Gum disease is a general diagnostic term used by the public referring to diseases in the gum tissues. We have gum disease when we see our gums are swollen, red, bleeding (when touched or during brushing), receded, enlarged, purulent or painful.
Indeed, gum disease does not only refer to the pink or red gums that are readily visible; it also implies the health status of the supporting bone beneath the gums. People with severe and long-time gum disease would also have long and mobile teeth.
Most of us (over 75%) have gum disease in our lifetime. It is crucial to know that there is not just one form of gum disease; there are multiple forms that can affect your overall oral health and wellness. If untreated, it can increase your risk of developing other cardiovascular system diseases, especially in the coronary arteries, diabetes, dementia, etc.
There are generally two forms of gum disease, gingivitis and periodontitis. Gingivitis refers to inflammation of the gums, which develops when plaque that contains bacteria (germ) and food elements slowly build up on the teeth along the gum lines (where your teeth and your gums meet). Given time, the plaque solidified with the calcium and phosphate found in saliva. The hardened masses are known as tartar or calculus. The tartar and plaque release toxins that trigger body cell reactions to cause inflammation around the unwanted buildups.
If left untreated, gingivitis advances into periodontitis, a much more severe form of gum disease. It can cause an infection that destroys the bone supporting your teeth, leading to tooth loss, bleeding gums, gum abscesses, and bad breath.
Gum disease affects most adults, but it can begin at just about any age. Gum disease often develops slowly and without causing any pain. Sometimes you may not notice any signs until the condition is severe and you are in danger of losing teeth.
A few risk factors can cause or make the person more prone to having it. The first and most common factor is poor oral hygiene. You should brush your teeth at least twice a day using a soft toothbrush to prevent gum disease. It is very important to brush the teeth before bedtime to ensure no food debris or drink accumulates on the teeth and in the mouth. When we are asleep, the salivary flow is slow, and the mouth can be dried up quickly, especially with the mouth open during sleep. The germs in the mouth can exert their disease-causing process unchecked in the long hours of sleep. The brushing should thoroughly reach every accessible surface of the teeth and be gentle (it would take at least two to three minutes to brush teeth each time). Floss at least once a day and see your dentist regularly for oral examinations.
Gum disease is often painless until the advanced stages. However, there are signs and symptoms in the following:
- Red, swollen, tender, shiny, puffy or sore gums
- Gums that bleed every time you brush or floss
- Gums that are receding or pulling away from the teeth, causing the teeth to look longer than before
- Loose or separating teeth
- Pus between your gums and teeth
- Taste of metal in your mouth
- Sores in your mouth
- Persistent bad breath
- A change in the way your teeth fit together when you bite
- A change in the fit of partial dentures
- Teeth that are sensitive for no reason
In its early stages, gum disease is tough to see. You may not know that you have a problem. Therefore, it is essential to see your dentists regularly for dental exams and cleaning. We use a tool called a “periodontal probe” to measure where your gums attach to your teeth during the examination. Healthy gums attach to teeth just below the edge of the gum. If your gums attach to your teeth below this point, it is a sign of gum disease. X-rays can also be used to see how much bone you have around the teeth and detect bone loss due to gum disease.
Once the gum disease is diagnosed, we need to find out the causes and underlying factors – poor oral hygiene, improper brushing technique, smoking, malocclusion (bad bite), misaligned teeth (excessive chewing force on the teeth that are out of alignment), lifestyle, life stress level, pregnancy and systemic diseases like diabetes, leukemia, immune suppression, vitamin deficiency etc. If the underlying factors are identified or suspected, the appropriate treatments are presented and discussed with the patient. That could be oral hygiene instruction, diet counselling and referral to our colleagues for further investigation.
Other measures like removal of the plaque and tartar, orthodontic treatments and occlusal equilibration, reduction of germs and toxins on the root surface covered by the loose, inflamed gums (mechanically like root planning and debridement, chemotherapy like topical application of antibiotics and ionizing radiation like a laser), surgically excision of the inflamed gums and recontouring of the defective bone. Systemic antibiotics and mouth rinse can also be part of the treatment protocols.
In some cases, guided tissue regeneration, bone grafting and the use of enamel matrix derivative (Amelogenins) may be considered to arrest disease progression and regenerate lost tissues.
The best medicine is always preventative medicine. The patients need to get their teeth checked and cleaned regularly to maintain oral health and total wellness.