Gum disease | 5 min read

What is gum disease and how does it develop?

Gum disease (periodontitis) begins when plaque bacteria build-up at and below the gum margin. If you do not remove the plaque every day by brushing or flossing it hardens into tartar (also called calculus). Plaque promotes a bacterial infection of the gums and calculus will allow more plaque to accumulate due to its roughness. In its early stage, gum disease is called gingivitis. Your gums may be a bit red or bleed when brushing your teeth, but you may not notice anything in the early stages.

When early gum disease is not treated the gingivitis gets more serious, your gums become swollen and may bleed more when brushing or flossing your teeth, but it will not be painful. Over time, the infection will penetrate deeper into the gums and reach the jaw-bone tissue. Once it reaches the jawbone it may destroy the bone and develop into advanced gum disease, also called periodontitis. Periodontitis will be painless, and most people are totally unaware of the disease. There are however tell-tale signs that you may have the disease.

Periodontitis is a chronic inflammation of the supporting soft and bone tissue surrounding the tooth. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum margin. Bacterial antigens and toxins and the body’s enzymes fighting the infection actually start to break down the surrounding bone and soft tissue that hold the teeth in place. If not treated, the gums and bone that support the teeth are progressively destroyed. The teeth may then eventually become loose and have to be removed.

Gum disease progresses silently and painlessly until you have a real problem. That is why it is so important to diagnose and treat it early before it becomes serious.

How common is periodontal disease?

Periodontal disease is one of the most prevalent non-communicable chronic diseases in our population. Approximately 70% of South Africans will develop the periodontal disease at some time in their lives. Your chances of developing periodontal disease increases as you get older. Research has shown that up to 30% of the population may be genetically susceptible to periodontal disease. Such people may be six times more likely to develop the periodontal disease in the presence of plaque.

Numerous studies have also concluded that smoking substantially increases your risk of gum disease and subsequent tooth loss. Smoking is also a risk factor for oral cancer and many other conditions.

Can it affect other members of my family?

Research has shown that periodontal disease is an inflammatory disease that is initiated and sustained by plaque bacteria beneath the gums. Thus technically, periodontal disease may not be contagious. However, the bacteria that cause the inflammatory reaction can spread through the saliva. This means that if one of your family members has periodontal disease, it’s a good idea to avoid contact with their saliva by not sharing eating utensils or toothbrushes. Deep kissing between partners may spread the disease between partners over time.

Why is periodontal disease a risk for my health?

Research findings suggest that periodontal disease may be linked to other chronic inflammatory conditions such as cardiovascular disease, diabetes, chronic renal disease, rheumatoid arthritis, respiratory disease and premature childbirth.

Bacterial antigens and toxins associated with periodontal disease can travel from the gum or bone tissues into the bloodstream and pose a threat to other parts of the body. It is therefore very important to eliminate the bacterial plaque that is responsible for initiating and sustaining periodontal disease and to treat the gum infection as soon as possible to ensure that your entire body stays healthy.

However, more research is needed to clarify whether periodontal disease actually causes health problems beyond the mouth and whether treating gum disease can keep other health conditions from developing.

How do I know that I have periodontal disease?

People are often not aware that they have gum disease and symptoms may not appear until an advanced stage of the disease. However, there are some warning signs for periodontal disease.

Table 1 Tell-tale signs of periodontal disease:

• Bleeding of the gums while brushing, flossing or eating

• Gum that are receding causing the teeth to look longer

• Tooth sensitivity

• Loosening of teeth

• Shifting of teeth and appearance of gaps between teeth

• Persistent bad breath

Any of these symptoms may be a sign of a serious problem and should be checked immediately by your dentist or oral hygienist. A clinical examination of your gums and jawbones is the only accurate way to determine if you have periodontal disease.

How is gum disease diagnosed?

Your dentists will ask you about your medical history to identify any conditions or risk factors such as smoking that may contribute towards gum disease.

Next, the dentist will examine your gums and note any signs of inflammation and bleeding. A tiny ruler or ‘probe’ is used to check for and measure periodontal pockets. In a healthy mouth, the depth of these pockets is usually between 1 to 3 mm. An x-ray is also taken to see where and how much bone is lost.

When gum disease is more serious, your dentist may refer you to a gum specialist called a periodontist to restore health and regenerate bone and gum tissues that have been lost because of the periodontal disease. The periodontist also treats serious forms of gum disease that do not get better with normal dental care. Advanced gum disease can be treated by deep cleaning, medications, surgery to eliminate or reduce very deep pockets and/or to regenerate lost soft and bone tissue with grafts.

When serious gum disease is found, brushing and flossing become even more important.

Key points to remember

You can prevent gum disease by following some simple rules. Early detection and treatment of periodontal disease together with meticulous oral hygiene can help you preserve your teeth and smile for life.

• Brush your teeth twice a day

• Floss every day

• Visit a dentist routinely for a check-up

• Visit an oral hygienist twice a year for a professional cleaning

• Don’t smoke

• Eat a well-balanced diet

If you have been diagnosed with periodontal disease, you should consider having both your dentist and periodontist be actively involved in the diagnosis and treatment.

Maintaining good periodontal health is important for overall health and well