Gum Disease

Gum disease, or periodontal disease, is a chronic inflammatory disease affecting the gums and bone supporting the teeth. It is one of the most wide-spread diseases in the world.

If left untreated, gum disease can lead to tooth loss and a poorer quality of life. Fortunately, gum disease is also preventable, and treatable if discovered early enough.

There are different types of gum disease. The earliest and mildest form of gum disease is gingivitis. It involves inflammation of the gums which may appear reddish and swollen.

If left untreated, gingivitis can develop into the more serious form of gum disease called periodontitis, where the inflammation spreads below the gums and along the root surfaces of teeth. It can cause permanent damage to the supporting bone around your teeth and if untreated can lead to loose teeth and eventual tooth loss.

 
 

 

What causes gum disease?

Gum disease is caused by bacteria found in the sticky dental plaque which accumulates along the gum line. If plaque is not removed by correct toothbrushing and cleaning between the teeth, the gums start to separate from the teeth, forming gum pockets. Over time, the supporting bone around the teeth is destroyed. Finally, teeth start to loosen and fall out.

Plaque and tartar along the gum line

Who can get gum disease?

Mild forms of gum disease are relatively common. However, certain factors may increase your risk of developing more severe gum disease:

• Smoking
  
• Diabetes (especially if poorly controlled)
• Stress
  
• Certain illnesses and medications which affect the body’s immune system
  

• Bleeding gums when brushing or flossing your teeth
  
• Red, swollen or receding gums where the roots of your teeth can be seen
  
• Shaky or loose teeth
• Teeth appearing to drift apart from their original positions
• Persistent bad breath
  

The early stages of gum disease are usually pain-free and so patients may not be aware of any problems. Hence, it is important to visit your dentist regularly to check for gum disease.

The appearance of diseased gums contrasts with how healthy gums should look in someone who has no history of gum disease – tissues around the teeth are pink, firm and not bleeding.

 

This photograph illustrates what stable gums should look like in someone who has been treated for gum disease – gums around the teeth are pink and firm with minimal bleeding but with spaces between the teeth due to the loss of bone from the disease process.
 

 

What is the treatment for gum disease?

Step 1: Assessment and oral-hygiene instruction and advice

The dentist will first perform a thorough check of your gums. A special instrument called a periodontal probe is used to record any periodontal (gum) pockets. X-rays will also be taken to assess the supporting bone. With this information, the dentist can determine the severity of the disease. Milder forms of gum disease can be treated by a general dental practitioner or oral health therapist, while more severe forms of gum disease are referred to a Periodontist (gum specialist) for management. The main goal of treatment is to reduce the amount of bacteria around your teeth and prevent the gum disease from getting worse.

You will also be taught how to clean more effectively around your teeth and gums. This is important as good oral hygiene is essential for successful treatment outcomes.

Step 2: Professional Gum Treatment

Initial Periodontal Therapy (gum treatment) involves removal of dental tartar (calculus) and plaque (bacteria) from tooth surfaces beneath the gumline. This process is usually performed under local anesthesia to ensure comfort during treatment. This process usually requires several appointments (2-4 visits) especially for patients with advanced periodontitis.

 Step 3: Reassessment

After several weeks (usually at least 8 weeks), your dentist will make a full assessment of your gums to check the progress of your treatment. If any deep periodontal pockets are still present, further treatment may be suggested.

Healing of the gums after completing Initial Periodontal Therapy (gum treatment) varies depending on your oral hygiene compliance, habits as well as the severity of your gum disease.

Step 4: Corrective Surgical Therapy

In situations of advanced periodontitis, sometimes, a surgical procedure may be advised by a gum specialist.

Under local anesthesia, the gums are gently raised and the root surfaces are thoroughly cleaned to ensure all tartar and plaque accumulations are removed. In some cases, adjustment of the bone contours around the teeth is also performed such that the gums can properly adapt to the root surfaces of teeth.

Another common gum surgery is regenerative periodontal therapy. This involves the addition of special bone grafts and membranes to regenerate bone that has been lost due to periodontitis. The gums are stitched back into place around the teeth and stiches are removed 1-2 weeks later.

A pre-requisite for gum surgery is good oral hygiene and stable medical condition.

Learn more about gum surgery here.   

Step 5: Aftercare- Supportive Periodontal Therapy

Once your gum condition has stabilized, you will be placed on a supportive maintenance program. Regular follow-up appointments are important to ensure that periodontitis does not return and cause further destruction of the gum and bones supporting your teeth.

Depending on the severity of the disease and individual risk of disease progression, we would recommend short regular maintenance appointments ranging from 3-6 months interval to ensure close monitoring of areas. The long-term stability of your gum condition is dependent on your overall general health, good oral hygiene habits, and regular professional dental check-ups. A lapse in any of these factors may cause disease recurrence.

Difference between SPT and SAP

What is the difference between regular scaling and polishing and periodontal treatment (deep cleaning)?

There are several differences between regular scaling and polishing and periodontal treatment (deep cleaning or scaling and root surface debridement). While both treatments aim to improve gum health, they differ in terms of the purpose and extent of gum disease they address.

• Regular Scaling and Polishing:  

Scaling and polishing are standard preventive routine procedures performed to remove dental plaque and surface dental tartar (calculus) from the tooth surfaces and along the gumline.

• Periodontal Disease Treatment (Scaling and root surface debridement): 

A professional deep cleaning, also known as scaling and root surface debridement, is a more intensive treatment aimed at treating periodontitis (moderate - advanced gum disease). It is a procedure that goes below the gum tissue to remove tartar, dental plaque, and bacteria from the root surfaces of the teeth and is usually performed under local anesthesia.

What is the difference between Supportive Periodontal Therapy and regular scaling and polishing visits?

After treatment of gum disease and the gum condition is stabilised, patients will be placed in an individualized maintenance programme called supportive periodontal therapy (SPT). As patients who have suffered from gum disease remain at higher risk of disease recurrence, the goal is to keep the gums healthy. During SPT, there is a strong focus on disease prevention with timely detection and treatment in cases of recurrence to preserve the gums and teeth for life.

SPT is not just a normal dental check-up. It includes a dental examination and the following:

• Updating of patients’ individual risk factors and performing an individualised assessment of the risk of disease recurrence
• Detailed gum and oral condition assessment
• Reviewing and providing customised oral hygiene advice best suited for the patient
• Professional debridement (cleaning) above and below the gumline to remove bacteria and tartar
• Treating areas where gum disease is still active (deeper gum pockets)
• Giving advice on the next recall period for monitoring;    

Regular scaling and polishing on the other hand are routine procedures performed in individuals with healthy gums or mild forms of gum disease and are not at risk of further breakdown of their gum condition.