Introduction

If your dentist has told you that you hava a gum disease or periodontal disease, do not fear you are not alone. A lot of adults suffer from one or another form of this disease. Periodontal disease can vary from a simple inflamation of the gums to a more serious gum disease that damages the soft tissue and the surrounding bone. In more advanced cases, there will be tooth loss.  The deterioration in the gums depends on how well you look after your teeth and gums daily after being diagnosed with gum disease.

What is the cause of gum disease?

Our mouth is full of bacterias. These bacterias, together with other mucus and other particles, forms sticky, colourless plaque which deposits itself on our teeth. Brushing and  flossing help to eliminate this plaque. When the plaque cannot be eliminated, it becomes hard and deposits are formed called tartar which cannot be eliminated with simple cleaning. Only a profesional cleaning carried out by a dentiist can remove the built up tartar.

Gingivitis

The longer the period of time the tartar is left on the teeth the more damage it can do. The bacteria causes an inflamation of the gums that is known as “gingivitis”. If a person has gingivitis, his or hers gums will be reddish in colour, they swell and bleed more easily. Gingivitis is a mild form of periodontal disease that can be cured with daily brushing and flossing, in addition to a periodic cleaning with your dentist. This type of periodontal disease does not cause loss of bone or damage to the soft tissue supporting your teeth.

Periodontitis (or pyorrhea)

When the gingivitis is not treated properly, it can convert into a periodontitis. This means that there is an inflamation around the tooth. In periodontitis, the gums move further away from the teeth and form spaces or periodontal pockets which get infected. Our immune system fights against the bacteria as the plaque extends and forms under our gums. The bacterial toxins and our body´s natural way of fighting infections begins to destroy the bone and tissue supporting our teeth. When the periodontitis is not treated properly, the bones, gums and surrounding tissues the support our teeth are destroyed. Over time this leads to teeth becoming loose and they may have to be extracted.

 Risk Factors

• Smoking. Do you need another reason to stop smoking? Smoking is one of the most significant factors related to increased periodontal disease. It also influences the effects of some treatments.
• Hormonal changes in girls and women. These changes make gums more sensitive therefore making our gums more susceptible to gingivitis.
• Diabetes. Persons who suffer from diabetes are at a higher risk of developing infections, such as gum disease.
• Other diseases. Diseases like cancero r AIDS and their respective treatments can also damage our gums.
• Medications. There are hundreds of medicines that can reduce the flow of saliva. Saliva protects our mouth , and if we do not produce enough our mouths are more susceptible to infections like gum disease. There are certain medications that cause the tissue around the gums to grow more tan normal. This makes it more difficult to keep our gums clean.
• Genetics. Some people are more prone to developing a serious case of gum disease tan others.

Who suffers from gum disease?

Generally speaking, people do not show signs of  gum disease until betwween 30-50 years . Men have a higher probability of developing gum disease. Although it is rare that adolescents develop periodontitis, they can develop gingivitis, the les severe case of gum disease. Generally, periodontal disease only devlops when you allow plaque to accumulate for a long time and below the gums.

How do I know if I have periodontal disease?

Symptoms of gum disease include :

• Constant bad breath
• Red or swollen gums
• Sensitive gums or gums that bleed
• Pain when chewing
• Loose teeth
• Sensitive teeth
• Receding gums o teeth that appear larger than normal size.

Anyone of these symptoms can be a serious problem and needs to be addressed by your dentist.

When you go to the dentist, the dentist should :

• Ask questions about your medical history in order to determine other problems or risk factors, like for example smoking habits,which influences gum disease.
• Examine gums to see if there are any signs of inflamation.
• Use a “probe”, which is like a small ruler to determine periodontal pockets and measure them. In a healthy mouth, the deepness of these pockets should be between 1 and 3mm. Normally this is a painless test.

What is the treatment involved?

The main objective of the treatment is to control the infection. The number of treatments and types of treatment may vary depending on how widespread the gum disease is. Whatever the treatment , a continuous home daily care is needed. The doctor may also suggest behavioural changes (for example,stop smoking ), as a means of improving the treatment results.

Deep cleaning ( scaling and root planning)

The dentist, periodontist removes the plaque through deep cleaning called scaling and root planning. The scaling consists of removing the tartar accumulated over and under the gum line. The root planning eliminates the rough areas in the root of the tooth . This helps to remove the bacteria which favour the development of periodontal disease. In same cases, a laser can be used to remove the plaque an tartar built up. This procedure results in les bleeding, inflamation and les discomfort than more traditional deep cleaning.

Medications

Medicines can be combined with these treatments, but this does not necessarily mean that gum surgery can be replaced. It all depends on how advanced the periodontal disease is as to whether or not the dentist or periodontist will recommend gum surgery. Regular check ups of the gums would be necessary to determine if medicines have reduced the need for surgery.

Surgery

 Flap Sugery

Surgery may be necessary if after carrying out deep cleaning and taking medicines there is still inflamation and deep periodontal pockets. A dentist or periodontist could carry out a gum surgery know as flap surgery to remove the tartar deposits from the deep pockets . This will help the patient maintain this part of the mouth healthy.This fairly common surgery consists of lifting the gums, removing the tartar and stitching up the treated gums. Subsequently, the gums will heal and they will adjust better around the tooth. This sometimes results in the teeth looking much bigger.

Gum Surgery with bone and tissue grafts

Besides flap surgery, your periodontist or dentist can recommend procedures to regenerate bone or gum tissue in the gums lost through gum disease. For bone grafts , natural or synthetic bone can be placed to stimulate bone growth. One technique which can be used is guided tissue regeneration, which consists of inserting a small piece of material between the bone and gum tissue. This prevents the gum growing in the place where the bone should be, therefore facilitating the growth of bone and tissue. Also growth factors can be used, these are proteins which help our body generate new bone naturally. In cases where there has been tissue loss in the gums, the dentist or periodontist may suggest a soft tissue graft, made of either synthetic or tissue taken from another part of the mouth to cover the exposed dental roots.