Periodontal Gum Disease

Periodontal diseases affect most people to varying degrees throughout their lives. Common signs and symptoms include bleeding gums, a bad taste, bad breath, gum shrinkage and gaps widening between the teeth, food impaction, temperature sensitivity and loose teeth. Pain is not usually a feature until the very late stages of the diseases. The following has been prepared to help patients understand the process of gum disease and how most people can be successfully treated for long periods of time.

Periodontal Diseases present as different forms of inflammation of gum tissues.

  • Gingivitis
  • Chronic Periodontitis
  • Aggressive Periodontitis
  • Periodontitis as a Manifestation of Systemic Diseases
  • Necrotizing Periodontal Diseases

These different forms of periodontal inflammation need to be distinguished by your dental professional. Auto immune diseases, such as lichen planus and pemphigoid present as gingival inflammation and need to be distinguished from plaque related periodontitis. These lesiona are often associated with pain which is not common in chronic periodontal diseases. In health the gum is attached where the crown of the tooth meets the root. When the area is examined closely, with a microscope, there is a ligament found under the gum attachment that extends all the way around the root. The ligament goes into the root on one side and bone on the other. This apparatus is responsible for retaining teeth in the jawbone. Measurement of the distance from the top of the gum to where it attaches on the tooth as well as the amount of bleeding on probing, provides information regarding the health status of the gums. Ideally, the probe will only advance approximately 1-3mm and the tissues will not bleed. It is most important that the gums do not bleed when they are probed, as healthy gums do not bleed on brushing, flossing or gentle probing. The crevice where we insert the probe is also where plaque first develops.

Plaque is almost 100% bacteria. We have over 300 species of bacteria in our mouths but out of those 300 different species there are only 10 to 20 types that cause gum disease. The species related to gum disease do not thrive in oxygen-rich environments, they are ‘anaerobic’. The harmful bacteria thus need a certain kind of environment in which to flourish. This crevice provides a niche where bacteria can easily attach. As initial plaque layers are thin, oxygen can easily permeate, allowing only the healthy bacterial colonies to survive. The disease causing bacteria do not exist in fresh, newly formed dental plaque. Effective brushing and flossing techniques keep a ‘healthy’ plaque associated with the gum line.

If the plaque accumulates and thickens around gum margins and restorations, the anaerobic bacteria can survive within the plaque protected from the oxygen outside. Once these bacteria are living around the gum line they can cause damage to the gums. These bacteria and their products in the plaque produce an inflammatory reaction in the tissues. The inflammation results in bleeding and can lead to irreversible loss of the ligament and bone around the teeth. The space created by the damage is what we call a ‘pocket’, the depth of which we measure with the probe to establish the extent of the disease around each tooth. Oxygen supply is non-existent in the pocket providing a perfect environment for the destructive bacteria to thrive. Calcified plaque deposits (calculus) forming on the root surfaces also provide extra surface area for the attachment of anaerobic bacteria. Once the pockets have formed, an improvement in brushing and flossing above the gum line will not alter the environment at the base of the pockets where the bacteria are happily multiplying. Tissue destruction can easily progress because superficial cleaning does not affect the base of the pocket where the disease process is taking place. It is only the superficial bleeding that reduces with good brushing and flossing techniques.

If you have noticed bleeding or swollen gums, bad breath or taste, sensitive or loose teeth, shrinking gums or food impaction then call us for a consultation. These are sure signs of gum disease. If you have diabetes or are a smoker then you are at a much greater risk of developing gum disease.

 

Diabetes and oral health Diabetes and gum disease often go hand in hand and the bad news is that gum disease can cause teeth to become loose and even fall out if left untreated. People with diabetes are prone to infections and the mouth is no exception.

F1Figure 1: Before treatment
F2Figure 2: After treatment
F3Figure 3: Before treatment
F4Figure 4: After treatment

Apart from increased risk of gum disease, decay and fungal infections can also be a particular problem for diabetics. Unless dental cleaning is super good, bacteria will stay on the teeth to form plaque which causes infl amed swollen gums and leads to bone loss.

Plaque is the cause of gum (periodontal) disease so it is essential to keep the teeth as clean as possible for a healthy mouth.

If your gums bleed when brushing, flossing or after eating, if there is bad breath, shrinking gums, tooth sensitivity, food packing or loose teeth then it is likely you have gum disease. You need help and fast, even if you are not diabetic. Diabetes however, makes gum disease three times as likely and more aggressive, often with a more severe response to plaque.

Damage to the bone around the teeth from gum disease is irreversible so it is critical not to ignore bleeding gums. The good news is that help is simple and easy to access.

