Good oral health is essential to anyone’s normal development. Having your teeth and gums in perfect condition lets you eat whatever you want and enjoy a good quality of life.
That changes when we develop an oral disease, as is the case with periodontitis, or advanced gum disease, which brings a series of degenerative changes in the bone and gums around the teeth, leading in its terminal phase to severe bone loss and to teeth falling out for lack of support.
What is it?
Periodontitis, or advanced gum disease, is a multifactorial disease caused by the bacteria in plaque; it is made worse by tobacco, and a genetic predisposition is also needed to develop it. Bacteria that build up chronically on the gums cause inflammation, known as gingivitis, and if that persists over time it will also lead to gum recession and bad breath, or halitosis; if the gingivitis progresses and the bone supporting the tooth starts to be destroyed, it turns into periodontitis, which has 3 stages: mild, moderate and severe. If it is not treated in the early stages it will become terminal, ultimately leading to loose teeth and tooth loss.
How does it appear?
If you keep up good dental hygiene and brush regularly after every meal, as well as using floss and interdental brushes, plaque is removed. But if we do not remove it, over time that soft, sticky plaque hardens into tartar. For tartar to form it needs something to settle on, which is the plaque, and it starts to build up at the gum line, that is, at the point where the gum begins to cover the tooth.
Once that happens, only a professional cleaning at a dental practice can remove the tartar for good. That is why at Clínica Peydro we recommend a cleaning at the practice at least once or twice a year, depending on the patient and their habits. If that is not followed there is a high chance that tartar will form and gingivitis will develop, which shows up as inflamed, red gums that can bleed easily when brushing, eating or even spontaneously. Bleeding while brushing is a symptom of gingivitis and calls for a visit to the dental practice, since healthy gums do not bleed.
We should bear in mind that there are other factors that, alongside the presence of bacteria, can encourage both gingivitis and periodontitis to appear, such as smoking, the hormonal changes women experience or pregnancy, conditions such as diabetes, and the use of medication that reduces saliva production, which is essential for controlling the amount of bacteria in the mouth. There are also genetic factors that make some people more prone than others to developing gum disease.
Symptoms
The initial build-up of tartar can start to cause a mild form of gum disease, which means losing the first few millimeters of bone around the tooth. If it is not treated and dealt with properly, the layer of tartar will keep growing below the gum line, separating the gum from the tooth and forming pockets that slowly widen year after year and extend toward the root of the tooth. Little by little the teeth start to become loose. And when the bone loss is truly severe, the teeth simply fall out.
Gum disease is known as the silent disease because it does not hurt. In its early stages only the dentist can diagnose it. However, some signs that should alert the patient are the following:
- Inflamed, red gums.
- Bleeding gums, especially when brushing.
- Discomfort and even pain when chewing food.
- Tooth sensitivity to changes in temperature.
- Receding gums, showing more of the tooth surface.
- Permanent bad breath from the bacterial load.
- One or more loose teeth.
- Teeth gradually changing position
- Flaring: the teeth tip outward
As well as all these symptoms, the diagnostic methods used at our practice, such as dental X-rays and probing (measuring the depth of bone loss), will determine whether we are dealing with gingivitis or periodontitis and, if it is the latter, what stage it has reached
Causes
There are various causes behind periodontitis appearing:
- Poor dental hygiene:We recommend brushing your teeth three times a day after each main meal. If we do not brush properly, plaque will start to settle on our gums and will sooner or later lead to gingivitis.
- We recommend brushing your teeth three times a day after each main meal. If we do not brush properly, plaque will start to settle on our gums and will sooner or later lead to gingivitis.
- Irregular visits to your dentist:It is a good idea to see the dentist once a year for a professional cleaning. If you do not, plaque can build up excessively in areas the patient finds hard to reach.
- It is a good idea to see the dentist once a year for a professional cleaning. If you do not, plaque can build up excessively in areas the patient finds hard to reach.
- Tobacco
- Genetic predisposition:Although the environment plays an essential part in the development, outlook and progression of gum diseases, in the case of periodontitis there is a strong genetic component. “Heritability is around 50% in this disease, which is considerably more than for breast or colon cancer”, says Dr. Ángel Carracedo, director of the Fundación Pública Gallega de Medicina Genómica.
- Although the environment plays an essential part in the development, outlook and progression of gum diseases, in the case of periodontitis there is a strong genetic component. “Heritability is around 50% in this disease, which is considerably more than for breast or colon cancer”, says Dr. Ángel Carracedo, director of the Fundación Pública Gallega de Medicina Genómica.
