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Gum Disease

Gum treatment

Gum disease or periodontitis causes the bone that holds your teeth in place to break down. It is a chronic disease with slow or rapid degeneration that varies from individual to individual and that can cause tooth loss if left untreated. Upon each preventive care examination, we gather a collection of data of the periodontal status which will help us to detect periodontitis.

Several factors can cause periodontitis. Significant tartar build-up and inadequate dental hygiene can be monitored through specific scaling procedures and personalized hygiene instructions. Other factors are harder to control such as heredity, stress, some systemic diseases and hormonal changes.

Our team of hygienists will take the time to explain and give you advice to help you stabilize this disease.

What is gum tissue?

The gum is a soft tissue in the mouth that covers the alveolar bone (the bone that supports the teeth) and surrounds the base of the teeth to keep them in place.

Two types of gums are present in the mouth: the attached gum, which supports the teeth, and the free mucosa. We will focus here on the attached gums.

A healthy gum is characterized as follows:

  • It is pink and firm, has a texture similar to that of an orange peel, and is completely attached to the teeth;
  • Its volume allows it to support the teeth adequately;
  • It is not red or swollen (which can indicate inflammation);
  • It does not bleed when brushed or flossed;
  • It covers the tooth in a way that hides the root.

What is periodontitis?

The periodontium, sometimes called periodontium, is the tissue that supports the teeth, including :

  • gingiva (18, 19, 20, 21) ;
  • alveolar bone (23): part of the jawbone in which the teeth are implanted;
  • cementum (7): the protective layer that covers the root of the teeth in the alveolar bone;
  • periodontal ligament (22): the tissue that surrounds the root of the teeth and is located between the cementum and the alveolar bone;
  • nerve elements and blood vessels in the vicinity of the tooth.

A healthy periodontium protects and surrounds the teeth. When the periodontium is affected, it cannot fulfil its protective role. The roots of the teeth can then become exposed, unstable and more vulnerable to infection. In the most severe cases, unhealthy periodontium can lead to tooth loss.

Gum disease

According to the Canadian Dental Association, gum disease is the most common dental problem. The development of gum disease can be sneaky. The slow progression of the disease and the absence of pain at the beginning of the disease mean that the person affected is often unaware of it.

The good news is that gum disease, although it can cause significant damage, can very often be prevented or treated when detected early. However, when the disease is too advanced, it can lead to tooth loss.

Risk factors

Several factors must be considered to determine the likelihood of a person developing gum disease. Here are the most important ones:

  • poor oral hygiene;
  • diseases that weaken the immune system (HIV/AIDS, leukaemia);
  • weakened immune system due to severe stress;
  • diabetes, especially if not properly controlled;
  • hormonal changes caused by pregnancy and menopause;
  • certain medications that have side effects on the gums;
  • smoking.

How does the mouth contribute to gum disease?

Many bacteria are present in the mouth. These bacteria produce acids when they digest sugar from food debris. These acids, together with salivary proteins and food particles, create a biofilm (slimy film) that is deposited on the teeth and surrounding structures. If this biofilm is not removed promptly by proper brushing, it becomes plaque, which, when mineralised, becomes tartar. It should be noted that tartar cannot be removed by brushing or flossing; only professional scaling can remove it.

Plaque and tartar are responsible for tooth decay and gum problems.

Gingivitis

Gingivitis is a widespread disease that is caused by the accumulation of plaque and tartar on the teeth, which leads to inflammation of the gums. It affects adults as well as children and adolescents. The symptoms of gingivitis are very easy to detect:

  • the gums become swollen, red and smooth or shiny;
  • Gums bleed when brushing, flossing or spontaneously for no apparent reason;
  • the appearance of periodontal pockets (spaces between the gums and the teeth) is also possible in some cases
  • persistent bad breath (halitosis), even after brushing the teeth.

Gingivitis is the first (least severe) stage of periodontal disease. At this point, no signs of the disease are visible on a dental X-ray, indicating that the structures that support the teeth are not affected. The patient does not usually complain of pain during gingivitis, but pain may occur when the gums become inflamed. The good news about gingivitis is that it is easily treatable and preventable when improvements are made to oral hygiene. This means that gingivitis is reversible and does not degenerate if treated early. If you see signs of gingivitis, it is very important to continue brushing and flossing properly even if your gums are bleeding.

