The main cause of periodontal disease is dental plaque. Dental plaque is the sticky, colourless film that constantly forms on your teeth. Daily home oral care (proper brushing and flossing) is a must to prevent plaque build-up. If plaque is not removed, it can turn into a hard substance called calculus (tartar) over a period of time.

Calculus is very hard and can only be removed during a professional cleaning. If it develops below the gums onto the tooth root, it makes plaque removal more difficult. This can increase your risk of contracting periodontal disease.

Toxins (poisons) produced by bacteria in plaque irritate the gums and cause infection. In addition, these toxins destroy the supporting tissues around the teeth, including bone. When the bone is affected, gums separate from the teeth, forming pockets that fill with even more plaque and infection.

As the disease progresses, the pockets deepen, destroying more gum tissue and bone. The teeth eventually become loose. If periodontal disease is untreated, the teeth may need to be removed (extracted).

Periodontal disease can affect one tooth or many teeth in your mouth. For example, your front teeth may not show signs of disease while a tooth in the back of your mouth may become loose due to severe disease progression.

Common signs of periodontal disease

• Bleeding gums during brushing
• Red, swollen or tender gums
• Gum abscesses (boils)
• Pus from between the teeth and gums (leaving a bad taste)
• Loose or separating teeth
• Longer-looking teeth as a result of gums that have pulled away from the teeth (gum recession)
• Persistent bad breath
• Vague discomfort (e.g. itchiness or dull ache)
• A change in the way your teeth fit together when you bite

Common forms of periodontal disease

Gingivitis

This is the mildest form of periodontal disease. Gingivitis causes the gums to become red, swell and bleed easily. There is little or no pain at this stage. The most common complaint at this time is that of bleeding gums whilst brushing teeth. It is reversible with professional treatment and good home oral care.

Mild Periodontitis

If gingivitis is left untreated, it can progress to periodontitis. Mild periodontitis causes the destruction of supporting bone and tissue around the teeth.

Moderate to Advanced Periodontitis

At the mid-stages, periodontal disease can lead to more bone and tissue destruction. The most advanced form of disease includes extensive bone and tissue loss.

At this point, teeth are often loose and may have to be removed.


                        Healthy gums

                    Red, swollen gums

                    Plaque and calculus

                            Bone loss

                Loose, separating teeth

You may have periodontal (gum) disease and not have any of the above symptoms. Most people do not experience pain with the disease.

Many people over the age of 35 develop periodontal disease. You should ask your dentist if you don't know the state of your periodontal health. Your dentist will be able to detect the disease and refer you to a periodontist (gum specialist) if necessary.

During a periodontal examination, a small measuring probe is used to assess your periodontal health. The probe is gently placed between your tooth and gum to determine the condition of your gums. Radiographs (X-rays) are also taken to assess the condition of the bone below your gums.

Preventing periodontal disease

Daily oral care is a must to prevent plaque build-up. Your dentist will help ensure that your oral care technique is correct and effective.

Regular dental visits are also important. Daily cleansing will minimise calculus (tartar) formation but will not completely prevent it. A professional cleaning at least twice a year is necessary to remove calculus from places your toothbrush, floss and other cleaning aids may have missed.

If you have had treatment for periodontal disease, you may need professional maintenance more frequently.

Flossing	Brushing teeth
Interdental brush	Professional cleaning by dentist

Treating periodontal disease

The goal of treatment is to stop the progression of disease, return you to good oral health and then to help you maintain it.

Depending on how far the disease has progressed, treatment can vary widely. If detected in the early stages, simple procedures (e.g. scaling, polishing, root planing) are done to remove plaque and calculus from below the gumline and eliminate the infection-causing bacteria.

Your dentist will show you how to brush and floss your teeth properly, and may introduce special brushing aids to clean hard-to-reach areas of your mouth. A mouthrinse may also be recommended.

If the disease has advanced to the point whereby the periodontal (gum) pockets are deep and the supporting bone is lost, further treatment involving surgery may be necessary.

Supportive periodontal treatment

Once the disease has been arrested, patients are seen regularly for professional maintenance. This phase of treatment, known as supportive periodontal treatment, allows your dentist to assess your periodontal health and make sure your infection stays under control.

At each visit, your mouth is examined, calculus and plaque are removed and, if necessary, your teeth are polished and your bite checked. Periodontal disease is a chronic disease, just like diabetes. Without careful, ongoing maintenance, the disease can recur.