Periodontics: Treating Gums and Bone Surrounding the Teeth

Mar 9, 2018

Although this area of dentistry – just as all others – is incredibly important, periodontics has essentially been neglected by both patients and dentists alike. Periodontics focuses on treating and maintaining the health of the structures that support the teeth – the jawbone and surrounding gum tissues.

Currently, more teeth are lost during adulthood to periodontal disease than to dental caries (decay) – so why has periodontics been so neglected? The answer lies in the fact that periodontal diseases develop so slowly with relatively little pain, whereas dental caries can occur quickly and can cause often unbearable pain. The majority of patients do not receive necessary periodontal treatment unless encouraged by their dentist or dental hygienist.

What are the most common periodontal diseases?

Although there are several diseases and conditions that can affect the gums and bone of the jaw, the most common of these are gingivitis and periodontitis. Gingivitis is the early stages of periodontal disease, which is marked by an inflammation of the gums and does not affect the bone. If left untreated, this condition can progress and begin to degenerate the underlying bone. This is known as periodontitis, and is much more difficult to treat.

If you think you may have some form of periodontal disease, you should speak to your dentist or dental hygienist. Most general dentists are able to treat periodontal disease, and if the level of disease is beyond their knowledge or capabilities, they will refer you to a reputable periodontist who specializes in such treatment.

What You Feel or See: Symptoms, signs or conditions related to periodontic dentistry

  1. Bleeding Gums

You may notice blood coming from your gum tissue after eating particularly hards foods, brushing your teeth, or using dental floss. If you’re able to see the area where the blood is coming from, you may notice that the gum tissue is darker in color than the areas that are not affected. Usually, inflamed gums are red whereas healthy gums are pink. Healthy gums should not bleed unless they have been subjected to some form of temporary abuse such as over-brushing, over-flossing, or eating hard foods.

Gums that bleed often or regularly are usually a sign of disease in the gum and/or bone tissue – most commonly gingivitis (inflammation of the gums) or periodontitis (disease of the gums and underlying bone). Bleeding of the gums can often be upsetting, as it is usually unexpected and does not appear normal.

If the bleeding is recent, has only occurred for a short time, and there are no obvious factors that may have caused the bleeding (such as over-brushing), then gingivitis is the most likely cause. However, if bleeding has occurred for quite some time, then it is most likely periodontitis which has likely begun to affect the underlying bone. Professional dental care is required to treat this condition. The following treatments are available:

  • Dental prophylaxis
  • Teeth scaling
  • Periodontal surgery

 

  1. Red or Dark Pink Gums

When gum tissue is darker than normal, it can appear to be dark pink or red. This usually means the gums have become inflamed and are engorged with blood, and may bleed if stimulated such as through brushing. Many conditions can cause gums to become red, such as:

    • Mouth breathing: breathing through the mouth, rather than the nose, can cause a build up of sticky residue on the teeth and gums

 

  • Food debris build-up: leaving small amounts of food on the tooth and gum surfaces for a long time
  • Consuming alcoholic beverages
  • Smoking
  • Long-term breakdown of gum & bone that has increased the amount of blood in the gum tissue

 

It is usually difficult for a patient to self-diagnose the cause of red gums, but a dentist or dental hygienist will know the cause after examining the patient. Red gums often indicate the presence of disease. Treatment usually consists of one or more of the following methods:

  • Dental prophylaxis
  • Teeth scaling
  • Periodontal surgery
  • Scaling & polishing teeth, followed by medicinal rinses
  • Surgery for correcting the cause of mouth breath

 

  1. Yellow/creamy substance from space between teeth and gums

When pus starts to discharge from between the teeth and gums, it almost always indicates the presence of advanced periodontal disease. Pus is a combination of food debris, microorganisms (bacteria), and dead cells, and its presence is a sure sign of an infection. Stimulating infected gums through brushing or eating hard foods can lead to the infection being spread to other areas of the body via the blood (bacteremia). Pus discharge can cause foul breath. Treatment should be sought as soon as possible to prevent further breakdown of the gums and teeth. Treating periodontal disease that has progressed to this level is much more difficult than earlier stages of disease, but in most cases the affected tooth or teeth can be saved, and remain in use for many more years. Treatment options include:

  • Teeth scaling (limited potential for successful treatment)
  • Scaling & polishing teeth, followed by medicinal rinses (limited potential for successful treatment)
  • Periodontal surgery
  • Extraction of affected tooth/teeth, followed by artificial replacement(s)

 