Main types of gingivitis

  • Simple or chronic gingivitis: This is the most common form of gingivitis. It is caused by plaque and tartar and can be prevented by adopting healthy oral habits. The main symptoms are swollen, red, smooth and easily bleeding gums; there is almost always no pain.
  • Ulcero-necrotic gingivitis: This is often present in people whose immune system is compromised, either by disease or severe stress. The most serious consequence of this type of gingivitis, caused by very aggressive bacteria, is the destruction of the gums, which causes the appearance of spaces between the teeth and the gums. The symptoms are similar to those of chronic gingivitis, but with the addition of severe pain and heavier bleeding.
  • Hypertrophic (hyperplastic) gingivitis: This is mainly caused by the side effects of certain drugs. It differs from the other two types of gingivitis in that the gums are more swollen and can sometimes cover the teeth, making it more difficult to clean them. In hyperplastic gingivitis, the texture and colour of the gums are normal, but the gums are very fibrous.

Periodontitis

Periodontitis is gingivitis that has not been treated or has been detected at a late stage. It therefore affects the periodontium (tissues that support the teeth). It is the most advanced stage of gum disease and is serious because the damage it causes is irreversible.Le résultat le plus probant est la perte des dents entourées du parodonte atteint par la maladie. The most obvious result is the loss of teeth surrounded by periodontium affected by the disease.

The damage of periodontitis is associated with periodontal pockets that form around the teeth where tartar has accumulated. Over time, the bacteria in these pockets destroy the periodontium, in particular, the periodontal ligament and the alveolar bone. In doing so, the teeth will gradually loosen, which may make them appear longer. The teeth will then become loose and eventually fall out if no intervention by a dental professional is made.

The mobility of one or more teeth is what usually brings a patient to the dentist rather than pain, which is not usually present at this stage of the disease. Several factors can contribute to the development of periodontitis:

  • the amount and type of bacteria in the periodontal pockets
  • the presence of certain diseases that influence the effectiveness of the patient’s immune system and its ability to fight the bacterial infection that has set in
  • genetics;
  • smoking;
  • diabetes.

Evolution of gingivitis into periodontitis

As mentioned above, periodontitis is gingivitis that has not been treated properly. Gingivitis is usually painless and can progress very slowly, over several years, to the stage of periodontitis. It is therefore important to be alert to the signs of gingivitis in order to treat it at the source or stop its progression before it develops into periodontitis, as it is often too late to intercept periodontitis before irreversible damage occurs. Fortunately, not all gingivitis develops into more severe periodontal disease, but any signs of gingivitis should still be taken seriously.

Preventive measures

Gingivitis and periodontitis can be prevented by simple means:

  • IMPORTANT: contrary to what most people think, you should floss BEFORE brushing your teeth because when the floss comes out of the interdental space, it can propel food debris and bacteria onto the teeth.
  • Brushing: Brushing should be done at least twice a day, ideally after meals but especially before going to bed at night to remove the film created by bacteria with food deposits accumulated during the day.
  • Flossing: Flossing, when done correctly once a day, ideally at bedtime, helps to remove food debris and bacteria from between the teeth, areas that are difficult to reach with a toothbrush. To make good use of it, it’s best to wrap it around your middle fingers; this will give you more dexterity.
  • Stop smoking: Smoking greatly increases the risk of developing periodontal disease. It is therefore in a smoker’s best interest to stop smoking if he/she wants to keep his/her teeth long and his/her gums healthy.

Regular visits to the dentist

An annual visit is essential, and sometimes more frequent visits may be recommended for individuals with particular gum and tooth problems.

  • During this checkup, a clinical examination is performed to assess the condition of the teeth and gums. X-rays are also taken to provide the dentist with additional information about the teeth and surrounding structures that are not visible to the naked eye.
  • If tartar has built up on the teeth, professional scaling is performed. To prevent it from returning too quickly, advice may be provided by the hygienist or dentist.

It is important for pregnant women to have their mouth examined by a dental health professional at least once during pregnancy, preferably during the second trimester.

 

 

Gum recession

When a significant amount of gum tissue is missing around one or more teeth, the survival of those teeth is at risk. This condition is called gum recession, also known as receding gums. In severe cases, gum recession can cause tooth loss if the level of attached gum tissue is inadequate and too much of the tooth root is exposed.

Gum recession can occur as a result of gum disease or orthodontic treatment. In many other cases, it can be caused by improper tooth brushing (too vigorous or using the wrong technique).

In the example shown here, tooth recession is severe. Part of the root of most of the teeth is visible, making them appear much longer than normal, and there is now insufficient gum tissue to support them. If nothing is done to improve the situation, this person risks losing the teeth that are most affected by recession.