What is Periodontal Disease?

What is Periodontitis?

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Periodontitis is a deep seated form of gum disease that destroys the ligaments and bone that hold your teeth in the jaw.

It is a “quiet” disease that you may not know you have unless your dentist examines you very carefully.

It presents with some or all of the following features:

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• Bleeding gums (e.g. when you brush your teeth)

• Gum recession (shrinkage)

• “Pocketing” (this is the development of a deep space between your teeth and gums)

• Mobility of teeth (teeth move excessively)

• Drifting of teeth (spaces appear between teeth) and / or

• Pus, swelling and abscess around some of your teeth

• Bone loss (this can only be seen on x-rays)

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Does Periodontitis affect everyone?

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Many studies show that severe periodontitis only affects about 10% of the adult population, but it can start in your teenage years. There is also a very aggressive form of the disease which affects between 0.1% (Caucasians) and 2% (Afrocaribbeans) of younger patients.

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Why do I suffer from Periodontitis?

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Historically, it was believed that the accumulation of plaque (due to poor oral hygiene) was sufficient to initiate periodontitis in all individuals. However, research shows that 10% of people are resistant to getting periodontitis even if their oral hygiene is poor. 10% are highly susceptible and will develop disease even with quite good oral hygiene and most of the remainder will develop the disease eventually (by 65 years-of-age) if they have average oral hygiene.

Susceptible patients develop the disease because their immune system over-reacts to the presence of plaque at the gum margin and especially between the teeth. These patients are “at risk” of early tooth loss because they possess, or have been exposed to “risk factors”.

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What are the risk factors?

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Risk factors are circumstances that increase your chances of getting the disease; they do not necessarily cause the disease. The following are the main risk factors:

• Genetics 

• Stress
• Smoking

• Drugs
• Diabetes

• Pregnancy

• Genetics Studies of twins have taught us that about 50% of periodontitis is due to your genetic make up and you cannot change this. In these patients it is vital they have meticulous oral hygiene.

• Smoking Smoking is the largest “modifiable” risk factor for periodontitis. It reduces the blood supply to your gums, and therefore you do not heal properly after treatment. Treatment does not work as well in smokers and the disease is often impossible to control.

Stopping smoking is the only sure way of improving treatment outcomes; even then it may take several years before you heal as well as a person who has never smoked.

Research has shown the following features in relation to smoking:

• Specific bacteria responsible for periodontitis are 2-3 times higher in smokers
• Smokers accumulate more tooth stain and calculus (tartar), making cleaning harder
• Smokers lose bone twice as much as non-smokers in periodontal disease
• Smokers are prone to persistent treatment failure
• Smokers receiving treatment for periodontitis are twice as likely to lose teeth as non-smokers
• Stress If you are stressed, the body has a reduced ability to fight against periodontal infection. It may also affect your ability to brush your teeth effectively.
It is important to speak to your doctor if you are stressed and they can find the right people to help you.
• Diabetes Diabetes sufferers have an increased risk of having periodontitis. Periodontitis makes it harder for diabetes patients to control their blood sugar levels. Poorly controlled diabetes has the following adverse effects on periodontitis:
• Reduced ability of the body’s defence cells to fight properly against the bacterial plaque.
• Increased damage caused by certain types of immune defence cells in your body.
• Poor healing following periodontal treatment.
 

If periodontitis is treated, it improves the control of blood sugar and lipid (fat) levels in diabetics. Therefore it is important to treat and regularly maintain the health of your periodontal tissues. It is important to speak to your doctor to check your sugar levels if you have a history of diabetes in the family.

• Drugs Some drugs, taken for certain medical problems, are associated with overgrowth of the gums in a small number of patients, which can make oral hygiene more difficult. Examples include: drugs used to control blood pressure like nifedipine, felodipine, amlodipine; the anti-epilepsy drug Phenytoin and the immunosuppressant Ciclosporin.
• Pregnancy If you are pregnant, you may experience bleeding and / or overgrowth of your gums. This is due to the hormonal changes in your body. It is vital that you increase the time you spend brushing your teeth regularly to prevent plaque from accumulating under the gums. In most cases, the gums stop bleeding after child-birth and the overgrowth reduces. However, severe bone loss can occur during pregnancy. Extra attention to tooth brushing is recommended during pregnancy. We also recommend you also see a hygienist every 3 months during your pregnancy.

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I am concerned, what can I do next?

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Periodontitis cannot be cured, but it can be stopped and held at bay so that you keep your teeth for much longer, if not for life. The most important thing you can do is to learn how to achieve the highest standard of oral hygiene possible. Like diabetes, patients have to monitor their blood glucose levels and be careful with their diet, you have to monitor your plaque levels and be careful with your oral hygiene.
 

No matter what we do for you, unless you are cleaning meticulously and conscientiously on a daily basis at home, our treatment will fail.

If you feel you need help with any of the above issues, please inform our reception team and we will be happy to see you for a consultation and recommend a customised plan to help control your gum disease.

For advice on what your role is, in managing your periodontitis, please ask for a separate leaflet.
It is also recommended that you get your family members, including parents, siblings and/or children to see a dentist regularly and to detect gum disease early.

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Teaching and Training

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We also offer regular training and teaching courses, including mentoring services. For further information, click here.