Gum disease is a condition caused by inflammation of the supporting structures of your teeth. It is caused by bacteria that have been allowed to accumulate in between your teeth and gums.
As gum disease progresses, the bone that holds your teeth in position starts to shrink, and over time, your teeth become loose and eventually fall out. If diagnosed and treated early, gum disease can be treated with professional intervention and excellent oral hygiene.
This guide will go over everything you need to know about gum disease.
The 2 main stages of gum disease
Gum disease comes in many different forms, which we will explain in detail below, but the two main stages of gum disease that you need to know are gingivitis and periodontitis.
Gingivitis
Gingivitis is the name given to the condition when your gums (aka gingivae) are swollen and bleed when gently touched (for example, with your toothbrush when brushing your teeth). Gingivitis is an early stage of gum disease and can progress to periodontitis if not treated quickly.
Periodontitis
When your gums are inflamed for an extended period of time, the supporting structures of your teeth (the jaw bone and periodontal ligaments) start to break down and shrink. This is known as periodontitis.
When your dentist mentions ‘gum disease’, they are most likely referring to Periodontitis.
Casues of gum disease
Gum disease is caused by a build-up of bacteria called plaque around your teeth and gums. Plaque bacteria feed on sugars present in your mouth to multiply and grow.
Your body responds to this build-up of plaque bacteria by creating inflammation (inflammation is your body’s natural defence against foreign substances). However, the side effect of this inflammation is that your periodontal structures get damaged and break down.
Inadequate oral hygiene (improper brushing and cleaning) will allow plaque bacteria to build up around your teeth and gums.
High sugar diet - A diet with a high frequency of sugar intake will allow plaque bacteria to proliferate and grow.
Smoking and vaping reduces the blood flow in your gums and increases your risk of gum disease.
Uncontrolled diabetes will also increase your risk of developing gum disease.
Several other medical and genetic factors can increase your risk of gum disease and make it harder to treat; however, the underlying cause of any gum disease is the presence of plaque bacteria. If you can keep the plaque levels around your teeth and gums low, you should be able to manage your gum disease.
Consequences of untreated gum disease
In short, the main consequence of untreated gum disease is that your teeth will get loose and fall out.
Gum disease progresses very slowly and is not something that you develop overnight. It takes years of plaque buildup and inflammation for your periodontal structures to break down.
Once you have active gum disease and the structures around your teeth remain inflamed, you will undergo something called ‘bone loss’. Your teeth are held in place by your jawbone, and when you have periodontitis, this bone starts to shrink.
A small amount of bone loss is okay, but as the bone shrinks more and more, your teeth will start to become loose. They may even start moving into obscure positions, eventually falling out of your mouth.
Bleeding - Untreated gum disease leads to bleeding when brushing or even when you're not brushing.
Pain - Advanced gum disease can cause pain and aching in your gums.
Infections - Your gums may develop infections and abscesses, which can be painful.
Bad breath - Gum disease often results in bad breath.
Tooth movement - Gum disease loosens your teeth, and they can start moving and becoming more crooked.
Tooth loss - If left untreated, your teeth will start falling out of your mouth, leaving you with gaps or, in severe cases, no teeth to chew food.
Diagnosing Gum Disease
It’s essential to know how gum disease is detected and diagnosed. During a dental check-up, your dentist will screen for gum disease. The screening is known as a BPE (Basic Periodontal Examination). This involves using a probe to check the health of your gums.
Each sextant of your mouth will be given a score of 0-4 depending on what the results of this probing are:
Code 1 = Bleeding (gingivitis) (can be managed at home with good oral hygiene)
Code 2 = Calculus or an overhanging dental restoration is present that needs addressing.
Code 3 = Mild gum disease (requires professional treatment)
Code 4 = Advanced gum disease (requires professional treatment)
Treatment of gum disease
Gum disease must be treated as quickly as possible to stop it from progressing. You can not re-grow the bone that has already been lost from around your teeth, but you can prevent further bone loss.
