Gum disease is a very common chronic condition that effects almost 1 in 2 persons in the UK to varying degrees.

It is the most common cause of tooth loss in the UK and worldwide.

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There are 2 types of ‘Gum disease’ – one causes reversible damage and is known as ‘Gingivitis’ and the other causes irreversible damage and is known as ‘Periodontitis’.

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Gingivitis is where your gums become inflamed due to the presence of bacteria (plaque) that accumulates near to it. This inflammation is typically characterised by a ‘fiery red appearance’ bleeding and swelling of the gums to varying degrees and occasional discomfort but rarely pain. In the presence of gingivitis the bone supporting the teeth is fully intact.

Once the bacteria around the teeth and gums is removed thoroughly the inflammation, swelling and bleeding should subside and the gums should return back to full health hence the reversible nature of this disease.

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Periodontitis is characterised by swollen and inflamed gums similar to gingivitis however the main feature of this condition is that the bone supporting the teeth is lost. Additionally it also has typical features of loose teeth, receded gums, a ‘long in the tooth appearance’, bad breath, drifting of teeth and an increase in the gaps between the teeth. It can also result in regular gum infections and eventual loss of the teeth.

According to the British society of periodontology more than 45% of the UK population is affected by gum disease in some capacity.

Yes, it is entirely preventable and especially in the early stages quite easily treatable. In some cases we can only control the disease process with the aim of prolonging the life of the teeth.

Both Gingivitis and Periodontitis are typically painless and therefore can impart a false sense of security where most people may not even know they have it until it is too late.

Gingivitis alone (where there is no bone loss around the teeth) can be treated by removing the plaque and bacterial deposits around the teeth and gums and they should return back to health.

Periodontitis (where you have had bone loss around the teeth) unfortunately cannot be cured but can be ‘controlled’. By getting the right treatment promptly and controlling the risk factors we can bring the gums back to health again and stabilise the disease process. This would ensure the teeth would survive longer. Any bone you have already lost up until that point will unfortunately not regenerate and so the sooner this disease is noticed and treated the longer you will hold onto your teeth.

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There are many factors that contribute towards gum disease and it boils down to how susceptible or vulnerable you are to this disease process. Whilst we know that plaque bacteria is responsible for the damage that occurs – for some people the plaque causes a more disproportionate damage than with others.

The risk factors that contribute towards an increased vulnerability to gum disease are:

· Genetics: Gum disease runs in families and some people are more genetically prone to getting this condition than others. In such cases even small amounts of plaque will cause a disproportionate amount of damage to the gums and supporting bone rendering tooth loss more likely at a younger age and even in the presence of relatively good oral hygiene..

· Smoking: Smoking has a well-established link to gum disease. Smoking results in a higher degree of damage to the gums and greater chance that treatment will not be successful unless the smoking is stopped permanently

· Medical history: Diabetes and other medical conditions that reduce ones immunity result in a greater risk of gum disease. The more poorly controlled the diabetes is, the more likely that the gum disease will take hold and the more severe it likely to be.

· Medication: Certain medications that are taken cause enlargement of the gums making cleaning of these areas more difficult and increasing the risk of gum disease. Your dentist will advise if this is the case and may need to liase with your GP to discuss safe alternatives that do not cause gum enlargement.

· Poor oral hygiene: In theory if one has no plaque they cannot get gum disease. Whilst it is impossible to ensure a 100% plaque free mouth – it is every individuals responsibility to ensure that plaque levels are kept to an absolute minimum by ensuring exceptional levels of personal oral hygiene measures coupled with regular hygienist visits to get professional assistance where required.

· Certain deficiencies: In certain cases individuals may present with severe generalised gum disease but who are otherwise healthy, do not smoke, have no known family history and have exceptional oral hygiene. In these cases we would usually advise a blood test to be taken to rule out any potential undiagnosed conditions (such as diabetes) or deficiencies which may be contributing to this unexplained severity in gum disease.

· Other factors: Damaged teeth, broken fillings and ill-fitting crowns can create a rough surface making cleaning difficult and increasing the risk of damage to the gums. In such cases fixing these issues will help resolve the gum issues

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If the soft plaque is not removed from a particular surface it usually solidifies (calcifies) after 3-7 days. This solidifies plaque is known as calculus and can only be removed professionally by a dentist or hygienist). Calculus traps more plaque under it making it an obstruction to effective cleaning in certain areas where the bacterial can act unhindered in causing damage to the gum unbeknown to us.

