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Periodontitis

Summary

Periodontal disease is the most common chronic inflammatory disease in humans affecting nearly half of adults in the UK. It is a complicated inflammatory disease that affects the supporting structures of the teeth - root, connective tissue and bone. Gingivitis is when the gum disease is only affecting the gums, in periodontitis however the bacteria have migrated down the root and created a pocket around the tooth where they can live and multiply without being disturbed.

Periodontitis can be either chronic (slow progression) or aggressive, both types are initiated by the bacteria in dental plaque. Gum disease cannot happen without bacteria but the extent and severity of the disease are affected by the body response, genetic factors and environmental risk factors.

Risk factors for Gum Disease

In the mouth	General
Calculus (tartar - calcified plaque)	Smoking
Partial dentures (false teeth)	Diabetes, hormonal changes(ie pregnancy)
Poorly placed Fillings with overhangs	Some medications
Gaps between teeth	Genetic predisposition
Deep groove in teeth	Stress

Symptoms of Periodontitis

Bleeding gums
Red inflamed/swollen gums
Receding gums
Recurring infections
Mobile teeth
Pain on chewing
Drifting/Change in position of teeth - may feel different in bite
Bad breath
Bad taste

Home care advice

Probably the most important factor in whether treatment for periodontitis is success is the improvement in home care - your cleaning habits. Here are some pointers on improving your oral hygiene.

A good quality electric toothbrush used as instructed by the manufacturer
If using manual brush - Modified Bass technique
Interdental Cleaning is very important ideally using interdental brushes. Use the largest size that will comfortably go between your teeth. This is likely to mean having different sizes for different areas of your mouth
Dental floss - for areas where interdental brushes will not fit then dental floss can be used to break up the bacterial colonies between your teeth.
Mouthwashes - can be used as well as the cleaning methods above but not instead of. Chlorhexidine mouthwashes and gel are recommended for short term use as prolonged use may reduce effectiveness and may cause staining

Periodontitis REQUIRES full assessment by a dentist and home care alone is not going to be sufficient. Untreated periodontitis may result in tooth loss seek treatment as soon as possible after lockdown.

Treatment

The aim of treatment for periodontal disease is to maintain the existing tissue around the teeth, saving teeth where possible, and improving the health of the gums.This is achieved in 3 broad ways:

Eliminating the pathogens (harmful bacteria)
Correcting behavioural factors through improvement of oral hygiene and cessation of smoking (if applicable)
Re-establishing the environment that supports beneficial bacteria.

The treatment will usually be performed by a combination or your general dentist, dental therapist, dental hygienist and specialist periodontist in the following stages:

Thorough examination and recording of current health of the periodontal tissues (gum health, pocket depths around the teeth, bone loss, mobility)
In depth oral hygiene smoking cessation programme (if applicable)
Non-surgical periodontal treatment - cleaning above the gums followed by debridement underneath the gums to remove calculus deposits and clean the root surfaces
Reassessment to assess the effectiveness of Stage 3, should include the same metrics as in Stage 1.
If assessment shows unresponsive areas, then a surgical approach may necessary to allow improved access and visualisation for the deep cleaning
Maintenance - a vital part of periodontal treatment. Periodontitis does not just go away it requires continued hard work from both the patient and the dental team. Maintenance include continued oral hygiene instructions, cleaning (above and below the gum line) and the metrics from stage 1

References

Mendis S, Davis S, Norrving B. Organizational update: the world health organization global status report on noncommunicable diseases 2014; one more landmark step in the combat against stroke and vascular disease. Stroke 2015; 46: e121−122. doi: 10.1161/strokeaha.115.008097.