swellings and abscesses, receding gums, and loose and drifting teeth. The end point is loose teeth that can’t be saved and are eventually lost. These are also trends to suggest that gum diseases can contribute to heart disease, diabetes and psychological disorders.

The Cause

The main cause of gum disease is bacteria found in dental plaque. This is the sticky white film that forms on your teeth daily. The bacteria produce toxins, or poisons, that irritate the gums and cause them to become inflamed – this is known as gingivitis. If left untreated, the bacteria start to destroy the gum, bone and ligament that hold the teeth in place. This is known as periodontitis. The gums separate from the teeth, causing gaps known as pockets.

The aims of treatment

The main aim is to stabilise the condition and prevent any further destruction.

The majority of patients are treated non-surgically. This is sometimes referred to as deep scaling or root planing and consists of cleaning out the pockets to remove the tartar, debris and toxins on the root surfaces. This is also combined with intensive oral hygiene instruction which together can result in the pockets ‘sticking back’ to the teeth.

In some cases, it may be possible and appropriate to attempt to reform, or regenerate, bone. Likewise, previously destroyed gum tissue (recession) can also be replaced. These procedures are surgical in nature, and are usually delayed until the overall condition is stabilised to a degree. They are not always necessary in order to treat the disease successfully.

Side Effects

Both surgical and non-surgical treatments are painless because local anaesthetic is used. Once this wears off, the side effects to expect are:

• Pain, tenderness – normal painkillers resolve this
• Sensitivity to cold – this is temporary
• Increased recession or gaps between teeth – ‘black triangles’ – this is not reversible

What next?

The majority of people respond well to treatment, but you get out what you put in. This means if you carry out the recommended oral hygiene protocol and maintain them, you have a greater chance of responding to treatment. Many other factors can affect the response – these include a maintenance program which is the key to long term success and stability. This may mean regular visits with the dentist and hygienist and also regular assessments with the periodontist to avoid relapse of the condition. Failure to comply with maintenance may result in the need for repeat treatment.

Other reasons to see a Periodontist

Your dentist may also refer you for reasons other than gum disease. These include:

• Replacing lost gum tissue (recession)
• Crown lengthening procedures (to allow the dentist to successfully restore teeth or improve appearance)
• Bone and gum grafts – to prepare the tissues prior to bridge or implant placement