Periodontal Disease
Information about periodontal disease and your treatment with Bristol Dental School.
Periodontal disease (gum disease) is inflammation of the gums and tooth supporting tissues. Periodontal disease is most commonly caused by a build-up of plaque on the teeth. Bacteria in the plaque damage the gums and bone. Periodontal disease can be improved by regularly cleaning plaque from the teeth and gums. Periodontal disease can be localised, which means it only affects a few teeth, or generalised, which means it affects most of the teeth.
Some people are at a higher risk of gum disease. Risk factors include:
- High levels of plaque
- Smoking or chewing tobacco
- Family history of gum disease
- Diabetes
- Hormonal changes:
- Pregnancy
- Oral contraceptives
- Hormone replacement therapy (HRT)
Periodontal disease can be broadly divided into 2 forms: gingivitis, which affects the gums, and periodontitis, which affects the gums and tooth supporting tissues. Gingivitis causes bleeding gums and is a reversible form of periodontal disease. Periodontitis causes the loss of bone around teeth and is irreversible. Losing bone reduces the support surrounding the tooth and in some cases can lead to tooth loss. Gingivitis is thought to progress to periodontitis, however, this is largely preventable by effective brushing techniques.
Symptoms
The main symptoms of gingivitis are:
- Bleeding gums, especially when brushing teeth
- Inflamed gums (red and swollen)
- Sore/painful gums
The main symptoms of periodontitis are the same as for gingivitis but with the addition of:
- Gum recession (teeth look longer because the gum shrinks)
- Mobile teeth
- Drifting teeth / tooth movement
- Tooth loss
- Halitosis (bad breath)
- Pus from the gums
Diagnosis
There are multiple ways to assess your gum health including:
- Probing around the gums and teeth using a periodontal probe:
- When healthy, the gums sit tightly around the neck of the tooth.It is not possible to insert a periodontal probe beyond 3mm.
- If periodontal disease has caused bone loss, the gums no longer sit tightly around the tooth and a periodontal probe can be inserted deeper than 3mm around the tooth. This is called a periodontal pocket.
- Taking x-rays to assess the teeth and bone levels.
- Checking plaque levels (often using a blue dye).
Treatment
How is periodontal disease treated
Periodontal disease is managed by the patient and by the dental professional through a combination of home oral hygiene measures and dental treatment. The most important part of periodontal treatment is achieving low plaque levels through good oral hygiene. Patients who have good oral hygiene have lower plaque levels and better treatment success.
Patient oral hygiene measures:
- Brushing twice a day (once before bed and one other time) with a toothbrush and fluoride toothpaste.
- Cleaning in between the teeth once a day with a dental aid, e.g. interdental brushes or floss.
Dental treatment:
- Periodically cleaning plaque/calculus from above the gums.
- Periodically cleaning plaque/calculus from below the gums (if periodontal pockets are found).
- Certain cases require more complex treatment such as periodontal surgery to clean teeth. However, the vast majority of cases are successfully treated without the need for this.
Benefits of treatment
- Reduced inflammation: this reduces the risk of further gum and bone loss, and therefore reduces the risk of tooth loss
- Reduced plaque levels: the teeth and gums are cleaner which reduces the risk of bacteria causing further periodontal disease
- Reduced risk of bad breath: bacteria that cause gum disease are a cause of bad breath. Removing the plaque and bacteria can improve bad breath.
Risks of treatment
- Relapse: if oral hygiene and regular dental visits are not maintained, gum disease has a high risk of relapse. A small number of patients do not respond to periodontal treatment even when they have excellent oral hygiene and attend regular dental visits.
- Repeat treatment: most patients require more than one course of periodontal treatment to see an improvement in their gum health.
- Gum recession - unhealthy gums are inflamed and swollen. With successful treatment, the gums become healthier and shrink back to the level of the bone. This can expose the root of the tooth which can lead to the following:
- Tooth sensitivity - this can cause a sharp shooting pain when teeth are exposed to cold/touch. This is usually temporary but some patients report long term tooth sensitivity.
- ‘Long’ teeth - with gum recession, the teeth can appear longer.
- ‘Black triangles’ - the gums usually fill the entire space between the teeth. However, with gum recession the space between teeth is exposed causing the appearance of ‘black triangles’ between the teeth where the gum originally was.
- Soreness: after periodontal treatment your gums may feel sore for a few days. The dental professional treating you will provide you with instructions of how to manage the gum soreness and keep your teeth/gums clean whilst your gums are sore.
What happens after treatment is finished
To check that you and your dental professional are happy with the outcome of your treatment, you will be reviewed after your treatment is finished.
When all of your dental treatment is complete, you will be discharged from the dental school. We advise that you find a dentist outside the dental school to continue to look after your gum health.
Questions you may want to ask
- Which of my teeth are affected by periodontal disease?
- What can I do to improve my oral hygiene?
- How many appointments will I need for periodontal treatment?
Maintaining good oral hygiene at home
Maintaining good oral hygiene is crucial for healthy teeth and gums, and will help reduce the risk of decay and gum disease. Brush your teeth twice daily for 2 minutes with fluoride toothpaste and clean between your teeth with floss or interdental brushes.
Smoking and alcohol increase the risk of oral disease. If you want to quit smoking or reduce your alcohol intake, please talk to the clinician you see for further advice.
It is important to attend dental check-ups regularly, as this will help your dentist to identify any dental disease early.
Patient information leaflet
Download the information on this page (this also includes images) as a printable leaflet: Periodontal disease patient information (PDF, 454kB).