Periodontal Disease. All you need to know.

Many people worry about gum and periodontal disease, the two often get confused so this blog post is dedicated to helping you understand the differences between gum and periodontal disease as well as how to treat both… And, probably most importantly, how to prevent both!

Statistics for Periodontal Disease

  • 45% population have chronic periodontal disease
  • 70.1% of adults over 65 have gingivitis  (2010 estimates from the USA)

These statistics show the prevalence of periodontal and gingival disease. These people are all at risk of developing additional systemic health problems if their oral health problems are not kept under control.

Health issues associated with poor Dental Health

There are a variety of systemic illnesses and oral health (OH) links, including but not limited to:

  • Diabetes and OHRead research which shows the link between persistent poor glycaemic control and the incidence of gingivitis , periodontitis and alveolar bone loss.
  • High Blood Pressure and OHfind out more
  • Irritable Bowel Syndrome and OHRead research which shows that the microbiom is a potential source of inflammation in irritable bowel syndrome
  • Autoimmune diseases and OHRead research which shows that patients with higher plaque index are more likely to develop autoimmune diseases in 30 years.
  • Possible Erectile Dysfunction Syndrome Read research which shows that oral health could be considered a risk factor for erectile dysfunction
  • Gum disease and heart palpitations find out more

How do you know if you have gum disease? 

Gingivitis is classified as a superficial infection of the gums, bleeding whilst brushing is usually a warning sign and if left untreated it can lead to more serious periodontitis.

Symptoms of gum disease (gingivitis) include:

  • Reddening of the gums.
  • Puffy gums.
  • Gums which lead either spontaneously or during brushing.
  • Buildup of plaque in between teeth into sticky, hard tartar.
inflamed gums
inflamed gums caused by a buildup of tartar

How do you know if you have periodontal disease?

Periodontal disease (periodontitis) is a profound inflammation of the gum and other tissues. It can lead to tooth loss and may affect general health, particularly cardiovascular health. It also has health risks for people prone to diabetes or for pregnant women.

Symptoms of periodontal disease include::

  • Gums that bleed during or after brushing.
  • Continuous bad breath which cannot be alleviated by either brushing or mouthwash.
  • Gum recession (showing more tooth as the gums pull away).
  • The pockets around the teeth which may have a tendency to pack with food and be difficult to clean.
  • Drifting or loose teeth.

How can periodontal disease be fixed? 

There are a few treatments to fix periodontal disease, depending on how far the disease has advanced.

Treatment in the Early Stages

Initially your dentist or periodontist may carry out the nonsurgical treatments, this involves a root planing procedure. This is where the tartar that has hardened on your tooth is scraped away beneath the gum line. It can often take a few visits to completely remove and clean the tooth.

After the tartar has been scraped away the soft tissue can then reattach and completely heal after a few weeks.

Very often a local anaesthetic is used to make the treatment comfortable.

Treatment in More Advanced Stages

As periodontal disease progresses it becomes more difficult to treat and often surgical procedures are required. These can include:

  • Gum Grafts. Very often the gum will have receded with advanced periodontal disease, grafts can be taken from other areas of your mouth (usually the palate) and grafted to rebuild the gum that has been lost. This can help reduce sensitivity around any exposed roots.
  • Bone grafting. In conjunction with the gum grafting bone grafting can help to restore infected tissue. A synthetic or natural bone graft will be used to replace lost bone giving the soft tissue a structure on which to reattach and re-grow.
  • Pocket reduction. This occurs when the plaque and bacteria pack themselves down next to the tooth to create a large pocket where the soft tissue is not attached. Pocket reduction treatments involve a periodontist opening a small flap of soft tissue providing access to the underlying tooth. The tooth can then have any infected tissue remove, the area can then be left to heal.

Is periodontal disease reversible

Yes, although if it is left completely untreated it will progress and result in tooth loss. The more periodontal disease is left to progress without treatment the more difficult it is to treat and a more difficult it is to save teeth, bone and gum. The key is to get treatment under way as soon as the disease is detected.

What other problems can periodontal disease cause? 

  • Altered taste. The bacteria in the mouth can give a nasty taste which doesn’t go away.
  • Bad breath even after brushing. This is caused by the bacteria and infection involved.
  • Tooth loss; gaps develop, loose teeth
  • Reduced enjoyment of food, caused by mobile teeth and pain.
  • Limited diet as the teeth are not able to chew food enough.
  • Reduced nutrition (meats/fibre foods that need chewing) 

This then all results in:

  • Altering stomach acids and the ability to digest food
  • A lack of confidence due to the bad taste, bad smell and inability to eat.

