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Section Questions and Answers

Gum Disease or Periodontal Disease

  1. What does "periodontal" mean?
  2. Which are the periodontal tissues?
  3. What is periodontal disease?
  4. What causes periodontal disease?
  5. What are dental plaque, calculus or tartar?
  6. What else can cause periodontal disease?
  7. How can I tell if I have gingivitis or periodontitis?
  8. How will my periodontist diagnose periodontal disease?
  9. What is a periodontal pocket, and why is it a serious problem?
  10. Can periodontal disease be prevented?
  11. What is the treatment for periodontal disease?
  12. Can periodontal disease come back again after treatment?
  13. Is there pain and swelling with periodontal surgery?
  14. How will my teeth look and feel after treatment?
  15. Should I be concerned about loose teeth?
  16. What other periodontal problems can develop?
  17. Can periodontal surgery improve my smile and appearance?

"Safe and effective measures exist to prevent the most common dental diseases - dental caries and periodontal diseases...These measures include daily oral hygiene procedures." U.S. Surgeon General's Report

 
1. What does "periodontal" mean?

  • Periodontal means "surrounding the teeth". Peri means around or surrounding, while dontal refers to teeth.
  • The tissues surrounding the teeth are called periodontal tissues.
  • A Periodontist specialises in the treatment of periodontal tissues.

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2. Which are the periodontal tissues?

  • The periodontal tissues include:
    • The gums (also called gingiva). Gums consist of soft, pink tissue, which covers the alveolar bone.
    • The gum line is where the tooth meets the gum.
    • Bone (alveolar bone). This is the bone in which the roots of teeth are embedded.
    • Periodontal Membrane. This connects and attaches the roots of teeth to the bone.

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Normal anatomy
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Normal gums

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3. What is periodontal disease?

  • Periodontal disease is an inflammation or infection of periodontal tissues.
  • There are two main types of periodontal disease:
     
  • Gingivitis
    • This is inflammation or infection of the gums only.
    • Most people have gingivitis at some time or other.
    • Untreated gingivitis may lead to periodontitis.

  • Periodontitis
    • This is a destructive infection that can affect all the periodontal tissues, that is, the gums, the bone and the periodontal membranes.
    • Chronic periodontitis develops slowly, other kinds of periodontitis develop more rapidly.
    • This is a common disease - at least 50% of adults show some symptoms of periodontitis.
    • It is the major cause of tooth loss.

Chronic periodontitis

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Before
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After treatment
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X-ray showing
bone loss


Rapidly progressing periodontitis

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Before
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After
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X-ray showing
bone loss


Juvenile periodontitis

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Gum loss
between teeth
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X-ray showing
bone loss

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4. What causes periodontal disease?

  • Dental plaque on teeth, is the major cause of gingivitis and periodontitis.
    • Bacteria within the plaque cause periodontal disease.
    • Calculus (tartar) is hardened or calcified plaque that sticks to teeth, and is a cause of periodontal disease. It ranges in colour from yellow to black and is covered by plaque.
    • The effects of plaque can be even more damaging if the patient is in poor health, or has a low resistance to disease.
  • It has not been finally determined whether periodontal disease may be passed from person to person.

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5. What are dental plaque, calculus or tartar?

  • Dental plaque is a thin film of bacteria and other organic material that sticks to teeth.
    • Plaque cannot be rinsed off, but it can be removed by brushing and flossing.
    • If plaque is not removed, it can cause periodontal disease.
    • The longer that plaque is allowed to remain on teeth, the greater are the risks of gum disease.
    • If plaque is not removed, it can harden to form calculus.
    • Calculus causes gum problems. It should be professionally removed as regular brushing will not do so.
    • Calculus occurs more often in older children and adults.
    • Diets rich in soft, sticky, carbohydrate foods with high sugar contents encourage plaque formation.

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6. What else can cause periodontal disease?

  • Periodontal disease is caused by one or more of the following:
    • Puberty and pregnancy can make people more susceptible to periodontal disease.
    • Medical problems such as diabetes and blood or genetic disease.
    • Smoking is known to contribute to periodontitis and other oral diseases.
    • Medications such as birth-control pills, and drugs for treating heart disease.

