Gum Disease - Patient Information

GUM DISEASE Gum disease can be in its minor form, which is called GINGIVITIS. This is inflammation of the gums and may cause bleeding. Gingivitis may progress to the more serious form called PERIODONTITIS, which is when the bone that holds the teeth in place dissolves. As this destruction progresses, the teeth become less and less supported until they become loose and are eventually lost.

WHAT CAUSES GUM DISEASE? Gum disease is a disease of bacterial origin that occurs in people whose immune system make them susceptible to the attack of these bacteria.

Everyone has bacteria in their mouths, but patients suffering periodontal disease don’t have the immune system needed to defend themselves against the bone-dissolving type of bacteria. It is therefore essential to have these bacteria removed. Patients who have the protective immune system don’t need to remove all the bacteria. The bacteria will be removed by me, then kept off your teeth daily by you. This will be achieved by me showing you a specific regime of brushing your teeth. This is different from routine tooth brushing and will be devised specifically for you. I will supervise your performance and support you with anything you need. The susceptibility of a weak immune system may be due to your genetic predisposition or a medical disease. The most common causes of the susceptibility are SMOKING and DIABETES, but there are many others. Although your immune system may not be defending you against disease around your teeth, there is no reason to suggest that you have a generalised weak immune system or that you are susceptible to any other diseases. WHAT DOES GUM DISEASE RESULT IN? The bone surrounding the teeth dissolves, causing the teeth to be less supported. The gum that overlies the bone may recede a little, but generally stays roughly where it is. In healthy areas without bone destruction, the space between the gum and bone is 3mm or less. As bone dissolves, leaving the gum behind, it creates a space between the two that dentists call a PERIODONTAL POCKET. The presence of this pocket has the following relevance: The bristles of a toothbrush may reach 2-3mm under the gum if angled correctly. If a pocket is any deeper than this then the bacteria can harbour in this relatively deep area and be inaccessible for cleaning and therefore cause further bone destruction. The deeper the pocket, the less oxygen is available, as it is further away from the outside world. It so happens that the species of bacteria that cause bone destruction are those that survive in conditions of low oxygen availability. The conditions are therefore conducive to disease progression.

TREATMENT Oral Hygiene You will be a shown a specific regime to remove the bacteria from the junction where the teeth meet the gums. The technique is specific to you, based on the shape of your gums and teeth and the measurements I would have taken during the assessment. Professional cleaning above the gum Any bacteria that have collected above the gum would have calcified to form tartar. This may look bad and smell bad but more importantly it sticks more recent bacteria to it and makes it difficult for you to perform oral hygiene. Professional cleaning below the gum The bacteria that have now migrated into the periodontal pocket also need to be removed with specially designed instruments, some of which vibrate and wash during the process. Some of these bacteria are soft and some have calcified to form hard deposits that are stuck on the tooth root surface. We will remove as much as possible. You will be made numb first so that you cannot feel this being done. Sometimes stitches are placed to assist in healing.

TREATMENT AIMS If you are maintaining a successful oral hygiene routine than there will be minimal bacterial re-colonisation. As previously mentioned it is the periodontal pocket that is conducive to the progression of the disease. The aim is to reduce this space as much as possible. This will occur in two ways: 1. As the root surface is made smooth by the removal of the calcified bacteria, the gum will STICK to it, providing some support. Although this cannot be as strong as the support initially provided by the bone, it is a substantial improvement. 2. The gum will RECEDE so that it migrates closer to the position of the dissolved bone. The space between the gum and the bone will therefore be less, therefore there will be more oxygen at the site. These are conditions that the disease-causing bacteria struggle to survive in. POST-OPERATIVE CONCERNS After giving you a thorough scrub, it may be sore as the gums heal. Operating on gums can be compared to similar operations on the skin. Soreness during this healing phase can be controlled with pain-killer tablets, mouthwashes and specific toothpastes and should only take a few days. As we are hoping for the gums to recede a little, the disadvantages of this is that it exposes parts of the tooth surface that were previously covered by gum. Gum recession can be over the neck of the tooth and in-between the teeth. These areas can initially be a little sensitive but they will eventually de-sensitise as they become used to the outside world and take up fluoride from the water and toothpaste. As more tooth surface becomes exposed, the teeth will also appear longer. If this is towards the back of the mouth it is often irrelevant but there may be some aesthetic concerns if it happens towards the front of the mouth depending on how much the natural position of your lips mask your teeth when you smile. As teeth are roughly triangular, the gum recession in-between the teeth will give rise to triangular spaces between the teeth. Again, if at the front of the mouth, this could be of an aesthetic concern to you. Another disadvantage is that these larger gaps get food caught in them, which therefore may need cleaning following meals. RE-EVALUATION OF DISEASE AND TREATMENT SUCCESS

Further measurements of pocket presence are made 2 months after treatment. If you and I have succeeded then we should expect most of the pockets to have reduced in depth, giving rise to conditions where the disease is unlikely to progress. It is extremely unlikely to have 100% success, so a few sites may not have reduced as much as required. These can be managed in the following way: 1. Re-instrumentation This involves having the sites cleaned and debrided of any re-colonising bacteria before they get a chance to cause disease progression. This should be planned for every 2-3 months. 2. Surgery This involves opening the gum to gain better access to the adhered calcified bacteria therefore improving the likelihood of successful removal. The gum will then be closed again, not quite where it was before, but nearer the bone, therefore immediately ELIMINATING the pocket. MAINTENANCE Gum disease is often successfully CONTROLLED. However it is never CURED. Following successful treatment, you will need to attend for occasional check-ups and superficial debridement so that your gums can be maintained in health.

QUESTIONS & ANSWERS

You are always welcome to ask me any questions at any time and I will continually encourage you to do so. It is vitally important that you are happy with the treatment you are receiving and this requires a basic understanding of the science of gum diseases. My role in managing your disease is relatively small as it will be you that keeps it under control, but I will be supervising you and supporting you every step of the way.