Gum disease is a chronic bacterial infection of the gums and the bone supporting the teeth. It can affect one tooth or several teeth. If left untreated, it may lead to the loss of tooth or teeth.

The main cause of gum disease is bacterial plaque. It is a sticky film, made up of bacterial and salivary protein, that accumulates on the surface of the teeth. The plaque causes ‘gingivitis’ which is an inflammation of the gums. The gums become red and puffy, and bleed easily. Gingivitis is a mild form of gum disease which is reversible.

Left untreated, it can progress to a more advanced stage of gum disease called periodontitis. The gums start to separate from the teeth, allowing bacteria to form periodontal (gum) pockets which will destroy the underlying supporting structures (bone and connective tissue). The teeth may eventually become loose and need to be removed. The disease can occur at any age.

You may be more prone to gum disease if you have any of these risk factors:

• Poorly controlled diabetes. This means that you are at a higher risk of developing infections, including periodontal disease.
• A heavy smoker. Smoking is the most significant risk factor associated with the development of periodontitis.
• Undergoing hormonal changes such as puberty or pregnancy in females.
• Taking certain medications that may cause your gums to swell or overgrow (certain anti-hypertensive and immuno-suppressant drugs).
• A lower immunity against infection due to HIV infection or if you are undergoing cancer treatments.
• Poor nutrition.
• Genetic susceptibility to periodontal disease.

Signs and Symptoms

• Bleeding gums when brushing or flossing your teeth
• Red, swollen or puffy-looking gums
• Painful or tender gums
• Pus discharge from the gums causing a bad taste in the mouth
• Gum abscesses
  (gum swelling with pus)
• Shaky teeth
• Teeth appearing to drift apart from its original position
• Receding gumline (gum recession)
• Persistent bad breath
• Vague discomfort or dull ache in gums and teeth

You may still have gum disease and not have any of the above signs and symptoms as most people do not experience any pain with gum infection.

Plaque forms within hours after it has been removed from your teeth. Effective removal of plaque can help to prevent gum disease. These are some preventive steps:

• Brush your teeth at least twice daily. Brushing after every meal is also helpful.
• Brush half an hour after a meal. If you have consumed acidic food or drinks, this helps to reduce tooth sensitivity.
• Floss everyday.
• Use an interdental brush on teeth with a larger gap.
• Visit the dentist routinely, twice a year for a check-up and professional cleaning.
• Do not use tobacco products.

Remember, your gums and the underlying bone support all your teeth in place and a beautiful smile starts with healthy gums!

The type of treatment and number of visits will vary depending on the extent of the disease. Regardless of the treatment, it is important that you maintain good oral hygiene. Smokers are strongly advised to quit smoking to improve treatment outcome.

Initial Periodontal Treatment

Plaque that is allowed to accumulate on the teeth over time will harden to form calculus (tartar). Calculus being rough will trap more plaque. It can only be removed by professional cleaning by a dentist or dental hygienist.

Removing the bacterial plaque and calculus is necessary to allow the gums to heal.

• Scaling - Removing the calculus from above and below the gum line.
• Polishing - Removing plaque and stains from the root surface.
• Root Planing - Using special instruments to remove tough calculus and bacterial deposits along the root surfaces, usually under local anaesthesia.

As your gums heal, they normally shrink, and you may notice gaps appearing between your teeth. Your teeth may also experience increased sensitivity to cold food or drinks. If this occurs, your dentist can recommend toothpaste or gels/rinses for sensitive teeth.

Surgical Treatment

Gum Surgery

If deep periodontal (gum) pockets and gum inflammation persist following initial periodontal treatment, this could be due to calculus in difficultto- reach areas. Your periodontist may then decide to perform surgery to gain access to clean the teeth better and to further reduce the pockets. In certain conditions, your periodontist might use grafting materials to promote regeneration of destroyed bone and gum tissues.