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Puberty gingivitis
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Pregnancy gingivitis

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Gum growth with heart
disease medication

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7. How can I tell if I have gingivitis or periodontitis?

  • The important things to watch for are:
    • Bleeding gums, or blood on your toothbrush.
    • Bad breath.
    • Teeth that are discoloured by plaque or calculus.
    • Loosening of teeth.
    • Teeth changing position.
    • Gaps appearing between teeth.
    • Food wedging between teeth.
    • Receding gums, making the teeth look longer.
  • Gingivitis and periodontitis are not painful when caused by plaque.
  • In the advanced stages, painful abscesses can develop.

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8. How will my periodontist diagnose periodontal disease?

"Most adults show signs of periodontal or gingival disease." - U.S. Surgeon General's Report

  • Your periodontist will assess the following factors:
    • Your dental and medical history, and any family history of periodontal disease.
    • How well and effectively you clean your teeth.
    • The amount and position of plaque and calculus on your teeth.
    • The colour, shape, quality and quantity of gum tissue.
    • The presence of bleeding and pus in the gums.
    • The formation of "pockets" around the teeth.
    • Loss of attachment of the periodontal tissues to the teeth.
    • The firmness or looseness of your teeth.
    • A complete set of intra-oral x-rays will be taken. These will show the degree of bone loss around the teeth.

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Gum disease

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Illustration of x-ray
showing gum disease

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9. What is a periodontal pocket and why is it a serious problem?

  • A periodontal pocket is the space that develops between the tooth and the gum when gum disease has destroyed the original attachment of the gum to the tooth.
    • The gum pulls away from the tooth and a pocket is formed.
    • The presence of pockets shows how far the disease has progressed.
    • Pockets offer safe havens for the bacteria that cause and advance periodontal disease.
    • The bone around the tooth will be become infected and will shrink. With the loss of support the tooth will become loose.
    • Pockets and their contents cause bad breath.
    • The aim of the treatment is to eliminate the pocket, or at least to reduce its depth.

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Probe ready
in position
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During probing

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10. Can periodontal disease be prevented?

Periodontal disease that is caused by plaque can be prevented by the regular daily removal of plaque. Home care and professional cleaning are needed.

  • Home Care will include:
    • Careful brushing at least twice a day.
    • Rinsing with special mouthwashes.

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      Brush position
    • Regular and thorough use of dental floss or superfloss.

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      Superfloss
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      Dental tape

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      Regular floss
    • Using interdental brushes which clean between the teeth.

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      Interdental brushes
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      Interdental brushing
    • Using end tuft brushes.

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      End tuft brush
    • The use of plaque disclosing solution or tablets, which stain plaque and show where further brushing is needed.

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      Stained plaque
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      After brushing
    • Interdental tooth sticks.

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      Tooth sticks
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      Use of tooth sticks

  • Regular professional cleaning
    Professional cleaning by the dentist or hygienist is important for the prevention of periodontal disease.

See Toothbrushing and Cleaning Between the Teeth

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11. What is the treatment for periodontal disease?

The treatment for periodontal disease depends on whether it is
(A) a gingivitis or (B) a periodontitis caused by plaque.

A. Gingivitis caused by plaque
Homecare and Professional Cleaning are the methods of treatment.

  • Homecare
    Home Care for Gingivitis includes the twice daily removal of plaque by correct brushing and flossing.
  • Professional cleaning
    Professional cleaning by the hygienist, dentist or periodontist will include:
    • Scaling, which is the professional removal of plaque and calculus.
    • Root planing, which is the smoothing and polishing of root surfaces.
    • Scaling and planing must be carried out regularly to control the disease.
    • Regular return or recall visits to the periodontist, dentist or hygienist are therefore essential.

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Before
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After

B. Periodontitis caused by plaque
The treatment for a periodontitis is more radical than for a gingivitis, which is merely an inflammation of the gums.
Home care and professional treatment are combined to cure the disease.

