Unhealthy gums are a common occurrence now-a-days due to change in lifestyle and habits in the fast-paced world.
What are the signs of gum disease?
Any of the following conditions may indicate the presence of gum disease, and a dentist should be consulted.
Symptoms may include:
- Bleeding Gums
- Swollen Gums
- Persistent Bad Breath
- Painful Chewing
- Suddenly Sensitive Teeth
- Loose Teeth
- Gum Recession
Gum disease should be treated as soon as possible because it’s linked to increased risk factors for conditions like:
- Heart Disease
- Respiratory Disease
To determine whether you have Gum-related disease and how severe it is, our dentists may:
- Review your medical history to identify any factors that could be contributing to your symptoms, such as smoking or taking certain medications that cause dry mouth.
- Examine your mouth to look for plaque and tartar buildup and check for easy bleeding.
- Measure the pocket depth of the groove between your gums and teeth by placing a dental probe beside your tooth beneath your gum line, usually at several sites throughout your mouth. In a healthy mouth, the pocket depth is usually between 1 and 3 millimeters (mm). Pockets deeper than 4 mm may indicate Periodontitis. Pockets deeper than 5 mm cannot be cleaned well.
- Take dental X-rays to check for bone loss in areas where your dentist observes deeper pocket depths.
Your dentist may assign a stage and a grade to Periodontitis based on the severity of the disease, the complexity of treatment, your risk factors, and your health.
The goal of Periodontitis treatment is to thoroughly clean the pockets around teeth and prevent damage to the surrounding bone structure. To have the best chance at successful treatment, one would need to adopt a daily routine of good oral care, stop tobacco and alcohol use, and manage health conditions that may impact dental health.
It is a procedure that removes tartar and bacteria from tooth surfaces and from beneath the gums. It may be performed using traditional dental instruments, a laser, or an ultrasonic device.
- Periodontal Scaling: Once gum disease has started destroying the gum and bone around teeth, ordinary cleaning isn’t enough to stop the progress of the infection. A procedure called Deep Scaling (Curettage), which is much more extensive and time-consuming than routine cleaning, becomes necessary. It removes the tough plaque and tartar that are the usual culprits of causing infection below the gum line.
- Root Planing: Root planing smoothens root surfaces, discouraging further buildup of tartar and bacteria, and removes bacterial by-products. These by-products contribute to inflammation of the gums and delay healing or reattachment of the gum to the tooth surfaces and, therefore, it is important to remove these.
- Topical or oral antibiotics can help control bacterial infection. Topical antibiotics can include antibiotic mouth rinses or insertion of gels containing antibiotics in the space between teeth and gums or into pockets after deep cleaning. However, oral antibiotics may be necessary to completely eliminate infection-causing bacteria.
When deep pockets of infection persist even after periodontal scaling, it becomes important to resort to corrective surgery or other treatment. Such surgical treatment is designed to correct defects by reshaping or regenerating new, healthy bone and gums
- Flap Surgery (Pocket Reduction Surgery): In this procedure, tiny incisions are made in the gum so that a section of gum tissue can be lifted back to expose the roots for more effective Scaling and Root Planing. Because Periodontitis often causes bone loss, the underlying bone may be re-contoured before the gum tissue is sutured back in place. After healing, it’s easier to clean these areas and maintain healthy gum tissue.
- Soft Tissue Grafts: When you lose gum tissue, your gum-line recedes thereby generating the need to have some of the damaged soft tissue reinforced. This is usually done by removing a small amount of tissue from the roof of the mouth (palate) or using tissue from another donor source and attaching it to the affected site. This can help reduce further gum recession, cover exposed roots, and give one’s teeth a more pleasing appearance.
- Bone Grafting: This procedure is performed when Periodontitis has destroyed the bone surrounding the root of one’s tooth. The graft may be composed of small fragments of the patient’s own bone, or the bone may be synthetic or donated. The bone graft helps prevent tooth loss by holding the tooth in place. It also serves as a platform for the re-growth of natural bone.
- Guided Tissue Regeneration: This procedure allows re-growth of bone destroyed by bacteria. In this procedure, the dentist places a special piece of bio-compatible fabric between existing bone and the tooth. The material prevents unwanted tissue from entering the healing area thereby allowing bone to grow back.
- Tissue-stimulating Proteins: Another technique involves applying a special gel to a diseased tooth-root. This gel contains the same proteins found in developing tooth enamel and stimulates the growth of healthy bone and tissue.
- Laser Therapy:This is another procedure to help improve gum health. The gum pocket is treated with a soft-tissue laser to eliminate the harmful bacteria sitting deep in the periodontal pockets, remove unhealthy tissue, and help stimulate healing.
Lifestyle and home remedies
After treatment, it is absolutely critical that patients practice good oral hygiene and seek regular professional maintenance care in the dental clinic.
Patients can try these measures to reduce or prevent Periodontitis:
- Brush your teeth twice a day or, better yet, after every meal or snack.
