Periodontitis (gum) disease

Periodontitis is the inflammation of the gums and the surrounding tissue. Along with tooth decay it is the most widely spread dental condition. It attacks the tissue that holds the teeth in place (the periodontium) and because it is not accompanied by any pain it often goes unnoticed for a long time.

The risk of contracting periodontitis increases with age. If left untreated it can result in tooth loss. The mouth is home to more than 600 types of bacteria, most of which pose no threat to your oral health. They form what is termed a biofilm — meaning plaque — on the tooth surfaces, the edge of the gum and interdental spaces. If plaque is not thoroughly and regularly removed it hardens and forms dental calculus, otherwise known as tartar.

Inflammation in the gums is known as gingivitis. The main symptom of gingivitis and the first warning sign is bleeding gums. The area where the gums meet the tooth forms a natural barrier which can often prevent bacteria from getting deeper into the gums. If gingivitis is left untreated, however, this protective wall becomes penetrable, and the inflammation can spread along the tooth to the bone and the periodontal ligament.

What happens next is a staged destruction of the tooth-bearing periodontium. As the gums recede part of the periodontium is destroyed. Next, something called a gum pocket forms. From this moment on yet more bacteria can enter. The body's own increased immune defences cause further destruction of the periodontium as they fight the bacterial attack. The gums recede even further as does the jaw bone. The tooth becomes loose. In the worst case the tooth may be lost — even without ever having been affected by tooth decay.

Not everyone is equally at risk of periodontitis. The process and the severity of the condition are dependent on certain internal and external factors:

1. It has been scientifically proven that disposition to periodontitis might be passed down from generation to generation.
2. Insufficient oral hygiene is the main contributor to the formation of periodontitis, beginning when dental calculus and bacteria cause gingivitis.
3. Nicotine consumption has an adverse effect on the immune system. This means that smokers are twice to seven times more likely to suffer from gingivitis. Moreover smokers often do not know that they have gingivitis because the first warning signal — bleeding gums — often does not occur in them. The likelihood of treatment success is limited if the patient keeps smoking. 
4. Diabetes increases the risk of periodontitis. Badly adjusted blood sugar values immediately impact on the immune systems of the periodontium. This means that gum inflammation may occur more frequently, and may take longer to heal.
5. Psychological stress and hormonal changes also impact on the immune system, making periodontitis more likely to occur, and enabling it to develop more quickly. During pregnancy there is also an increased risk of contracting periodontitis.
6. Inherent or acquired weaknesses in the immune system, such as AIDS, are a contributing factor to patients developing periodontitis.
7. Certain medication, such as that aimed at reducing a patient’s blood pressure or other drugs that may weaken the immune system, can cause the gums to swell. This may be a contributing factor in the development of periodontitis.

Bacteria can enter the blood stream through inflamed gum tissue, being transported to other parts of the body with potentially serious effects on systemic health.

Diabetes

If your glucose values are badly adjusted, this may be a contributing factor in developing periodontitis. This also works the other around: periodontitis makes it harder to adjust your blood sugar levels. This is because the effectiveness of the insulin used in diabetes treatment is weakened due to gingivitis.

Strokes and heart attacks

Periodontitis patients have an increased risk of strokes and heart attacks. Moreover bacteria absorbed into the bloodstream through infected gum tissue can be a contributing factor to infections in the heart, artificial heart valves, and hip and knee joints.

Pregnancy

Pregnant women tend to be more susceptible to gingivitis and periodontal inflammation. A severe form of periodontitis can increase the risk of complications and low birth weight.

Periodontitis may go unnoticed because it is painless in its early stages, but there are warning signs:

• Bleeding gums (when brushing or eating)
• Swollen and red gums
• Retreating gums
• Sensitive tooth necks
• Lasting bad breath and / or a continuously bad taste in your mouth
• Pus exiting the gingival pockets
• Loosening teeth

If you notice one or more of these warning signs see a dentist immediately. Only a Specialist periodontist can tell you whether you have periodontitis.

