Healthy gums, or periodontal health is characterized by strong firm tissue surrounding the teeth. The space between the gum and the tooth is of minimal depth, there is no bleeding from the tissues during brushing or flossing, and the mouth is comfortable with no malodors.
When periodontal disease is present the space between the gum and tooth deepens. A “pocket “ is formed. The deeper the pocket becomes, the more bone is lost compromising the support of the teeth. Left untreated the inevitable result is tooth loss.
Warning signs Of Gum Disease
- gums that bleed when brushing or flossing
- red, swollen or tender gums
- gums that have pulled away from the teeth
- pus at the gum line when the gums are pressed
- teeth that are loose or are changing position
- any change in the bite
- any change in the fit of partial dentures
- constant bad breath or bad taste
Note however, patients can still have gum disease and NOT exhibit these warning signs.
The Stages of Periodontal Disease
Normal Healthy Gingiva (Gums)
Healthy gums, periodontal ligament and bone anchor the teeth firmly in place.
Stage 1: Gingivitis
Plaque (bacterial buildup) and its by-products irritate the gums, making them tender, inflamed and likely to bleed. If plaque is not removed it can harden into calculus (tartar).
Stage 2: Periodontitis
In time, as plaque and calculus build up along the gumline, bacteria in the plaque begin to break down the connection between the supporting soft tissues and the tooth. As the disease progresses, bacteria attack the bone tissue as well.
Stage 3: Advanced Periodontitis
The gums can pull away from the teeth as more bone and the periodontal ligament are destroyed. Teeth – even teeth without decay – may become loose and need to be extracted.
Periodontal Disease Management
Early stages are treated by subgingival scaling and root planning to remove the hardened deposits and restore the roots to clean smooth surfaces. Other treatments can include:
- oral irrigation after deep cleaning
- antibiotics or other medications
- additional home care beyond daily brushing and flossing
Advanced Periodontal Disease Treatment
Flap and Osseous Surgery
The diseased area with the bony defect is accessed by a flap incision around the involved teeth. The gum tissue is reflected back exposing the bone. The bone is contoured and any residual calculus is removed. The gum tissue is then replaced and sutured into a new position that will heal and allow for ease of cleaning.
Regenerative Osseous Surgery
In certain situations where the bony damage is confined to small contained defects, bone grafts can be placed for guided tissue regeneration to rebuild the missing bone. The damaged site is accessed through a flap surgery. Any diseased tissue present is removed from the bony defect. Sometimes the bone still needs to be recontoured some to aid healing. Bone grafting material is placed down into thte defect. A resorbable barrier membrane is placed to cover the graft material during healing and the gingival flap is sutured back into position.
Plastic Periodontal Surgery
Gum recession can occur for several reasons such as a muscle pulling on the gumline, traumatic tooth brushing, periodontal disease and the tooth’s position in the jaw. Gum recession can lead to dental sensitivity, root caries and a compromised and unesthetic smile. Often, it is possible to correct the recession and cover the root while preventing further recession. This will ultimately improve the prognosis of the tooth.