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Applecross PERIODONTICS - Services
periodontal disease
Periodontal diseases affect most people to varying degrees throughout their lives. Common signs and symptoms include bleeding gums, a bad taste, bad breath, gum shrinkage and gaps widening between the teeth, food impaction, temperature sensitivity and loose teeth. Pain is not usually a feature until the very late stages of the diseases. The following has been prepared to help patients understand the process of gum disease and how most people can be successfully treated for long periods of time.
Periodontal Diseases present as different forms of inflammation of gum tissues.
- Gingivitis
- Chronic Periodontitis
- Aggressive Periodontitis
- Periodontitis as a Manifestation of Systemic Diseases
- Necrotizing Periodontal Diseases
These different forms of periodontal inflammation need to be distinguished by your dental professional. Auto immune diseases, such as lichen planus and pemphigoid present as gingival inflammation and need to be distinguished from plaque related periodontitis. These lesiona are often associated with pain which is not common in chronic periodontal diseases.
In health the gum is attached where the crown of the tooth meets the root. When the area is examined closely, with a microscope, there is a ligament found under the gum attachment that extends all the way around the root. The ligament goes into the root on one side and bone on the other. This apparatus is responsible for retaining teeth in the jawbone.
Measurement of the distance from the top of the gum to where it attaches on the tooth as well as the amount of bleeding on probing, provides information regarding the health status of the gums. Ideally, the probe will only advance approximately 1-3mm and the tissues will not bleed. It is most important that the gums do not bleed when they are probed, as healthy gums do not bleed on brushing, flossing or gentle probing.
The crevice where we insert the probe is also where plaque first develops. Plaque is almost 100% bacteria. We have over 300 species of bacteria in our mouths but out of those 300 different species there are only 10 to 20 types that cause gum disease. The species related to gum disease do not thrive in oxygen-rich environments, they are ‘anaerobic’. The harmful bacteria thus need a certain kind of environment in which to flourish.
This crevice provides a niche where bacteria can easily attach. As initial plaque layers are thin, oxygen can easily permeate, allowing only the healthy bacterial colonies to survive. The disease causing bacteria do not exist in fresh, newly formed dental plaque. Effective brushing and flossing techniques keep a ‘healthy’ plaque associated with the gum line.
If the plaque accumulates and thickens around gum margins and restorations, the anaerobic bacteria can survive within the plaque protected from the oxygen outside. Once these bacteria are living around the gum line they can cause damage to the gums. These bacteria and their products in the plaque produce an inflammatory reaction in the tissues. The inflammation results in bleeding and can lead to irreversible loss of the ligament and bone around the teeth. The space created by the damage is what we call a ‘pocket’, the depth of which we measure with the probe to establish the extent of the disease around each tooth. Oxygen supply is non-existent in the pocket providing a perfect environment for the destructive bacteria to thrive. Calcified plaque deposits (calculus) forming on the root surfaces also provide extra surface area for the attachment of anaerobic bacteria.
Once the pockets have formed, an improvement in brushing and flossing above the gum line will not alter the environment at the base of the pockets where the bacteria are happily multiplying. Tissue destruction can easily progress because superficial cleaning does not affect the base of the pocket where the disease process is taking place. It is only the superficial bleeding that reduces with good brushing and flossing techniques.
If you have noticed bleeding or swollen gums, bad breath or taste, sensitive or loose teeth, shrinking gums or food impaction then call us for a consultation. These are sure signs of gum disease. If you have diabetes or are a smoker then you are at a much greater risk of developing gum disease.