At every dental check-up the dentist will always do a general gum screening assessment to give us an overview of the general health of the gums. The presence or fiery red, swollen and bleeding gums in the presence of plaque indicate gingivitis whilst the presence of ‘deep pocketing’ and bone loss on an x-ray is indicative of periodontitis.

If the general gum assessment reveals a problem then depending on the severity a separate appointment may be required to carry out a more comprehensive gum assessment where the severity of the disease is accurately mapped out so it can be treated more effectively with a targeted approach

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A healthy gum is usually attached tightly to the tooth surface with very little gap between the tooth and the gum and no bleeding present. This gap known as a ‘pocket’ is 3mm or less in the healthy state which is usually very easy to keep clean with oral hygiene measures. When gum disease takes hold the gum detaches from the tooth surface and swells. This creates a much larger depth of pocket in between the tooth and gum making cleaning via a normal tooth brush much more difficult. If you have deep gum pockets (>4mm) in the presence of bone loss then you have irreversible gum disease (periodontitis). This must be treated swiftly to prevent the loss of the tooth.

You must visit your dentist for regular check ups and they will advise on whether you have gum disease and if so to what degree. You will also be advised on preventive strategies to keep the gums healthy for the long term. Some tell tale signs to look out for include: bleeding gums, sore gums, bad breath, gum boils, loose teeth

Gingivitis is treated by professional cleaning with a dentist or hygienist either with or without local anaesthetic to remove the plaque and calculus deposits that have accumulated in the mouth. The dentist/hygienist will then instruct the patient on the most effective oral hygiene measures and then it is down to the patient to ensure an exceptional level of oral is maintained until the next cleaning session to ensure the gingivitis resolves.

Periodontitis is also treated by professional deep cleaning under local anaesthetic to remove all the plaque, bacteria, calculus and diseased tissue in all the deep pockets present in the mouth. This is known as ‘non-surgical’ gum treatment and usually done over 4-5 visits if the whole mouth is affected.

In certain cases gum surgery may be required to eliminate ‘stubborn pockets’

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The success of the initial treatment course depends on many factors such as how severe your gum disease was in the first place, your genetics, whether you are still smoking or not, the level of your immunity, how much care and attention you pay to the health of your gums, how effective your personal daily oral hygiene measures are, the state of your general health and many other factors.

At the very least the initial treatment will slow down the progress of the disease and allow you to keep your teeth for longer.

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The common side effects are: a temporary increase in sensitivity, recession of your gums as they shrink and become less swollen following successful treatment, longer looking teeth as the gums recede and an increase in the spaces in between your teeth. Once the gums are stable any cosmetic issues can be managed with cosmetic dental treatment where required.

Gum disease can always return if any of the risk factors mentioned above return or become more prevalent.

Every 3 months would be the ideal

Your treating dentist should arrange a review in approximately 6-8 weeks to assess the health of your gums and the progress you have made. If the gum disease is completely stable then he/she will recommend you continue to see the hygienist every 3 months for maintenance alongside the exceptional levels of oral hygiene and home care that you will need to maintain at all times.

If there are still some residual diseased sites at this stage then you may need to have further non surgical treatment sessions or even surgery specific to the stubborn sites.

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This depends on how stable the gums remain. If at subsequent check ups your gums remain healthy and stable then you will only need your regular hygiene visits. If any part of the gums deteriorate then further treatment sessions under local anaesthetic maybe required throughout your life as and when necessary to ensure that your teeth last as long as they possibly can.

The same factors that determined why you got the disease in the first place – namely genetic pre-disposition, the effectiveness of your oral hygiene measures, how frequently you attend for dental check ups and hygiene visits, how much you care for the health of your own gums, how well you follow professional advice, whether you smoke, your general health status, the level of immunity, if you are diabetic then how well controlled your immunity is amongst other factors.

Diabetes has the most well established link to gum disease. The more poorly controlled the diabetes the severe the gum disease will be. Any other conditions that reduces ones immunity can contribute to the severity of the gum disease process

Any dentist or hygienist with the appropriate training and experience. The dentist will make the diagnosis and can also treat the condition or arrange appointments with a hygienist who will work under the dentists’ prescription.

Gum disease is known as ‘the silent disease’ and so the majority of the time it will be painless so a lot of people may not know that they are suffering from it. By the time it causes symptoms it usually is at an advanced stage. Not treating it will invariably mean it will deteriorate leading to the eventual loss of some or all of your teeth.