Periodontal gum disease: (Periodontitis)

Periodontitis is a nasty one and in most cases people don't know they have it until it is too late.

If you are seeing gum recession, have very red gums that may even bleed after light teeth brushing then you should have your gums examined by a periodontist for the presence of periodontitis.
Or even your local dentist will detect gum disease.

Periodontitis is not curable in the sense that if your gums are already separated partially from some teeth, treatment will not glue them back, but it can be stopped in it's progression and the nasty effects of it (teeth falling out) can be delayed considerably if treated soon and then periodically.

Periodontitis gum disease symptoms:

Gum recession:
What periodontitis does is the more it progresses the more the gum and the tooth it surrounds grow apart, or in other terms - the gum does not adhere to the tooth and hence does not support it well.
The deeper the gum does not adhere to a tooth - the less gum support the tooth has which then leads to that tooth becoming lose and unstable, but mainly allowing infection to get even deeper between the gum and tooth.
The deeper the gums are not adherent to the tooth, the easier it is for the bacteria and infection to get to the actual jawbone around the roots of the tooth - eventually causing the tooth to fall out.

This can also lead to visible gum recession and even spaces between the bottom of teeth.

Gaps between teeth
If you see a space between your teeth that was not there before, the gums may have receded or the teeth might have moved apart.
In dental speak this is called 'migrating'. If two adjacent teeth which formerly contacted each other, and now no longer touch as they previously did, the appearance of gum recession or a 'space' is related to this 'migration' or separation of the teeth.

Bleeding Gums
If your gums are bleeding when you brush them, you definitely have gum disease, even if the bleeding is not at the sight of the recession. Patients who have gum recession have a tendency to avoid brushing where the gums meet the teeth thinking that protects the gums.
This is incorrect.
Since many people do not brush where the gums meet the teeth, they may not have any evidence of bleeding gums, even though gum disease is present. This is why the absence of bleeding gums does not mean there is no gum disease present, while the presence of bleeding always means that gum disease is present.

Bad Breath
Bad breath can be a sign of gum disease or it can be present if there is no gum disease. Bad breath can be caused by certain foods, the lack of proper cleaning of the teeth even with no gum disease, the build-up of bacteria on the tongue or even from stomach problems. However, if bad breath does not go away after brushing and flossing properly, including brushing the tongue, you must consider that there may be serious gum disease where the pus and bleeding from the disease are contributing to the bad breath problem.

Red Gums
The normal gum colour is usually described as 'coral pink'. If you see that your gums are red in colour, you should be suspicious that gum disease is present. Reddened gums may not always bleed. However, if you have red gums, especially shiny red gums, and even if they don't bleed upon brushing them, you should see a periodontist. If you are a 'mouth breather' this can contribute to the appearance of red gums and then gum infection.

Loose Teeth
If you are aware of looseness of some teeth, this is a very clear sign that advanced gum disease may be present. When the patient is aware of looseness, that is usually a very bad sign since patients don't perceive looseness until the teeth are very loose and sometimes hopeless.

What causes periodontitis ?
Gum disease is caused by the bacteria that are normally in the mouth. The types of bacteria may vary with some patients having more types of bacteria that are associated with aggressive gum disease. The bacteria then accumulate where the gums meet the teeth. The gums normally form a 'ditch' or 'sulcus' that goes completely around the tooth like a 'cuff on a shirt goes around your wrist'. Once the bacteria cause the gums to become infected, the gums detach from the teeth. When the gums are healthy, the normal depth of the 'sulcus' is 1-3 millimetres. When the gums detach from the teeth as a result of the gum disease, a diseased 'sulcus' is called a 'pocket' and the 'pocket' has a depth deeper than the 3 millimetres. of the 'sulcus'.

This deeper depth of the 'pocket' then prevents the patient from treating their own gum disease since a patient can not clean into a 'pocket' and eliminate the excess bacteria when the pocket depth is deeper than 3 millimetres. The untreatable (by the patient) gum disease then spreads into the underlying bone which supports the teeth. This causes loosening of the teeth. If the gum disease is not treated early enough, the patient will lose her teeth.

Risk factors of periodontitis
things that help gum disease (Periodontitis) to progress:

There are other considerations besides the gum factor that can cause or help gum disease to advance faster

Smoking
Smoking has been shown to increase the chances of getting gum disease and also of having more aggressive types of gum disease.

Diabetes
Patients who have diabetes or who have diabetes in their family can be predisposed to having gum disease or to having a more aggressive type of gum disease. If a patient has poorly-controlled diabetes, this may be associated with a more involved type of gum disease.