- Use a medium-sized toothbrush and replace it at least every three months.
- Consider using an electric toothbrush, which may be more effective at removing plaque and tartar.
- Floss daily.
- Use a mouth rinse to help reduce plaque between your teeth, if recommended by your dentist.
- Supplement brushing and flossing with an inter-dental cleaner, such as a dental pick, inter-dental brush or dental stick specially designed to clean between your teeth.
- Get regular professional dental cleanings, on a schedule recommended by your dentist.
- Don’t smoke or chew tobacco.
Phases of treatment
When treating periodontal disease, there will be three phases of treatment that your dentist will take you through. These include:
Phase I: The Etiological Phase
Treatment in this phase will focus on controlling the infection and restoring the healthy microbiota that should be there. We will also try to determine the cause of the periodontal disease to strike right at the root of the problem.
You’ll be educated about what you have to do for home care, which will include taking care of your overall health. You will also be required to stop smoking and to maintain excellent oral hygiene.
Procedures called “Scaling” and “Root Planing” will also be performed during this stage, wherein the dentist will clean your teeth deeply and remove plaque and calculus. Medications may also be prescribed.
Phase II: The Surgical Phase
After the first phase, an analysis will be made somewhere between four and eight weeks and if the analysis will show that the more conservative treatments have proven to be ineffective in completely rectifying the problem, treatments will move into the surgical phase. This usually happens in cases where pockets of infection or plaque and tartar are too deep to clean.
Surgery could include leveling shallow bone defects or using regenerative surgical techniques for deep bone defects. The goal of these surgeries will be to remove the pockets of space between the teeth and the bone that can break down or be destroyed due to periodontal disease. This, in turn, will eliminate the room for bacteria, plaque, and tartar to fester.
Surgery can be done under general anesthesia and many people don’t feel pain after the surgery. Most will miss only one day of work.
Phase III: The maintenance phase
The maintenance phase focuses entirely on preventing the periodontal disease from returning. A high recurrence rate is commonly observed in cases of inadequate maintenance and hygiene.
All the required oral hygiene practices will be thoroughly detailed to you including daily brushing, use of dental floss, and use of mouthwash.
Some individuals may be moved to a restorative phase if extensive surgery was performed in Phase 2. Implants or prosthetics may be inserted if teeth were extracted or if a large amount of tissue or bone had to be removed. Orthodontic treatment can also help align your teeth properly, making them easier to care for.
What types of specialists treat gum disease?
Periodontists focus entirely on evaluation, diagnosis, and treatment of disease of the gum and bone surrounding the teeth. In advanced cases of Gingivitis or Periodontitis, a general dentist may recommend a gross debridement of superficial plaque and tartar and such cases will, then, be referred to a periodontist for evaluation. Periodontists may recommend a variety of non-surgical or surgical procedures to help stabilize the gum condition. Periodontists are also highly skilled at performing treatments of other conditions of the gums and bone including gum and bone grafts, functional and esthetic Gingivectomy, Gingivoplasty, implants, and crown lengthening. Because gum disease in its advanced stages is the primary cause of tooth loss today, periodontists are especially important in working to treat a difficult disease.
What types of medications are used to treat gum disease?
Chlorhexidine Gluconate (Chlohex-ad) is an antiseptic mouthwash that can be used under the direction of a dentist to help reduce the bacteria that cause gum disease. Additionally, antibiotic therapy can be combined in various ways to help treat Periodontitis. Pellets or gels like PerioChip that contain Chlorhexidine or Doxycycline can be placed in deep gum pockets, after completion of Deep Scaling and Root Planing, to kill stubborn bacteria and reduce the size of periodontal pockets. These modes of delivering medications are very effective because the agent is released slowly over the course of about seven days. Additional medications such as Xylocaine and NSAIDs may be needed for pain control during and after treatment.
Are home remedies or natural treatments effective for gum disease?
There has been evidence to suggest the effectiveness of the following over-the-counter and natural treatments for gum disease:
- Green Tea has antioxidants that reduce inflammation in the body.
- Hydrogen Peroxide helps kill bacteria when used as a mouthwash or as a gel in a custom fitted tray, but it must not be swallowed at all.
- Rinsing using warm salt water can help soothe sore mouth tissue.
- Baking Soda diluted in water can be used to rinse and brush the teeth and gum-line to help neutralize the acids that irritate the gum tissue.
- Oil Pulling (swishing or rinsing): There has been little evidence to prove that sesame oil or coconut oil can help reduce bacteria that cause gum disease, but, it has been become a recent trend. On a case by case basis, people have noticed improvement with this treatment though we do not recommend it due to lack of clinical proof.
Is it possible to reverse gum disease?
