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Gum disease begins with gingivitis and can progress to periodontitis. There are a number of signs it is present and several ways that dentists can identify and treat the disease.

What is gum disease?

Periodontal (gum) disease is the term for any disease affecting the structures holding the teeth in place, including gums, ligaments and bone. In its earliest stage, called gingivitis, the gums become inflamed but as it progresses, soft and hard tissues retaining the teeth are affected, which threatens tooth integrity. It is most commonly caused by poor dental hygiene habits that allow the bacteria to remain and plaque to build up and form calculus.

Our bodies are full of bacteria (good and bad) and our mouths are no exception. If harmful bacteria is not cleaned from the teeth through flossing or brushing, plaque forms which, over time, can harden and become calculus or tartar. Calculus or tartar cannot be cleaned by brushing alone and requires the intervention of a dentist or dental hygienist.

What are the seven signs of gum disease? 

There are several risk factors for gum disease, but smoking is considered the most significant and the one that has the biggest impact upon subsequent treatment outcomes. Hormonal changes in females, medications and genetic susceptibility are all other risk factors as are systemic inflammatory conditions and use of medications.

Signs of gum disease to watch out for include:

  1. frequently bleeding gums

  2. red, inflamed, sore gums

  3. receding gums

  4. discomfort or pain when chewing or general tooth sensitivity

  5. loose teeth 

  6. structural changes in your mouth such as bite, fit of teeth or in the fit of prosthetics (dentures) or tooth movement

  7. halitosis (bad breath) or dysgeusia (unpleasant taste in the mouth) are also indicators to be mindful of.

How will your dentist diagnose gingivitis or periodontitis? 

Dentists diagnose gum disease in three key ways:

  1. Examination: In dental examinations, teeth and gums are examined for any signs that indicate a gum disease and your dentist may inquire about medical history to identify conditions or risk factors that may increase your risk. They may also refer to a periodontist who have the expertise to provide treatments not offered elsewhere.
  2. Measuring the depth of periodontal pockets: Periodontal pocket measurement is generally a painless investigation (unless disease is severe) where a metal probe is inserted below the gum line to measure the depth of the space between the gum and tooth, which enlarge as plaque builds up and acid eats into the teeth and gums. Pockets of 1-3mm are considered optimal and anything over that as indicative of disease. This is used to measure the severity of the disease.
  3. X-rays: X-rays are used to identify deterioration of surrounding structures such as bone and again will clarify the severity of disease. 

Classification of gum disease 

Dentists classify the disease using the following four categories:

Gingivitis

This is the mildest stage of the disease, indicative of inflamed gum tissues. Those with diabetes, pregnant women, and steroid users are at increased risk of developing gingivitis; if untreated the risk of serious periodontal problems in the future is increased.

Chronic Periodontal Disease

The next stage is known as chronic periodontal disease. This is where gingivitis has progressed leading to steady deterioration of the gum and bone tissues. This is generally age-related (over 40), hence why receding gums (and thus teeth appearing longer) typify chronic periodontal disease.

Aggressive Periodontal Disease

Aggressive periodontal disease is the next stage in severity which involves a considerable increase in symptoms: loss of bone and tissue attachment is rapid; and this form of gum disease is often associated with diabetics and smokers.

Necrotizing Periodontal Disease

Finally, those suffering from pre-existing conditions such as chronic stress, HIV, immunosuppression, and malnutrition are most at risk of developing a necrotizing periodontal disease which involves tissue death and rapid destruction of the structures surrounding the teeth.

The periodontal treatment your periodontist could recommend 

The goal of periodontal treatment is to thoroughly clean the periodontal pockets to prevent damage to surrounding bone, and these treatments may be carried out by a periodontist, dentist or dental hygienist. Treatments are most successful when complimented by appropriate lifestyle changes such as sound oral hygiene and refraining from tobacco products.

Nonsurgical treatments

Less invasive procedures for milder forms of the disease include non-surgical treatments such as

  • Scaling,
  • Root planing
  • Medications (antibiotics).

Surgical treatments 

Dental treatments for advanced periodontitis may include

  • Flap surgery (to reduce pockets)
  • Soft tissue grafts
  • Bone grafting
  • Guided tissue regeneration
  • Tissue-stimulating proteins

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