Gum Disease & Tooth Replacement
Gum disease is one of the biggest causes of tooth loss
What is Gum Disease?
Gum disease consists mainly of two conditions, gingivitis and periodontitis.
Both are caused by plaque, a sticky layer of bacteria which attaches to the tooth surface, initially at the gum line.
Gingivitis: Everyone is prone to gingivitis. This is where the gums become inflamed due to the presence of plaque, resulting in red, swollen and often bleeding, tender gums. It is reversible as plaque and tartar removal (tartar is hardened plaque) will resolve all signs and symptoms of gingivitis.
Periodontitis: Although not everyone is susceptible to periodontitis it is common, being the sixth most common disease in the world. Approximately half of us exhibit some degree of periodontitis and about 10% of the world’s population displays a severe form of the disease.
Periodontitis occurs if gingivitis does not resolve due to the continued presence of plaque, allowing the bacteria to spread along the tooth surface, including below the gum line. This plaque eventually eats away at the gum tissue connecting to the tooth surface, peeling the gum away to form a space below the gum line, called a pocket and this destruction results in bone loss and possibly gum recession.
Although plaque is the only actual cause of periodontitis, habits such as smoking and vaping, conditions such as diabetes and some autoimmune diseases can increase people’s susceptibility to the condition. There is also a link between periodontitis and cardiovascular disease, rheumatoid arthritis, dementia, and osteoporosis. There is also a genetic link with periodontitis.
Periodontitis can cause gum tenderness, swelling, recession and loose teeth. Unlike gingivitis, periodontitis is not reversible and if allowed to progress, more and more bone loss will occur, hence the risk of the teeth becoming loose. Increased mobility of teeth can sometimes reduce the ability to chew or even prevent the patient from eating completely with the affected teeth. Severe bone loss can eventually result in tooth loss.
Treatment
Gingivitis: In the case of gingivitis, treatment consists of professional dental cleaning and plaque control advice; without the patient achieving an adequate level of daily cleaning, gingivitis will return.
Periodontitis: As periodontitis is also caused by plaque, the deposits need to be removed, often under local anaesthesia, with specially adapted scalers. However, the patient must adopt an excellent standard of daily cleaning, including between their teeth before the clinician should consider cleaning the tooth surface below the gum line; plaque will otherwise reform at the gum line and, without a thorough cleaning the bacterial deposits to spread along the tooth again, reaching the tooth surface within the pocket (i.e., below the gum line) and starting the whole process again. In addition, regular hygienist visits for routine cleaning are essential in periodontally susceptible patients and this, along with an excellent daily standard of plaque control, needs to be a lifetime commitment.
Although gum and bone destruction caused by periodontitis is permanent, stabilising the condition will help prolong the life of teeth and often indefinitely if the disease is caught early enough.
If teeth fall out or need to be removed due to the extent of tissue destruction, the spaces can be restored if the patient so wishes. The treatment options are a denture, a bridge (if the teeth supporting the bridge are strong and healthy enough) and dental implants; a thorough assessment is required to establish which restorative treatment options are appropriate. Please note that the placement of dental implants should only be carried out once the periodontal condition of the whole mouth is stable. Without gum health around all remaining teeth there will be an increased risk of developing the equivalent of periodontitis around the dental implants and increase the risk of failure around them.