A dentist, hygienist or specialist periodontist can carefully remove the bacterial plaque and tartar from parts of the teeth which cannot be reached by simply cleaning at home. With proper treatment the gums stop bleeding and heal rapidly. Coaching from the dental team in brushing and fl ossing techniques will help keep teeth clean and the gums healthy in between visits for professional maintenance cleaning.

Quitting smoking is also essential for maintaining your teeth and oral health, as well as helping manage diabetes.

If you are diabetic, keeping good control of blood sugar is vital to decreasing the severity of any gum disease. In turn, healthy gums help maintain good blood sugar levels.

The connection between the two diseases is strong and it is important not to ignore either, even though there may be no pain or severe symptoms. A healthy mouth is essential to a healthy body and you do not have to be a diabetic to get that benefit.

There is no question that patients with diabetes should be seen by the dental team as part of their annual cycle of care alongside physicians, optometrists, dieticians, podiatrists and exercise physiologists.

Dr Jane McCarthy, Periodontist

Applecross PERIODONTICS | Exemplary Periodontal Care in Perth, Western Australia

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AAP launches “Love The Gums You’re With” to raise national consumer awareness about periodontal disease

To elevate the critical role of periodontists and to educate consumers on the importance of maintaining a healthy relationship with their gums, the American Academy of Periodontology (AAP) has launched “Love The Gums You’re With” – a national public relations campaign featuring relationship expert and host of ABC’s “The Bachelor” Chris Harrison. This campaign provides an exciting opportunity to support our members and raise awareness of periodontal disease.

Campaign overview

“Love The Gums You’re With” uses public relations strategies to inspire consumers’ commitment to healthy gums and to encourage people to visit a periodontist. You will see AAP President Dr. Stuart Froum and Chris Harrison in the media in the coming months as they work to educate consumers about the prevalence and treatment of periodontal disease while building awareness of our specialty. To achieve these goals, key elements of the campaign include the following:

  • A satellite television and radio tour reaching various markets across the United States;
  • National and local media interviews with Dr. Froum, Chris Harrison, and members of the AAP as spokespeople;
  • Social media posts announcing the campaign and leveraging our campaign logo and slogan;
  • A campaign-focused section on Perio.org.

 

What we want consumers to do

The campaign encourages consumers to visit Perio.org, interact with the fun elements of the site, and to understand when to seek a periodontist. To achieve this, the site allows them to:

  • Take a brief quiz to evaluate their gum health
  • Learn about the symptoms and causes of periodontal disease
  • Find a periodontist in their area

 

What you can do

The campaign-focused section of Perio.org houses a campaign toolkit for your use. You are encouraged to use this toolkit, available only to AAP members, to promote the campaign messages to your patients and your local community. Your toolkit resources include the following:

We also encourage you and your patients to follow us on Facebook and Twitter, @PerioNews, using #LoveYourGums.

Launching this important national effort marks an exciting day for the AAP and our members. In the coming weeks, we look forward to hearing from you as we share and highlight campaign successes. For more information, please contact AAP Public Relations and Communications Manager Mame Kwayie at mame@perio.org.

Best,
Dr. Stuart J. Froum
President, AAP

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ORAL HEALTH

Telltale signs of diabetes in your gums

September 10, 2014

Dentists can identify people with type 2 diabetes, even those in the early stages with glucose metabolism problems, just by looking at the health of their gums.

Periodontist Jane McCarthy, who has sent many people to their GP for glucose tolerance tests because their mouth health indicated they were likely to be diabetic, said there was a bi-directional relationship between gum disease and diabetes, with some studies indicating a three-fold increase in periodontitis for those people with diabetes.

“When they get a periodontal defect it (accelerates) really quickly so they end up with a particular pattern of attachment loss and also inflammation. The inflammation doesn’t look in a lot of cases in line with how much plaque there is, there is an exaggerated response,” she said.

There is some evidence that chronic periodontal infections can lead to glucose intolerance and poor glycaemic control and that treatment can cause a small but significant improvement in blood sugar levels.

Diabetes WA education services manager Deb Schofield said the link between periodontal disease and diabetes was well established.

“We know that people with diabetes have a higher risk of developing gum disease than those who do not. There is also some evidence that suggests that in serious cases — as gum disease is a type of infection — it can have a negative impact on blood glucose levels, which of course a person with diabetes needs to manage carefully,” Ms Schofield said.

“That’s why it’s important for people living with diabetes to visit their dentist regularly for advice on self-care and to receive regular preventive maintenance to keep their teeth and gums healthy, along with early intervention should problems occur.”

The West Australian