First of all we evaluate the level of severity of your condition. We take a large-scale x-ray (OPG) to better see the formation of your jaw bone. We also measure the depth of gum pockets. The level of bleeding and loosening of the teeth are assessed. If your periodontitis is severe or aggressive in nature we may prescribe antibiotics. For this purpose we will do a bacteria test, with results evaluated at our laboratory. This allows us to determine which type of antibiotics would be best in your case.

The treatment requires the dental surfaces to be free from plaque and the patient must have good oral hygiene. Only then can the treatment be successful in the long term. This is why, prior to commencing treatment, one or two appointments with our dental hygienist may be necessary. Our professional dental cleaning is the perfect preparation for this treatment, and by analysing your teeth we can determine how you can best care for them at home.

This is when periodontitis treatment can commence. We start by cleaning the pockets using hand tools. This is done under local anaesthesic. This treatment tends to be ultrasound aided, allowing us to smoothen the root surfaces to make it more difficult for bacteria to deposit in those areas.

Following treatment it takes two to three days for the gums to recover. During this period the inflammatory swelling will go down, meaning that your gums will again be tightly and strongly aligned with the necks of your teeth. However, this also means that your gums will shrink ever so slightly.

During the first few weeks after treatment the necks of your tooth may be sensitive. We will check the result over the course of the next few weeks. In most cases gingivitis is reduced following this initial treatment. Should treatment not be successful or the pockets be particularly deep, surgery may be required.

During follow-up treatment we will clean the root surfaces of your teeth by opening your gums. Cleaning will be done using hand tools and ultrasound again, also under local anaesthesic. This allows us to reach deep-rooted deposits.

Periodontitis usually leads to gum recession and in severe cases it damages the root and the tooth compartment in the jaw (known as the alveolar bone). In addition, the collagen fiber in the tissue which connects the root with the bone is damaged. All this can lead to tooth loss. Thanks to Guided Tissue Regeneration (GTR) and surgical gum correction, we can still save the teeth of our patients in these cases.

GTR refers to a procedure that restores the periodontium, the tissues that surround and support the teeth which may degenerate due to severe and aggressive periodontitis. GTR is necessary when the different types of tissue that make up the periodontium do not all recover at the same speed. The gums are effective at closing wounds, which means they tend to grow much faster than the root element, the collagen fibre bundles or the alveolar bone. However, it is these latter elements that ensure your teeth are securely kept in place. GTR helps by stimulating regeneration in these tissues, keeping the gums from spreading in an unbalanced way.

Following local anaesthesia the gums are opened up — only a small cut is needed to reveal the surface of the root. We begin by removing plaque and dental calculus, and should craters have formed in the jaw bone they are filled with bone substitute. 

The area is then covered with a membrane, creating a barrier between the gums and the dental root as well as the bone tissue. The cavity created allows the collagen tissue fibres and the bone tissue to regenerate freely. The membrane does not need to be removed because it is absorbable, and the last step is to stitch the area up.

Periodontitis often results in retreating gums, leaving the necks of teeth exposed. These tend to be extremely sensitive to cold, heat, sweetness and sourness. In addition there is usually an aesthetic issue, especially with the visible front teeth which can seem unusually long. A lot of patients then tend to avoid an open and unrestrained smile. 

Plastic-aesthetic gum correction can help by regenerating the lost gum area. In this micro-surgical procedure tissue from your palate is transplanted onto the exposed tooth necks, or alternatively existing gum material may be loosened and stretched until the areas exposed have been covered.

Following an in-depth conversation discussing your options we will decide together which method may be best suited to you.

We will, of course, discuss the costs of your treatment in detail prior to your treatment.

Periodontitis is a chronic disease, which means aftercare is critical to keep it from returning. 

This consists of the following three aspects:

• excellent oral hygiene at home
• having your teeth cleaned professionally two to four times a year
• having regular check-ups

This will guarantee long lasting effects from treatment, but without careful aftercare there is a high risk of periodontitis returning.