The most important step in treating a disease of any kind is early and proper identification. The same stands true for early stage gum disease (Gingivitis). And, if the patient religiously maintains his oral hygiene along with the necessary treatment, gum disease can be reversed. If identified at this stage, a professional dental cleaning and more thorough brushing and flossing is all that a patient needs to reverse the disease. Once the bacterial infection spreads to the bones in Periodontitis, irreversible changes start taking place with decreased attachment of the gums and bone loss. Therefore, it is very important to catch and treat gum disease as early as possible.
Is gum disease associated with other health problems?
There have been many attempts to understand the link between gum disease and other systemic health problems such as heart disease, stroke, and Alzheimer’s disease. 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. According to the American Academy of Periodontology, recent studies have shown that the bacteria involved in periodontal disease may play a role in the pathology of Alzheimer’s disease too. Even though it is difficult to prove or disprove such types of relationships, it is fair to assume that not having gum disease will remove any chances of such relationships coming into play.
How is gum disease managed in children?
A child should start having his or her teeth brushed with a pea-sized amount of toothpaste beginning at 12 months of age. Emphasis should be placed on brushing all surfaces of the teeth including the gum line. As soon as the gaps between the teeth start to close, it is important to start flossing. At the beginning, the parents should establish a routine to brush the teeth so the child can get used to it. As soon as the child is able, the brushing and flossing should be passed over to him or her and monitored by the parent to ensure a good and thorough technique and consistency. According to the American Dental Association (ADA), a child should get regular dental visits starting at about one year of age. Abiding by these guidelines will help prevent and treat gum disease in most children.
An increase in instances of Gingivitis is noticed during puberty due to the hormonal changes that occur throughout the body during that period. Adolescents should be monitored for good oral hygiene habits and taken to the dentist regularly to treat gum disease with professional dental cleanings.
How is gum disease managed in pregnancy?
Many pregnant women think that they should avoid visiting the dentist to keep their pregnancy safe, but they shouldn’t miss their professional cleanings as long as they feel strong and comfortable enough to manage that. During pregnancy, women are at a risk of developing pregnancy gingivitis as an increase in hormones, caused by pregnancy, makes the gum tissues more susceptible to attack from bacteria and other pathogens. An increase in swollen, bleeding gums is noticed quite often in pregnant women even if they have remained consistent with their oral hygiene. This heightened risk can be countered successfully by getting dental cleanings more often than usual during pregnancy.
Is it possible to prevent gum disease?
In most cases, it is very simple to prevent instances of Gingivitis and Periodontitis by ensuring proper plaque control. This can be done by brushing, to remove plaque from the outer surfaces of the teeth, and flossing, to remove food particles and plaque from in-between the teeth. Electronic toothbrushes sometimes prove to be more effective in removing plaque from some of the harder to reach areas of the mouth. And, rinsing the mouth with a mouthwash after brushing and flossing can help reduce the concentration of bacteria that causes gingivitis.
There are certain other factors that have a direct impact on the health of gums and managing them can supplement the oral hygiene practices for a greater impact:
- Sleep/stress:Our body’s immune system has the biggest role in preventing any kind of disease. Getting adequate sleep and reduction in stress gives tremendous boost to our body’s immunity thereby helping the body fight gum disease too.
- Smoking and Chewing Tobacco: Smokers and those who chew tobacco are much more prone to Gingivitis and Periodontitis than those who avoid tobacco.
- Orthodontic Therapy or Braces:It is much easier to remove plaque from straight teeth than crowded, overlapped, and crooked teeth. Braces can make a big difference in having healthier gums by reducing these problems.
- Diet:Limiting the usage of plaque-causing sugars and carbohydrates will help limit its presence. Eating a well-balanced diet will help keep the body’s immune system healthy and ready to fight infection.
What is the best toothpaste to use to prevent gum disease?
The main purpose of using a toothbrush is to remove plaque on the teeth that harbours bacteria and causes gum disease and tooth decay. We can use any toothpaste, along with consistent and thorough brushing habits, to accomplish this goal. Fluoride, a common ingredient in toothpaste, particularly stannous fluoride, helps kill bacteria present in mouth. There are other ingredients in toothpastes that help remove plaque more effectively and help keep plaque off the teeth after they have been brushed. The abrasive agents in toothpaste such as silicates and calcium carbonates help remove sticky plaque. Sodium Lauryl Sulfate (SLS) is a detergent in toothpaste that causes the foaming effect of toothpastes. Toothpastes vary in the amount of SLS they contain; a high concentration of SLS can cause problems for patients who have dry mouth or low saliva flow. Some toothpaste includes plaque-control agents such as pyrophosphates and zinc citrate that prevent plaque from sticking to the teeth after they’ve been brushed. Using toothpaste that contains any combination of these ingredients will increase the effectiveness of oral hygiene.
Is gum disease contagious?
While most of the factors that lead to Gingivitis and Periodontal disease are dependent on the individual, there is limited scientific evidence to affirm that Gingivitis and Periodontitis-causing bacteria can be passed down from parents to children and between couples.