Gum disease is an inflammation of the gums that can progress to affect the bone that surrounds and supports your teeth. It is caused by the bacteria in plaque, a sticky, colourless film that constantly forms on your teeth. If not removed through daily brushing and flossing, plaque can build up and the bacteria infect not only your gums and teeth, but eventually the gum tissue and bone that support the teeth. This can cause them to become loose, fall out or have to be removed by a dentist.
There have been many attempts to understand the link between gum disease and other systemic health problems such as heart disease stroke. Comparing the bacteria that cause dental plaque with the bacteria involved in heart disease suggests a correlation between gum disease and heart disease, but researchers have been unable to establish a cause and effect relationship. These types of relationships are difficult to prove or disprove, so it is fair to assume that aiming for a life free of gum disease will only help in leading a generally healthier life.
There are three main types of gum disease:
- Gingivitis
- Periodontitis
- Acute necrotising ulcerative gingivitis
Gingivitis
If you have gingivitis, your gums become irritated by plaque, which is a mixture of food, bacteria and bacterial waste products that can build up on your teeth. If you don’t clean plaque off your teeth regularly, it can get underneath you gum line, causing your gums to become red, swollen and they may bleed when you brush them.
This is the early stage of gum disease and if you remove the plaque, your gums will recover. But if you don’t clean the plaque off your teeth, the gingivitis may develop into a more serious type of gum disease called periodontitis.
Periodontitis
If you don’t get treatment for gingivitis, your gums may begin to pull away from your teeth, leaving small pockets. These pockets trap plaque that you can’t reach with a toothbrush. Over time, the plaque will harden to become tartar (calculus). Plaque and tartar build-up can cause further irritation, which may gradually spread to the bone structures around your teeth. As time goes on, the pockets can get deeper and more difficult to clean, and your gum and bone may shrink. This is called periodontitis.
If your gums shrink, they can expose some of the roots of your teeth, making them sensitive. And if you have bone loss, your teeth may become loose. If you don’t get treatment for a number of years, your teeth may fall out, or need to be taken out by a dentist.
Periodontitis can’t be completely cured; however, if you receive the appropriate treatment and make sure you floss and brush your teeth well, the progress of the disease can be stopped.
Acute necrotising ulcerative gingivitis (ANUG)
Also known as ‘trench mouth’, is a severe type of gum disease that develops suddenly. It can be treated with good dental hygiene, including brushing your teeth twice a day, flossing your teeth three times a week, and taking antibiotics.
Causes
Gum disease can be caused by a number of factors, but poor oral hygiene is the most common cause.
Poor oral hygiene, such as not brushing your teeth properly or regularly, can cause plaque to build up on your teeth.
Plaque
Your mouth is full of bacteria that combine with small food particles and saliva to form a sticky film known as plaque, which builds up on your teeth.
When you consume food and drink high in carbohydrates (sugary or starchy foods), bacteria in plaque turn carbohydrates into the energy they need, producing acid at the same time.
Over time, acid in plaque begins to break down your tooth’s surface and causes tooth decay.
Bacteria in plaque can also irritate your gums, making them inflamed and sore.
Plaque is usually easy to remove by brushing and flossing your teeth, but it can harden and form a substance called tartar if it is not removed. Tartar sticks much more firmly to teeth than plaque and can usually only be removed by a dentist or dental hygienist.
Who is most at risk?
As well as poor oral hygiene, a number of things can increase your risk of developing problems with your gums. These include:
- smoking
- your age – gum disease becomes more common as you get older
- a family history of gum disease
- diabetes – a lifelong condition that causes a person’s blood sugar levels to become too high
- a weakened immune system – for example, because of conditions such as HIV and AIDS or certain treatments, such as chemotherapy (powerful cancer-killing medication)
- malnutrition – a condition that occurs when a person’s diet does not contain the right amount of nutrients
- stress
- bleeding gums when you brush your teeth
- red and swollen gums
- a bad taste in your mouth
- a wobbly tooth or teeth
- gum abscesses (pus that collects under your gum)
- painful ulcers that develop suddenly and bleed easily
- bad breath
- a metallic taste in your mouth
- difficulty in swallowing or talking
- a receding of the V-shaped bits of gum between your teeth
- feeling generally unwell – possibly with a fever
Diagnosis
Treatment
- If the bone has been destroyed, your dentist may employ a new technique called tissue regeneration, which involves grafting the bone to offer a better chance of bone re-growth. To strengthen thin gums, soft tissue grafts may also be used.
- Guided tissue regeneration involves the insertion of a membrane to help in the bone regeneration process. This is sometimes useful during periodontal surgery.
- Periodontal flap surgery may be performed to reduce the pocket gap between the teeth and gums.
- If the jaw bone has craters housing bacteria and contributing to gum disease, the bone may be reshaped through bone surgery to eliminate the craters and help prevent future recolonization of bacteria growth.
Prevention
You can prevent gum disease by controlling the amount of plaque and tartar that builds up on your teeth. Regular visits to your dentist or hygienist, brushing and flossing your teeth properly and stopping smoking will help to do this.
Dental floss or inter-dental brushes can remove plaque and small bits of food from between your teeth and under your gum line – areas that a manual toothbrush can’t reach. You may prefer to use an electric toothbrush. There is some evidence to suggest that certain types of electric toothbrush may be more efficient at removing plaque than manual toothbrushes. It’s important to use the correct technique, so ask your dentist or hygienist for advice.
Some antiseptic mouthwashes reduce the amount of plaque bacteria when combined with regular brushing and flossing. However, there isn’t currently enough evidence to say whether mouthwash can help prevent gum disease. If you do use an antiseptic mouthwash, it’s important that you don’t use it for too long as it can stain your teeth. Always read the information on the mouthwash box or bottle and if you have any questions, ask your dentist or hygienist for advice.
Even thorough brushing and flossing can’t remove every trace of plaque as most people have irregularities in their teeth where plaque can build up out of reach and harden into tartar. This can only be removed by your dentist or hygienist during scaling.
