What is Gum Disease?
Types of Gum Disease
There are two main types of gum disease, namely infection of just the gum around the teeth, called gingivitis. The second, more serious type is called periodontitis and involves not only the gum but also infection of the jaw bone. Gingivitis develops in all people who do not remove plaque bacteria effectively and will develop within 3 weeks of not brushing and flossing correctly. Untreated gingivitis may develop into periodontitis and this may lead to the loss of teeth and systemic health problems.
Gingivitis is the mildest form of periodontal disease and signs of this may include bleeding of gums during brushing, red margins of gums around teeth and swollen gums (see figure 1). The strange thing about gum disease, especially gingivitis is that it will virtually never lead to pain. Most patients will therefore be unaware that they have gingivitis. Gingivitis is completely reversible with professional treatment and good oral home care with the correct brushing and interdental plaque removal.
Certain factors may predispose a person to gingivitis, such as smoking, aging, Diabetes, a familial (genetic) predisposition, stress and hormonal changes during puberty and pregnancy. Certain medications may also predispose the patient to the effects of plaque bacteria.
Untreated gingivitis may develop into periodontitis, although not all patients with gingivitis will develop periodontitis. Periodontitis is when the plaque bacteria grow underneath the gum and start breaking down the attachment of the tooth to the gum and jaw bone. This leads to the formation of a space between the tooth and the gum/bone and this is called a periodontal pocket. Again, very little discomfort may be experienced and virtually never any pain. A periodontist will examine the gum with a special probe to detect periodontitis and to identify the periodontal pockets. If periodontitis is not treated, teeth may eventually become loose, fall out or have to be extracted. If a patient experiences loosening of teeth, the periodontitis may already be in a late stage. Other signs to look for is if spaces develop between teeth (see figure 2). A periodontist has special training in detecting and measuring the extent of the periodontal pocketing and whether teeth can still be saved. Although some types of periodontitis may be of a more aggressive nature than others, most types are treated the same way. If periodontitis is seen in teenagers or young people under the age of 35, it is generally the more aggressive type and should be treated without delay as it may lead to rapid tooth loss.
There is no magic shortcut in the treatment of periodontitis. It requires a team effort between the patient and the periodontist, often involving the dentist and oral hygienist as well. Periodontitis is a disease that may pose a risk to the general health of the patient, especially for Cardio-Vascular disease and Diabetes. The treatment of periodontitis is never a once-off treatment and requires lifelong monitoring and regular re-treatment sessions to prevent tooth loss.
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