Healthy gums are pink, firm and tight, don’t bleed and form a natural seal between the tooth neck, gum margin and oral cavity. Tiny fibres hold the teeth tightly to the gums and underlying bone. This serves as a barrier to protect the sensitive tissue below from the penetration of bacteria that causes gingivitis (inflammation of the gums) and periodontitis (chronic inflammation that affects the gum, the fibre attachment and the bone supporting the teeth). Effective plaque control is essential to prevent the formation of the bacterial toxins, which attack the periodontal tissues, causing disease. If not well controlled, plaque and calculus will build up at the gum line and gradually spreads underneath the gum on the roots and infection occurs. The bacteria in the plaque continuously produce acids and toxins harmful to the gum, bone and fibre attachment. The gums get red and puffy, may bleed during brushing and flossing, may separate from the teeth and start to recede. A pocket space forms below the gum line and traps plaque and food. Normal brushing and flossing can’t reach to the bottom of the pocket where the focus point of infection is. Further destruction of the supportive bone and fibres will occur, the gums recede even more and the teeth may shift or loosen, and the bite may change.
If periodontitis is left untreated, it can lead to tooth loss. Most patients at some stage of their life develop periodontal disease and most start with gingivitis. Yet the dental team can sometimes overlook patients with periodontal disease, particularly in its early stages. Remember periodontal disease can progress slowly without any visible signs or symptoms. The only symptoms may be red swollen gums, bleeding of the gums when brushing or flossing, a persistent bad breath or unpleasant taste in the mouth and receding of the gums. As the disease progresses, teeth may become loose with even tooth loss in advanced stages.
Periodontal disease may be comparable to cigarette smoking, hypercholesterolemia and hypertension as a risk factor for coronary heart disease. Genetic factors, stress, systemic diseases like diabetes and habits such as smoking and alcohol abuse may retard the healing and also have a negative effect on the long term success of treatment. In some situations, the disease process “flits” randomly from one tooth to another, and in others, the disease process is localized to specific teeth. Some patients exhibit the phenomenon of “refractory periodontitis”: the periodontal breakdown persists despite receiving the correct treatment and maintaining excellent plaque control. The affected teeth are eventually lost.