Treatment for gum disease occurs in stages and depends on the extent of your condition. In general, treatment for gum disease involves the following:
Professional cleaning (PMPR/Scaling)
The first thing you need to do is remove the build-up of plaque already around your teeth. The best way to do this is to book an appointment with a dental hygienist (or a dentist in some clinics) to clean your teeth and gums thoroughly.
Plaque bacteria exposed to your saliva for over one week can harden and stick to your teeth. This is known as calculus. You can not remove calculus at home with your toothbrush.
At your hygiene appointment, the hygienist will use an ultrasonic scaler to remove any calculus and plaque that has built up around your teeth and underneath your gums (known as ‘scaling’ or ‘PMPR’). This usually takes one 60-minute appointment (or if the build-up is severe, it may take up to 2/3 sessions).
At your appointments, your hygienist will also coach you on properly cleaning your teeth at home and advise you about what sizes of interdental brushes you should use. Your hygienist will also recommend you come back after about 6 weeks to 3 months to re-assess how your gums are responding to initial treatment.
Excellent oral hygiene routine at home
Once your hygienist has thoroughly cleaned your gums, you need to prevent the plaque from building up around your teeth again by ensuring your oral hygiene routine at home is excellent, especially regarding interdental cleaning.
Tooth brushing - Make sure you brush twice daily for 2 minutes each with a rechargeable electric toothbrush using the proper technique.
Interdental cleaning - Using interdental brushes between teeth is essential to prevent gum disease. The shape of the brush and its bristles get underneath your gum and stop plaque from building up in that area. As a general guide, you must use the largest brush that comfortably fits the gap between your teeth. You may need to use a combination of 2/3 different sizes, and ideally, you want to do this twice a day.
Smoking - If you smoke, try to reduce and quit smoking. It will drastically improve the health of your gums.
Corsodyl mouthwash - There is no need to use Corsodyl mouthwash to treat gum disease. Corsodyl mouthwash contains chlorhexidine, which is excellent for short-term infections, but extended use will lead to heavy dental staining.
Floss - Flossing is a great tool to clean your teeth and prevent tooth decay where your teeth touch together, but it is better to stick to interdental brushes for gum disease. In an ideal world, you would use both, but that may become impractical. While treating your gum disease, stick to interdental brushes, and once your gums have stabilised, you can alternate between floss and interdental brushing.
With professional cleaning and an excellent oral hygiene routine at home, Most mild to moderate gum disease will stabilise, and you can maintain your healthy gums with regular visits to your hygienist (every 3-6 months).
Non-surgical management of gum disease (periodontitis)
If you still have gum disease (periodontitis) after initial cleaning and good oral hygiene, your dentist may advise that you carry out a course of non-surgical treatment. Many people simplify this to ‘deep-cleaning’. Non-surgical treatment of gum disease involves:
Full mouth charting of your gums - Your dentist will take detailed measurements, record precisely how loose your gums are around your teeth, and identify any areas of ‘pocketing’, bleeding, recession and mobility.
Subgingival PMPR/Scaling - Your dentist will use special ultrasonic scalers underneath your gums to remove plaque from the pockets around your teeth. This can get quite sensitive, so they may numb your teeth before doing so.
Follow-up charting of your gums - After healing, your dentist will take another set of detailed measurements to see which pockets have improved and which areas have not and decide on the following action.
Your dentist may repeat this process a couple of times if your gums have not healed but are generally responding well to treatment.
Surgical treatments for gum disease
If your gum disease has not responded to non-surgical treatment as highlighted above, you may need further treatment, usually done by a specialist periodontist. This can include:
Surgical PMPR - Lifting the gums and exposing the roots of your teeth and bone to allow detailed bacteria removal.
Pocket reduction - Cutting back your gums to create shallower pockets that are easier to keep clean.
Bone Grafting - Bone and tissue grafting from other areas of your mouth to increase the stability of certain teeth.
