Periodontal (Gum) Disease

What is periodontal disease?

Periodontal disease is an infection of the gums, teeth and jaw bone that can pose a serious threat to your oral health and overall health. Periodontal disease can start at just about any age and exists in two main stages: Gingivitis and Periodontitis:

Gingivitis (gum disease)

Gingivitis, also known as gum disease, occurs in the early stages of periodontal disease. Gingivitis is an inflammation of the gums caused by dental plaque that forms on teeth. As excessive dental plaque builds-up on teeth, the surrounding gums become irritated, red, inflamed and may easily bleed. If not removed, dental plaque built up on teeth hardens to form tartar.

Periodontitis

If gingivitis is not properly treated, it can advance to the later stage of periodontal disease called periodontitis. Periodontitis is an inflammation of the tooth or teeth. Over time, as plaque builds up below the gum line, the tissue that attaches the gums to the teeth is destroyed by bacterial enzymes in dental plaque. This causes the gums to pull away from the teeth and small "pockets" of infection form between the teeth and gums and fill with more plaque. Eventually, if periodontitis is not properly treated, the jawbone supporting the teeth will be destroyed and teeth may be lost.

Other causes of periodontal disease include smoking, excessive consumption of alcohol, improper use of dental floss and toothpicks, poor nutrition, vitamin C deficiency, pregnancy and certain medications.

Symptoms of periodontal disease

Periodontal disease is usually painless in its beginning stages so most people are unaware they have it. If you are diagnosed with periodontal disease early, the treatment will be easier and less invasive.

Symptoms of periodontal disease include:

  • Gums that bleed when you brush your teeth
  • Red, swollen, tender and receding gums
  • Pus between teeth
  • Loose teeth
  • Bad breath
  • A change in your bite or the way your dentures or mouthguards fit
  • Painful to chew

Diagnosis of Periodontal Disease

During each preventative care appointment, your hygienist should check for signs of periodontal disease and tooth decay by probing and charting your "pocket depths" using a small, blunt instrument called a periodontal probe.

Pocket depth

Pocket depth is a measurement (in millimetres) of the space between the top of your gum line (gingival crest) and the base of the pocket. To properly measure pocket depths, your hygienist must probe 3 points on the buccal (tooth surfaces adjacent to your cheeks) surfaces and 3 points on the lingual (tooth surfaces adjacent to your tongue) surfaces on all teeth. A healthy pocket depth is approximately 3 mm deep.

PSR score

After measuring your pocket depths, your hygienist will assign you a PSR score. A Periodontal Screening and Recording (PSR) score codes each of 6 regions in your mouth (called sextants) from zero to four. Scores of three or more in two sextants or four in one sextant indicates the presence of periodontal disease. Your hygienist should discuss your PSR score with you at the conclusion of your dental appointment as well as possible periodontal prevention and treatment plans.

Prevention of periodontal disease

In most cases, practicing good oral hygiene and scheduling regular preventative care dental appointments can significantly reduce your risk of periodontal disease.

Practice good oral hygiene

  • Brush twice per day using a soft-bristled toothbrush and a fluoridated toothpaste
  • Do not forget to clean the surface of the tongue while brushing your teeth, as bacteria tends to accumulate on the tongue
  • Floss at least once per day to remove food particles between teeth
  • Use a mouthwash with an anti-bacterial agent 1-2 times per day after brushing to kill odour-causing bacteria
  • Chew sugar-free gum after meals or snacks to help clear the mouth of excess bacteria

Schedule regular preventative care dental appointments

Dental cleanings and examinations performed at regular preventative care dental appointments can ensure excess plaque bacteria and tartar are effectively removed from teeth, decreasing the risk of periodontal disease. With regular dental examinations, your dental practitioner can also check if signs of periodontal disease are present. If you are diagnosed with periodontal disease early, your treatment can be easier and less invasive.

Treatment of periodontal disease

If signs of periodontal disease are present during a preventative care dental appointment, your dental hygienist will help you develop a periodontal treatment and prevention care plan that is tailored to your individual needs. Treatment for periodontal disease is generally ongoing with a focus on future oral health, so results from treatment should not be expected in one day.

The treatment timeline can vary depending on the type and severity of periodontal disease and often includes a combination of the following treatments:

Prophylaxis is a regular, routine dental cleaning and scaling. A prophylaxis cleaning involves scaling tartar, plaque and stains off of teeth above the gum line followed by a polishing.

Full mouth debridement scaling is a rough scaling that removes the majority of excess tartar and plaque build-up from the teeth and as far below the gum line as the patient can bear without anaesthesia. A full mouth debridement lets the gums begin healing while allowing the hygienist to perform a more accurate periodontal exam.

Root planing is the smoothing of the tooth root surfaces and consists of a deep dental cleaning that effectively removes the tartar, plaque and bacteria build-up from below the gum line and inside formed pockets. During root planing, local anaesthesia is almost always required. Root planing is far different from a regular prophylaxis, as regular dental cleanings can only remove plaque and tartar on teeth from above the gum line. Root planning is often the treatment of choice for more severe cases of periodontal disease.

Once periodontal disease has been successfully treated, together, you and your hygienist can set a periodontal maintenance care plan that best fits your needs. A periodontal maintenance care plan is important to prevent the re-occurrence of periodontal disease and ensures you keep your healthy smile for a lifetime!

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