  • Home care
    As with the treatment of gingivitis, correct and regular cleaning at home by the patient is essential.
  • Professional treatment
    This can include one or more of the following:
    • Scaling and root planing
      This is an important part of the treatment. It may take many visits to complete and have to be repeated.
    • Medications (antibacterial)
      The medication may be locally applied or taken orally.
    • Periodontal surgery
      Surgery may be necessary to remove plaque and calculus below the gum line.
    • Bone Rebuilding
      Surgery to reconstruct bone that has been destroyed by the disease is sometimes possible.
      It can include bone grafting.
    • Bone grafting
      The bone can come from the patient or a bone bank. Synthetic substitutes can be used.

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Bone loss
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Membrane over lesion
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After grafting

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X-ray before
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X-ray after


    • Guided tissue regeneration
      This is a new method for regenerating bone lost to periodontal disease.
    • Soft tissue grafting
      Gum grafting can restore gum tissue lost to disease or excessive tooth brushing.

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Before
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After
    • Gingival grafting or gum rebuilding
      Tissue is obtained from the patient or a tissue bank.
      Grafting improves the appearance of the mouth and the attractiveness of the smile that has been disfigured by injury or disease.

    Click to enlarge
    Before
    Click to enlarge
    After

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12. Can periodontal disease come back again after treatment?

  • Periodontal disease can recur for any of the following reasons:
    • The patient's general state of health is poor.
    • The home care and regular professional cleaning programs are not maintained.
    • The disease has spread into the spaces between the roots of multi-rooted teeth such as molars. It is very difficult to remove plaque from all these root surfaces.
    • The disease can even reappear after excellent treatment and good home care, for no known reasons. In these cases antibacterial drugs may be helpful.

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13. Is there pain and swelling with periodontal surgery?

  • A local anaesthetic will control pain during the treatment.
  • Pain relievers can be used if there is any discomfort after the treatment.
  • There should be little swelling. If there is any, applying an ice pack will help.

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14. How will my teeth look and feel after treatment?

  • Shrinkage of the gums can result and teeth may look longer.
  • When gum grafting has been done, the appearance is improved.
  • Loose teeth should firm up after treatment.
  • The exposed roots of the teeth may be sensitive to hot and cold.
  • Persistent sensitivity will be treated by the dentist.

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15. Should I be concerned about loose teeth?

  • Yes, because the main causes of tooth loosening are:
    • Periodontitis.
    • Teeth meeting in the wrong positions during chewing (malocclusion).
    • Bruxism or habitual tooth grinding may loosen teeth or wear them down.
  • Loose teeth can lead to:
    • Food packing between teeth and causing periodontal disease.
    • Teeth moving into wrong positions and spoiling the smile.
    • Worsening of existing periodontal disease problems.
  • Treatment for loose (mobile) teeth is:
    • Elimination of periodontal disease.
    • Correcting the way teeth bite together (occlusion).
    • Treating habits such as the grinding of teeth.
    • Splinting loose teeth to firmer ones.

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16. What other periodontal problems can develop?

  • Abscesses
    • These are localized red swellings that contain pus. They can be very painful.
    • Gingival abscesses occur in the gums only.
    • Periodontal abscesses can involve all the periodontal tissues.
    • Peri-coronal abscesses are found around the crowns of teeth. The most commonly affected are the wisdom teeth.
    • These abscesses are treated with antibiotics and minor surgery.
    • They do not necessarily result in loss of teeth.

      Click to enlarge
      Before
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      After
  • Gum irregularities

    Receding gums Click to enlarge
    Before
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    After graft
    Gum excess Click to enlarge
    Gum excess
    Uneven gumline Click to enlarge
    Before
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    After graft
  • Gum disorders that are not caused by plaque
    • Specific infections: Bacterial, Viral, Fungal
    • Injury such as burns, commonly caused by hot Pizzas, and less commonly caused by chemicals like aspirin.

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17. Can periodontal surgery improve my smile and appearance?

  • Like plastic surgery, cosmetic periodontal surgery can be used to improve your smile and appearance.
  • Cosmetic problems that can be improved by periodontal treatment are:
    • Gum excess

      Click to enlarge
      Before
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      After treatment

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      Final + crowns
    • Uneven or unattractive gum line

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      Before
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      After gum surgery

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      Final + crowns
    • Receding gum line

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      Before
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      After gum graft
    • Inflamed, swollen, red gums

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      Before
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      After treatment

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