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With the dental health week approaching, I would like to share a few words about a very common and silent disease which affects our teeth supporting structures: Gum disease.
Gum tissue in its healthy state will appear in pink or coral pink colour with natural variations in colour depending on race and complexion. It has firm, resilient tissues with orange-peel texture (known as stippling) with a shape that follows the contour of the teeth and forms a scalloped edge with no areas of redness, swelling or inflammation and no bleeding during daily brushing and flossing.
Gum disease starts affecting the gum tissues when they are exposed to a build-up of plaque around the neck of the teeth. Dental plaque is the major factor in causing periodontal disease. Dental calculus (tartar) also provides a surface for plaque to attach. This can form eighther above or underneath the gum line (supragingival or subgingival calculous) and is recommended to be removed by a dentist every 6 months. Other factors like hormonal changes during pregnancy or puberty , taking some medications, some diseases of immune system, uncontrolled diabetes and etc. are also able to exacerbate the progression of gum disease.
The gum disease has two main stages: gingivitis and periodontitis:
Gingivitis is inflammation of the gum tissue. The gums are irritated and swollen due to a plaque or calculus (tartar) build-up along the gum line. The gums may be sore, bleed easily and appear puffy, soft and swollen. Bleeding gum is one of the earliest and most common signs of gingivitis. The good news about gingivitis is that it is preventable and reversible through good brushing and flossing techniques (or other interdental tooth cleansing) and regular professional scaling and cleaning of the tartar around the teeth.
People might think it is best to stop brushing if their gums are red or puffy. But trying to keep brushing, as well as performing a thorough cleaning by a dental professional is often all that it takes to get rid of the bacteria and plaque that is causing the gingivitis. Soon the gums should look and feel better.
Periodontitis is when the bone and supporting tooth structures are destroyed. This is the advanced stage of the gum disease and happens when the gingivitis has been left untreated for a while. When the bone is damaged by gum disease, spaces can form between the tooth root and the gum. These spaces are called 'periodontal pockets' and within these pockets bacteria will trap and cause even more damage. Over time, more bone is lost, and larger spaces begin to form between the tooth and the gum.
If periodontitis is not treated it will progresses to the advanced stage, the gums severely recede (pull away from the tooth); pockets deepen and may be filled with pus. There may be swelling around the root and the patient may experience sensitivity to hot or cold or feel pain when brushing the teeth. This will eventually lead to the teeth that start getting mobile and need to be removed to stop the discomfort as well as the damage to the neighbouring teeth.
Periodontitis is a silent disease with no obvious initial signs; but there are some warning signs that some people may experience and seek a professional advised based on: gums that bleed when you brush or floss your teeth; gums that are red, swollen or tender; gums that have pulled away from teeth; infection including purulence(pus) between the teeth and gums when the gums are pressed; permanent teeth that are loose or separating; any changes in the way your teeth fit together when you bite; any changes in the fit of your partial denture; bad breath; and occasionally itchy sensation.
Healthy (A) vs Diseased (B) Periodontal Structures
The arrows indicate varying amounts of bone loss due to periodontal disease (from Miles DA et al: Radiographic imaging for dental auxiliaries, ed 3, Philadelphia, 1999, Saunders).
Periodontitis and the presence of heavy calculous build up.
