Periodontal disease is an inflammatory disease initiated by bacteria in the mouth that live in dental plaque. Where there are deep pockets alongside teeth these bacteria multiply and change in type and aggression with time. The bacteria cause your own body to breakdown the tissue anchoring your teeth into your jaw. The final end point can be wobbly teeth and early tooth loss or periodontal abscesses.
Periodontal disease is a progressive condition exacerbated by certain risk factors, the most well known one being tobacco smoking. It is possible for the condition to enter a period of ‘remission’ where minimal further tissue breakdown occurs or to be in an active phase where more tissue loss occurs. This can often be precipitated by times of stress. By cleaning your teeth well the total numbers of bacteria in your mouth can be reduced. All periodontal treatments rely on patients keeping their teeth very clean on a daily basis. If you have deep pockets around teeth however, professional cleaning by a dentist or hygienist is required to clean below the gum where your toothbrush can’t reach. If this is done regularly (normally at least every 3 months) it can help stop the bacteria in the pockets changing to the most aggressive kind and help slow down the destruction of your gums.
The aims of periodontal treatment are to:
- educate patients on how to clean their teeth really well
- thoroughly clean all tooth surfaces including those beneath the gumline if deep pockets exist
- try and reduce the depth of pockets and change the shape of teeth/ restorations and root surfaces to produce a more cleanable situation
- remove teeth that are hopeless as very deep pockets can act as a reservoir of aggressive bacteria to cross contaminate the rest of the mouth
- reduce or eliminate any risk factors for periodontal disease progression that can be changed
- regularly reassess the situation and ensure any changes are dealt with appropriately
What is Periodontal Disease?
Periodontal Disease is a major cause of tooth loss. It is a progressive disease and once affected you are always susceptible to further disease and will normally always require periodontal maintenance treatment. Not everyone is susceptible but if you are, you will need to have a more stringent preventative programme to avoid problems. As disease state worsens, treatment increases in amount, complexity and cost.
Many risk factors are known that increase your likelihood of future disease progression, some of these can’t be changed such as your genetic predisposition, but some can be. By changing these risk factors in a positive way your future disease activity can be reduced considerably. Changeable risk factors include smoking, poorly controlled diabetes (gaining good control improves periodontal outcome as well as Diabetic disease), effective removal of plaque, stress reduction (stress is known to be a major factor in Periodontal breakdown. Even patients who are being well maintained can suffer further periodontal breakdown if they suffer a period of high stress).
Destruction in Periodontal disease is caused by your own body’s defence system being activated by bacteria within plaque. The bacteria exist in a ‘Biofilm’ this is a bacterial community. Whilst in the Biofilm the individual bacteria become more immune to your defence system and antimicrobials than they would if they existed as individual bacteria. Whilst the Biofilm is very resistant to these defences, it can easily be broken down by mechanical means e.g. tooth brushing or professional dental cleaning procedures. It can rapidly reform however so regular break down is required. This is why your daily cleaning is so important in gaining control over your disease activity and why very regular (e.g. 3 monthly) professional cleaning is required.
One of the main problems is of access because Periodontal disease produces deep pockets around the teeth that are filled with the bacterial biofilm. These are very hard to clean and to do this you may need to develop new and more effective methods of cleaning your teeth. Often improvements can be made in cleaning between teeth and beneath the gumline. If you are severely affected with gum disease, thorough effective daily tooth cleaning will take about 10 minutes and this time should be factored into your daily routine. With such improvements, as well as having regular professional cleaning below the gumline, pocket depth can reduce, this often shows more of the tooth root and a slightly longer looking tooth. This is a much healthier situation as instead of a loose cuff of gum around the tooth with deep pockets of bacteria, tighter shallow pockets form with far less bacterial contents that are easier to keep clean.
Why is this important to your mouth?
Healthier gums can mean the difference between early tooth loss and keeping your own teeth longterm.
If you lose teeth we can replace them artificially. No method of tooth replacement works as effectively as your own teeth however. With a false tooth/teeth you may feel less confident worrying about teeth coming out, have problems eating the foods you like, your face shape will change as the bone that was surrounding your teeth is lost and you may find it harder to talk. The tooth replacement system may actually cause further damage to your remaining teeth as well, hastening their loss until you have no teeth. Even the most effective tooth replacement system we have, Dental implants, are not without their faults. Whilst they are very reliable they are very expensive, ranging from around £2000 to replace a single tooth up to £10000- £15000 to replace whole arches.
Improving gum health can mean less discomfort, your teeth feel firmer, are healthier, less likely to drift and you have nicer smelling breath.
To your General Health
Current research has also shown definite links between poorly controlled Periodontal disease and other systemic diseases. Whilst it is too early to say that gum disease causes these systemic diseases, it is looking far more likely that there is a causal link. It is known that your own body’s defence system that is activated by the bacterial biofilm, causes the release of lots of chemical substances that pass through your whole body. These can cause damage to tissues distant to your mouth (e.g. the tiny vessel walls that supply your heart) and predispose to systemic disease.
Diseases that are seen more often and have a link to poorly controlled Periodontal Disease include poorly controlled Diabetes, Coronary artery disease increasing your risk of a heart attack, Stroke, and Pregnancy complications (much higher risk of premature low birth weight babies which confers many additional risks to the growing child).
How I can help you?
Periodontal disease is the number one area for dental negligence claims as it is often poorly managed in general practice.
The scientific knowledge in this subject is rapidly growing and keeping abreast of all the advances requires a lot of dedication, attendance on courses/ conferences and studying of scientific publications.
My special interest subject during my Diploma and then Master of Science in Restorative Dentistry was Periodontal Disease and it’s treatment. I can be classed as a Dentist with a special interest in Periodontal Disease (DwSPi). This is a recognised status whereby I can take referrals from General Dental Practitioners for advanced Treatments of Periodontal Disease.
By far the mainstay of Periodontal Disease treatment is non-surgical cleaning below the gumline. In conjunction with this I use a state of the art dental laser to further reduce the bacterial load to gain even better results for my patients. Audited data of my patients show that on average, the number of deep periodontal pockets will half after only one round of non- surgical debridement with me. A full years course of treatment, often sees all pockets reduce to within normal ranges.
There are cases where more advanced techniques are required, these include:
- Surgery to access awkward surfaces beneath the gumline,
- Removal of single roots from molars
- Splitting a molar into 2 units so it is easier to clean
- Shaping the area where roots join in molars to make them easier to clean
- Regenerative procedures to try and encourage new bone growth
- Soft tissue graft procedures.
- Reduction of soft tissue that is impeding cleaning
Whilst it is always important to know your own limits and refer onto further specialists as required, I am very well qualified to offer these treatments to my patient base when required within the practice setting.
These techniques are not suitable for everyone or every situation but you can rest assured that if you are motivated and these options are possible, I will offer them to you. Such advanced techniques can allow you to keep very questionable teeth long into the future.