- Systemic conditions:Some uncontrolled systemic conditions can harm the health of our gums. Diabetes increases inflammation in response to bacteria, worsening the symptoms of gum disease and the destruction of the gum tissue and the bone supporting the teeth. Treatments for anxiety or depression reduce saliva levels and the natural protection saliva gives the oral tissues. Certain epilepsy medications, meanwhile, cause chronic inflammation and thickening of the gums. This large group of patients needs to be monitored closely at the dental practice.
- Some uncontrolled systemic conditions can harm the health of our gums. Diabetes increases inflammation in response to bacteria, worsening the symptoms of gum disease and the destruction of the gum tissue and the bone supporting the teeth. Treatments for anxiety or depression reduce saliva levels and the natural protection saliva gives the oral tissues. Certain epilepsy medications, meanwhile, cause chronic inflammation and thickening of the gums. This large group of patients needs to be monitored closely at the dental practice.
Treating gum disease
1- Gingivitis
Gingivitis, which as we have said is inflammation of the gums, can be treated with a scaling or professional dental cleaning, which means removing the calculus stuck to the teeth with ultrasonic and special dental instruments. In some cases we use anesthetic so we can reach every area that needs a deep clean.
2- Periodontitis
Starting treatment when gum disease is diagnosed and its symptoms are seen is essential to keep it from progressing and to cure it as soon as possible.
Treating periodontitis depends on how far the gum disease has progressed. It involves an active treatment phase that includes the following:
- In its earliest stage, a deep clean is carried out involving scaling of the tooth roots with mechanical and hand instruments to remove the tartar stuck to them, and planing of the root surface so the gum can reattach to the tooth root. This initial phase of active treatment also involves oral hygiene instruction so the patient becomes skilled enough to remove plaque at home.
- In some more severe cases surgery may be needed, which means lifting the gums to gain direct access to the roots, removing all the tartar and reducing or eliminating the periodontal pockets.
- In cases where there is gum loss or bone loss we have to turn to regenerative techniques such as connective tissue grafts and/or bone grafts.
After the active treatment phase comes a maintenance phase aimed at controlling the disease in the short and long term. Because it is a chronic disease, it needs lifelong monitoring at the dental practice to prevent the periodontal pockets and the bone loss from returning. Without that care, there is a risk the gum disease will come back within a few months. In this maintenance phase, visits to the periodontist should be made every 3, 4 or 6 months, depending on the patient, to check that the disease has been halted and carry out the necessary monitoring. Without them, the gum disease will flare up again.
How can periodontitis be prevented?
As we have said, good oral hygiene is essential for removing the plaque that is the initial cause of the disease. But there are also other factors that can play a part, as we said, such as taking certain medication, among others.
Keeping up good oral hygiene goes far beyond brushing your teeth, since other tools also have to be used depending on the case, such as floss or interdental brushes (which are far more targeted).
The consequences of letting good dietary and hygiene habits slip can affect more than the mouth or how you look. We now have enough evidence that some gum diseases can have effects throughout the body in people who are predisposed, and that they are linked to a higher risk of developing diabetes or controlling it less well, of having a cardiovascular event or, in pregnant women, of going into premature labor, notes Dr. Regina Izquierdo, periodontist and board member of the Sociedad Española de Periodoncia (SEPA).
We would stress again that seeing the dentist regularly clearly prevents a disease of this kind, since having a professional cleaning every six months or every year prevents tartar building up and the gum inflammation that follows and, most importantly, allows these diseases to be detected early, which is essential to keeping them from developing.
Can implants be placed with periodontitis?
Fortunately, the great advances in dental implants make it possible in most cases. Even so, the disease has to be under control before the implant is placed, since this is a disease of the bone and gums, not of the teeth. So first we treat and control the gum disease and, immediately afterwards, we place the dental implants.
It is also necessary to study the overall state of the mouth, especially the density and quality of the bone where the implant will go. With patients who have periodontitis, various things have to be taken into account, such as the final height at which the gum margin will sit after the tooth is extracted and the dental implant is placed.
Which professional treats gum disease?
The professional who treats this kind of disease is a dentist who has focused their practice on periodontics which, in our case, is Dr. Marta Peydro. As with all oral diseases, the key is making a thorough diagnosis of the case, and for that a work-up is carried out before deciding on the individual treatment in each case.
Is gum disease contagious?
As an infectious disease, and bearing in mind that our mouths contain up to 500 kinds of bacteria, those bacteria can indeed be passed on through saliva from one person to another. Whether the disease develops will depend on whether the person receiving them is susceptible to it because of factors such as the state of their immune system, how much plaque they have already built up and whether they smoke, among others. It is normally passed on over a long period of time, and relatives of diagnosed patients are always advised to have check-ups to determine whether the disease is present.