What happens if periodontal disease is not treated?

  • It can become a factor in other long term dental and health problems 
  • Treatment can be costly if left until late

Other factors to consider

if you have periodontal disease, all is not lost. It can be managed by kickstarting gums back into health using holistic/conservative management techniques. Initially there may be multiple visits and the cost of treatment can be broken down.

If you are concerned about gum disease or periodontal disease and would like a professional opinion about the treatments available, please do get in touch.

Periodontal disease and dental implant failure

Periodontal disease and dental implant failurePeriodontal disease and dental implant failure

One of the concerns with anyone that has dental implants is, how successful will they be? This is clearly a question which needs answering, working on the assumption that a dental implant has been placed into a sufficient amount of bone then the biggest reason that an implant files is lack of post-placement care.

A dental implant integrates entirely with the body and needs to be looked after much the same as a natural tooth.

How do dental implants fail

Typical reasons for failure of dental implants include:

  • Poor surgical decisions. This can involve placement of implants in insufficient quality or quantity of bone & poor design of the final restoration.
  • Abusing your oral environment. Studies show that smoking can inhibit healing, smoking restricts blood vessels which can mean that the implant placement doesn’t heal as well. Alcohol has also been shown to increase risk of post operative complications, including general infections and wound complications.
  • Dental decay. If you already have tooth decay on other teeth when you may be more susceptible to developing gingivitis and/or periodontitis around the implant area.
  • Overloading the dental implant. If you have a poor/heavy bite and/or grind heavily you may overload the dental implant and support structures. Extreme contact sports can also affect the success rate.
  • Overall poor oral hygiene. Implant failure is also exacerbated by bad oral health, implants succeed much better in a healthy environment.

Risk factors of periodontal disease and peri-implantitis

Risk factors for periodontal disease include:

  • Age – Indicators are that 70% of people over the age of 65 have periodontitis.
  • Smoking – Smoking affects your body’s ability to heal and alter is the bacteria levels in your mouth.
  • Genetics – Some people are just more prone to developing periodontal disease and peri-implantitis
  • Stress – Stress can lead to a general reduction in overall body health meaning your ability to heal is reduced. Stress can also mean you grind your teeth more.
  • Bruxism – Teeth grinding
  • Poor diet – A poor diet can also affect your body’s ability to heal itself leaving you more inclined to gum disease which then leads onto periodontal disease

The early warning signs

One of the earliest warning signs of periodontal or periimplant disease is gum disease or gingivitis. Periodontal and periimplant disease are the progression of gum disease which hasn’t been treated. Gum disease is an infection of the gum whereas periodontal or periimplant disease are an infection of the surrounding support structures around either the tooth or the implant.

Therefore the early warning signs include:

  • Puffy or red gums around the tooth or implant
  • Bleeding upon mild brushing around the gum or implant
  • Persistent bad breath.
  • Gums that are receding making the teeth look along.

Whether the signs appear around a natural tooth dental implant it’s important that the early warning signs are treated. If you end up with periodontal disease you can end up with tooth loss… Tooth replacement can then be quite expensive! The same can be said if you have gum disease around a dental implant, ultimately this could lead to failure of the implant and bone loss.

If the dental implants fails is it worth getting another?

Complete failure and loss of the dental implant happens in less than 3% of cases so it is fortunately quite rare. You should always have a discussion with your dentist about the reason the implant failed, if the reason can be clearly identified and resolved i.e. smoking, poor oral hygiene, teeth grinding etc then yes, it is probably worth having another dental implant.

If the reason for the implant failure persists then it may be wise to look for alternative ways to replace the missing tooth/teeth.

Is it possible to completely cure peri-implantitis?

Research published in 1994 using techniques modified from the periodontal arena have shown that the best way to treat peri-implant problems is to

“…arrest the progression of disease and to achieve a maintainable site for the patient’s implant”

The study goes on to say that

“Bone regeneration is possible in selected peri-implant bony defects when appropriate surgical techniques are used, implant surface preparation is achieved, and the cause is eradicated.”

It therefore is possible to treat periodontal disease and dental implant failure with skilful dental and surgical techniques.