Genetically-reduced resistance to gum disease
There are genetic considerations which predispose patients toward a more aggressive, severe type of periodontitis. Patients who have a family history of tooth loss or parents wearing dentures, should be more concerned about a genetic resistance consideration.

Type of bacteria that are present in a patient's mouth
It is not known why some patients naturally have bacteria present in their mouths which are not associated with aggressive periodontitis while other patients have the more aggressive type of bacteria.

Periodontitis transmission
It has been shown that patients can transmit gum disease bacteria to their spouses, and that when the spouses have gum disease, the other spouse is more likely to have gum disease. If you are shown to have a more serious type of gum disease, it is important to check the gum health of your spouse.

How gum disease is detected
Normal healthy gums are usually described as 'coral pink' in colour and usually fit to a nice sharp point as they approach the point where the teeth come together and contact. The healthy gums have a 'pebble grain' appearance which is called 'stippling'.

When gums become diseased, they:
- change in colour from coral pink to a more reddish colour
- change in form from a nice sharp, tapered form into a rounded, swollen, less tapered form.
- lose their appearance of stippling and become shiny as well as reddened.

The Periodontal Probe
The periodontal probe is basically a thin nail like instrument the dentist will insert between the gum and a tooth and depending on how far the 'nail' will slide in - the dentist can evaluate if one has gum disease.
If the nail (the probe) slides in more than 4 mm - then this could indicate gum disease.

How gum disease periodontitis can be treated
The treatment of gum disease varies depending on the degree of involvement with the disease.

There are three ways of treating periodontitis:
1) non surgical planning - with a long thin drill like device
2) surgical removal of infected gum tissue
3) and then prevention = brush your teeth like mad

Non surgical Planning of gum disease
A non-surgical treatment is called root planning.
Root planning is where the gum tissues are usually anaesthetized with a Novocain anaesthetic and the dentist or hygienist will scrape the diseased tooth root until it is clean and no longer contains bacterial waste products.
This is done by a long thin drill type of instrument which slides between the tooth and surrounding gum, and the turning motion, plus water and disinfectant squirted via this drill - clean out the bacteria and scrape the area around the tooth and between the tooth and the gum free of any material (infected tissue, pus, deep rooted tartar etc) that may be present.

If this is done at the initial phases of gum disease, the disease can be stopped in it's tracks, and be prevented from progressing.
If this is the case, the planning - drill scraping, should then be repeated periodically - say twice a year - even 3 to 4 times a year - or as often as suggested by your dentist.

Depending on how sensitive one is, this treatment can sometimes be done without anaesthetic, but if one is too sensible especially towards the outside of the teeth roots, then small injections of anaesthetic may be injected into the surrounding gum.

Root planning may sometimes be enhanced with antibiotics that are taken orally or placed into the gum 'pockets'. Not all cases of gum disease will have antibiotic enhancements as a part of their root planning therapy. After root planning, the gum tissues are usually tender or sore, but not usually painful. When the periodontist determines the gum disease aggressiveness, the periodontist can determine the modifications in the root planning treatments that best fit your case.

Gum Surgery
Gum surgery is done to eliminate disease pockets which still exist after all healing has been achieved following root planning. There are, however, a small number of cases which will not benefit from non-surgical root planning and surgery will be recommended without having root planning done. Surgery is most frequently done with a Novocain local anaesthetic. A periodontal dressing may be placed after the surgery in order to protect the tissues. There may be some pain after periodontal surgery.

When surgery is done and diseased tissue is removed, the teeth may have more root surface exposed. This amount of exposure represents the amount of root surface which lost its gum and bone support from the gum disease. The surgery does not causing unnecessary damage

How long will the benefits of gum treatment treatment last
The benefits of periodontal therapy are determined by the severity of your case before you were treated. If you have severe problems with many loose teeth, these teeth may not have much of a future. You should not invest much in teeth with a poor future.
However, if your teeth still have good strength despite gum disease being present, there is no reason why you should not get excellent long term results if you properly take care of your mouth after your gum treatment.

What do I need to do in order to maintain
good health after gum treatment
You must clean your teeth efficiently on a daily basis.
This means efficient brushing and flossing.
Patients who brush many times a day, but not once efficiently are not cleaning their teeth properly.

How to clean your teeth ?
Get a harder tooth brush, and don't be afraid to scrub the teeth really hard, especially near where the teeth meet the gums, use floss, and special mini inter-teeth brushes to get to the nooks and crannies that a normal toothbrush just can't reach.
Brush your teeth after meals, or at least three times a day, and spend at least 8 minutes brushing thoroughly each time.
This alone will do more wonders in gum disease prevention or stopping it's progression than any magical dental technology invented.