Gum Disease

Gum disease is a silent condition so most people do not realise they have it. Gum disease is irreversible and can spread to the bone under the gum area. Bleeding gums, bad breath, loose teeth are all symptoms – but are not always present. A gum disease diagnosis is an eye-opener as many people are unaware they have it until it is too late. It is linked to Type II diabetes, smoking, premature babies and heart problems.

What are gums? What are they made of and how do teeth attach to gums?

Your gums (also known as gingiva) are the pinkish tissue inside your mouth that surrounds and supports your teeth. They keep your teeth in line, operate as a shock absorber, and attach firmly to your teeth. They have a protective lining called the oral mucosa. It protects you from absorbing irritants and germs that are inhaled or placed into your mouth. Some parts of your oral mucosa have keratin. Keratin helps to make your mouth resilient to damage, similar to how it protects your hair and fingernails as well.

The periodontal ligament or periodontal membrane are tiny fibres which help stick the gums to the teeth. It works with the gums to hold the teeth in place.

What is gum disease and how does it cause damage?

Gum disease is an inflammation of the gums which can progress into an infection affecting the bone that encloses and supports your teeth. Another term is ‘periodontal disease’: “peri-” means around, and “-odontal” refers to teeth. Periodontal disease is a term that describes infections of the structures surrounding your teeth.

Here are four stages of gums disease ordered from least to most severe

  1. Gingivitis – swelling and inflammation of your gums caused by the build-up of bacteria in plaque. This is manifested as bleeding gums when brushing and flossing, bad breath and sore gums. Infectious bacteria go into the spaces around your teeth and start infecting your gums, with probing depths of 2-4mm. These probing depths are measured by your dentist using a special instrument with markings on it – like a ruler. The main treatment for gingivitis is improving oral hygiene at home and regular dental check ups. If left untreated, it can lead to periodontal disease, deeper pockets of infection, abscesses, cavities and tooth loss.
  2. Slight Periodontal Disease Level 2 – the disease progression when gingivitis is left untreated. The inner layer of the gum and bone pull away from the teeth. This creates spaces which collects food and bacteria, creating an infection. Your immune system tries to fight this infection but it is not very effective and results in the break down of the bone and gum around the teeth. With time, your teeth may loosen and this can eventually lead to tooth loss. This stage is silent, many people do not experience symptoms but probing depths are 4-5mm.
  3. Moderate Periodontal Disease Level 3 – infection now extends deeper under the gums and is destroying the supporting bone with probing depths of 6-7mm. Treatment involves scaling and deep cleaning in these pockets. The aim is to remove the deep deposits of bacteria harboring this aggressive gum infection. If left untreated, it can lead to severe bone loss, your teeth may become loose, bleeding and pus when eating and brushing, gum recession, teeth sensitivity and movement of your teeth.
  4. Advanced Periodontal Disease Level 4 – infection further deepens and the bacteria bury themselves deep under your gums. This allows them to protect themselves from your immune system and the bacteria becomes more virulent and disease-causing. Pocket depths at this stage are 7+mm. Your teeth are now more prone to further bone loss and loosening. The infection is now so deep that surgery or laser therapy may be required to thoroughly clean out any persistent deep pockets of bacteria. If left untreated, it can lead to gum recession, sensitivity to hot and cold, large spaces between teeth, shifting and loose teeth, teeth loss and dentures. The bacteria can readily enter the blood stream and cause many other health issues.

What are the factors which increase your risk of gum disease?

The degree of periodontal disease progression is tied to the virulence (or strength of attack) of the bacteria living in the plaque stuck to your teeth. It is also linked to the efficiency of the local and overall immunoinflammatory responses in your body. Remember, maintaining your oral hygiene at home and every six months at the dentist is your biggest tool for preventing gum disease.