What can happen if gum disease goes untreated?

Dr Samy – BSc BDS MFDRCS DipDSed MSc MClinDent MRDRCS LLM FDSRCS

 

Q. What is gum disease?

A. Gum disease describes inflammation of the supporting structures of the teeth. There are two main forms of gum disease: gingivitis and periodontitis.    

Q. What is gingivitis?

A. Gingivitis means inflammation of the gums only. This is when the gums around the teeth become red and swollen. Inflamed gums sometimes bleed when they are brushed.  

Q. What is periodontitis?

A. Gingivitis can progress to periodontitis. This only happens in patients in whom the immune system doesn’t defend against the bacteria. It causes dissolving away of the bone and supporting structures of the teeth. As the bone dissolves away, leaving the gum behind, it creates a gap between the two that dentists call a “Periodontal Pocket”. As the teeth progressively lose support, they become loose and are eventually lost.  

Q. What is the cause of gum disease?

A. All gum disease is caused by bacterial plaque. Plaque is a film of bacteria, which forms on the surface of the teeth, gums and tongue every day. Many of the bacteria in plaque are completely harmless, but there are some that have been shown to dissolve the bone that supports the teeth. To treat and prevent gum disease, you need to make sure that you remove as much plaque as possible from your teeth and gums every day. This is done by brushing and flossing the teeth, and regular visits to both the dentist and a dental hygienist. If periodontal pockets have formed around your teeth, then you will need a Periodontist to instrument these areas, as they are inaccessible to the toothbrush.  

Q. Am I likely to suffer from gum disease?

A. Probably to some degree. Most people have some form of gum disease, but it is often mild. However, the disease usually develops very slowly, and with relatively simple treatment, it can be slowed down to a rate that should allow most of us to keep most of our teeth for life. Different individuals vary in their susceptibility to the bone destruction that bacterial plaque causes. Some don’t suffer any bone loss at all, and some suffer so much that tooth loss is inevitable.  

Q. So is periodontitis a bacterial problem or an immune system problem?

A. Both factors must be present for it to occur. We all have bacteria in our mouths. Some people can rely on the immune system to defend against them, but some people’s immune system doesn’t cope, so have to rely on the physical removal of the bacteria to control it.  

Q. How will smoking affect my gums and teeth?

A. Smoking can make gum disease worse. Smokers suffer narrowing of blood vessels in the gums meaning protective cells of the immune system don’t arrive at the site where they are needed. Smokers also have a deficiency in the cell of the immune system that can defend against gum disease. Smokers are therefore very susceptible to bone destruction.  

Q. Are there any signs of gum disease that I may notice?

A. The first sign may be blood on the toothbrush or in the rinsing water when you clean your teeth. Your gums may also bleed when you are eating, leaving a bad taste in your mouth. Your breath could possibly also become unpleasant. Some people notice that their teeth move position.  

Q. Could gum disease be happening in me without me knowing about it?

A. Absolutely. In some diseases, such as tooth decay, pain is the usual alarm that tells the body that something is going wrong. There are many diseases in the body however that get progressively worse without such symptoms, heart disease and diabetes being examples, and periodontitis being another. Sometimes the gums don’t even bleed, especially in smokers and given that it is painless, the bone could be dissolving away without you knowing about it.  

Q. So how would I know if I have gum disease?

A. By visiting a Periodontist who will make accurate recordings in millimetres to check the distance between the gum and the bone and taking x-rays if necessary to examine bone height. This is a painless procedure although it may “pinch” occasionally. Your dentist may also perform a quick screening procedure to help you decide if a visit to the Periodontist is worthwhile.  

Q. Could gum disease be genetic?

A. Yes, there is a strong genetic link. So if a member of your family has been diagnosed with it, then it is certainly worth being checked.  

Q. Can gum diseases affect the rest of the body?

A. Yes. There is increasing evidence to suggest a link between gum diseases and general health. Research suggests that gum diseases are associated with heart diseases and pregnant women are susceptible to giving birth to pre-term low birth weight babies.  

Q. Can gum disease be a sign of more serious medical conditions?

A. Yes. Although gum disease most commonly happens in healthy subjects, it can be particularly bad in diabetics and patients with problems in their immune system.  

Q. What treatments are needed?

A. Following a full explanation of the status of your gums, a personalised demonstration of the most effective way to remove plaque from the surface of your teeth will be advised and demonstrated.  

Q. What happens if gum disease is not treated?

A. Unfortunately, gum disease progresses painlessly on the whole, so that you do not notice the damage it is causing, until teeth become loose and are lost. Over a number of years, the bone supporting the teeth dissolves, and if the disease is left untreated for a long time, treatment can become more difficult, or even impossible.  

Q. But I have always brushed my teeth! So why do I have gum disease?

A. Have you brushed them in the specific bespoke way according to the individual shape of your teeth and gums? The technique is far more important than the frequency and as people have different shape teeth and gums, it must be individually tailored for you to be most effective.  

Q. So what shall I use to effectively remove the plaque from my teeth?

A. The Periodontist will be asking you to pick up a number of oral hygiene aids, including a Braun Oral B electric tooth brush, a selection of TePe interdental brushes, and chlorhexidine toothpaste and mouthwash. Rarely, additional aids such as floss and single tufted brushes will also be advised. Some pharmacies and supermarkets stock what is required but on-line purchasing from amazon.com or dentocare.co.uk is likely to be easier.  

Q. What else may be needed?

A. Once your teeth are plaque-free and you are able to maintain good daily control, the Periodontist may decide to carry out further instrumentation of the root surfaces of the teeth, to ensure that both soft and hardened bacteria are removed from the deep pockets. This is known as root planing and renders the now clean root surface smooth so that the gum can attach to it to provide structural support. The Periodontist would also re-contour the shape of the gum to eliminate the periodontal pocket as well as making it a good shape for ease of brushing. Occasionally stitches are used, but these dissolve and therefore do not require removal.  

Q. What should I expect after treatment?

A. Operations on gums may be compared to operations on skin. A degree of soreness may be expected after the procedure as the site heals. You will be advised on how to keep this to a minimum with tablets, mouthwashes and toothpastes.

Q. Once I have periodontal disease, can I get it again?

A. In much the same way as many diseases of the body, periodontal disease is controlled rather than cured. Following successful treatment, as long as you keep up your daily routines as taught, any further loss of bone is extremely slow. Your Hygienist and Periodontist will supervise you into the future as much as you need.