Gum disease: what patients should know

Most patients are quite resistant to gum disease but in the region of 5-15% of the general population have a genetic susceptibility to gum disease.

Patients with a genetic susceptibility to gum disease should :

  • receive a definitive diagnosis as soon as possible
  • have a customised treatment plan devised to include extremely careful professional monitoring (visual checks, gum probing, x-rays)
  • spend more time cleaning their gum edges
  • receive preventative care
  • see the hygienist more frequently ( 3 monthly) + focus on cleaning at and under the gum edges twice daily.  
  • consider being referred to a gum specialist (periodontal specialist)

Gum disease has 4 major factors:

  1. The genetic make-up of the patient ( we cant alter that unfortunately).
  2. The quality of the patient’s home care cleaning regime: probably the most important aspect. We can show you how to improve your home care in several ways.
  3. The quality of the professional monitoring + quality of professional cleaning. Recording your gum health annually to follow your progress.
  4. Fillings, crowns bridges and dentures should be designed to help make cleaning as easy as possible.

Gum disease is usually painless in the early and middle stages when it can be relatively easily treated. Only in the later stages, do patients become aware of their gum problems usually by loosening of teeth. Sadly, when a patient is aware they have gum problems ( painful loose teeth and gum abscesses) it is often too late to save the affected teeth and extractions are needed.  

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How does a dentist tell if you have gum disease?

There are 3 critically important parts in evaluating gum health

1. Looking
2. Gum probing
3. Taking radiographs (x-rays)

1. Looking at the gums
It is well known that visual evaluation on its own, is unreliable as only severe gum disease can be spotted visually and teeth usually need removing.

Healthy gums below:

 

 

 

 

Unhealthy gums

 

 

 

 

2. Gum probing

It is mandatory that your dentist or hygienist takes special gum measurements (BPE or basic periodontal examination) every 12 months. Gentle gum probing is a KEY part of having your gums checked. The mouth is divided into 6 sections and a plastic probe is gently walked around your gums

Top jaw

Upper right back and side / upper front 6 teeth / upper left back and side teeth

 

 

 

Lower jaw

Lower right back and side / lower front 6 teeth/ lower left back and side teeth.

 

BPE codes: what do they mean

A six-part cell is used to notate your BPE readings and forms part of your dental records:

0

2

4*

4

3

1

This patient has gum disease in 3 out of the 6 zones of the mouth.

Codes 0, 1 and 2 😊 These codes associated with good gum health. O is perfect, 1 excellent and code 2’s good gum health.

Codes 3, 4 and 4* ☹ indicate gum disease (periodontitis) and we are required to seek more detailed information.

 

3.Radiographs to detect gum disease

Dental x-rays show the supporting bone: in gum disease bacteria erode the bone and appear as dark shadows:

 

 

 

 

Gingivitis

A gingivitis is a thin red line around the gum edges caused by the bacteria in plaque. There is often no pain with gingivitis. Simply brushing the gum edges will cure the gingivitis. If we treat gingivitis early patients cannot get periodontitis. EARLY INTERVENTION to cure gingivitis is the best way to avoid gum disease.

Photograph of gingivitis

 

 

 

 

Periodontitis

If a gingivitis is not treated quickly some patients go onto to suffer periodontitis. Bacteria invade the deeper tissues of the gums and bind to osteoclasts (bone removing cells) and cause bone removal. Pockets form which allow more bacterial to harbour in the deeper tissues. ]

Picture of periodontitis

 

 

 

 

 

Periodontal probing depths (PPD’s ) measured in millimetres (mm)

These are 6-point probing depths around each tooth. Three probing measurements are taken at the front of the teeth and three on the inside aspect of the tooth:

What do PPD values mean?

  • 0-4mm: normal range
  • 5-6mm:  the gums are inflamed or there is some bone loss. Usually better brushing + / – more frequent hygiene appointments can see the pockets reduce to within the normal range
  • 7mm plus:

If the only 7mm + pocket is the tooth that needs extracting we can usually proceed

If multiple deep pockets, defer treatment until other teeth pockets are reduced to normal range +    consider referral to periodontal specialist for definitive periodontal diagnosis and pre-implant treatment.

Early intervention + treatment of gingivitis

If your dentist spots gingivitis and you improve your gum brushing the problem is solved. The difficulty is persuading patients to brush better and for longer time when they are having no noticeable problems.

Early intervention + treatment of gingivitis

If your dentist spots gingivitis and you improve your gum brushing the problem is solved. The difficulty is persuading patients to brush better and for longer time when they are having no noticeable problems.

Gum disease + medical health issues

Severe gum disease is associated with some serious medical health issues:

  • Type II diabetes
  • Dementia
  • Arthritis
  • Coronary artery disease
  • SEPSIS

If bacteria are allowed to stagnate under the gum edges, they cause micro-ulcers which allow bacteria to enter the bloodstream. This is called a bacteraemia and your immune system then has to intercept the bacteria and kill them. If your immune system does not kill all the bacteria, they can travel to all the major organs of the body and can cause SEPSIS.

Severe sepsis has a mortality rate of 40-60%.

Signs of Sepsis

  1. Fever and chills: very low body temperature.
  2. Urinating much less than normal or not passing any urine at all.
  3. Rapid pulse.
  4. Rapid breathing.
  5. Nausea + vomiting + diarrhoea.
  6. Skin rash
  7. Sense of impending doom

Sepsis is on the increase in the UK, partly due to antibiotic resistance to anti-biotics. In addition, no new antibiotics have been invented since 1987.

Gum health and implants

All dental professionals should know that active gum disease can cause dental implants to fail.

It is very important that we evaluate a patient’s gum condition carefully before placing dental implants as patients susceptible to periodontitis are more susceptible to peri-implantitis.

There are, of course, patients who become frustrated that implant treatment is delayed by evaluating the periodontal problems they have but I believe this is the safest way to look after what is a challenging group of patients.

Periodontal specialist (‘gum’ specialist)

We have worked with Dr Ian Dunn (periodontal specialist : https://www.purelyperio.co.uk/gum-disease-dentist.html ) for many years and he has helped patients gain periodontal stability prior to us providing implant treatment.

Contact Us

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Dr P Young BDS PhD specialist in oral surgery

 

29 Castle Street, Northwich, Cheshire, CW8 1BA

 

Tel / Fax

01606 75615

Email

clinic@oralimplants.co.uk