  1. Gums have receded beyond original level, are sensitive and/or unsightly

Gum tissue naturally recedes over our lifetime, even in healthy mouths. In healthy patients where the gums may have receded slightly, the gum tissue should be pink and firm, with no tooth movement when pressure is applied. However, periodontal disease can also cause the gums to recede. This happens when the disease has caused the underlying bone structure to degenerate and reduce support of the tooth or teeth, which may move when pressure is applied. Tooth roots, which are darker in color than the crown (visible, enamel-covered part of the tooth), will be exposed and visible, and may be sensitive to touch, hot or cold beverages and foods, or cold air. As exposed tooth roots may look unsightly to you, receding gums will usually present two seperate potential issues:

  1. Sensitivity of the teeth
  2. An unsightly and disagreeable appearance

The following options are usually available to correct or reduce the effects of receding gums:

Sensitivity of the teeth

  • Replace your regular toothpaste with a desensitizing toothpaste. This may require a time period ranging from two weeks to indefinitely
  • Cover the exposed tooth roots with a plastic sealant to desensitize them
  • Chemical desensitization of the exposed tooth root
  • Chemical desensitization of the tooth surfaces, and use iontophoresis (small electrical current) to stimulate penetration onto the exposed tooth root
  • Periodontal surgery and grafting (limited potential for successful treatment)

 

Unsightly appearance

  • Placement of crowns (caps) to lengthen the appearance of the tooth, eliminating the appearance of two seperate colors.
  • Placement of veneers to lengthen the appearance of the tooth, eliminating the appearance of two seperate colors.
  • Placement of removable artificial plastic gums
  • Periodontal surgery (limited potential for successful treatment

 

  1. Food debris collects between the teeth

When periodontal disease becomes advanced, it reduces the support of the teeth, causing them to move when pressure – such as biting hard foods – is applied. Food and stagnant mouth debris can begin to collect in the spaces caused by such tooth movement. When accompanied by periodontal disease, these spaces between teeth are called secondary occlusal trauma. Treatment option include:

  • Periodontal surgery and placement of crowns (caps) to close the gaps
  • Periodontal surgery and orthodontic movement of the affected teeth to close the gaps
  • Scaling & polishing teeth, followed by medicinal rinses (limited potential for successful treatment)
  • Splinting the affected teeth then filling the gaps with wire or fibre-strengthened plastic

 

  1. Halitosis (foul breath)

There are many conditions that can lead to unpleasant or foul-smelling breath, including: periodontal diseases, poor/worn out crowns or fillings, problems with the digestive system, nose disorders, sinus infections, and many others. When periodontal disease is the cause of halitosis, the usual causes of the poor mouth odor are:

  • Fermenting food debris that has become trapped in the mouth
  • Pus resulting from bone breakdown and pockets formed between the gums and teeth
  • Stagnant oral debris that has not been removed

 

Treatments include:

  • Improving oral hygiene, with tongue cleaning
  • Scaling & polishing teeth
  • Periodontal surgery
  • Scaling & polishing teeth followed by medicinal rinses
  • Replacing poor/worn crowns and/or fillings
  • Examination and treatment by an ear, nose, and throat specialist
  • Examination and treatment by a general physician

 

  1. Gums cover some or all teeth

Many conditions can cause the gums to grow excessively, often so much so that they cover the teeth. These include various medications for other health conditions, orthodontic therapy, and many others. Gum overgrowth is often unsightly and usually causes the affected patient to seek professional assistance. In most cases, the teeth hidden by the overgrown gums are otherwise completely normal, healthy, and acceptable in appearance. Treatments for gum overgrowth include:

  • Improving oral hygiene
  • Periodontal treatment
  • Changing medications if this is causing gums to overgrow

 

  1. Gums are painful

When gums are sensitive or painful, this often indicates some form of dental issue ranging from a serious problem such as a dying or dead tooth, to something as simple as a hard piece of food such as a seed or popcorn shell stuck between the teeth. Periodontal diseases like gingivitis and periodontitis do not usually cause pain, often leading to treatment not being sought as soon as would be desirable.

What your general dentist, dental hygienist, or periodontist can do

Dental Prophylaxis

Most people will have had dental prophylaxis performed on them, usually on many occasions. It involves having a sand-like substance rubbed on the surfaces of the teeth to remove mild surface stains and soft debris accumulations. This is done by using a rotating soft rubber cup that holds the abrasive material over the surfaces of the teeth. This type of cleaning should be performed once every 6 months, although your dentist will recommend more or less regular cleanings depending on your personal circumstances.

Advantages of dental prophylaxis

Stains on the surfaces of the teeth are removed before they heavily accumulate and become more difficult to remove. Other developing dental issues may also be found during this examination before the worsen.

Disadvantages of dental prophylaxis

Although some patients may worry about having their teeth cleaned in this manner, this is a routine procedure for all dental patients, and there are no negative factors or disadvantages involved.

Risks of dental prophylaxis

When performed correctly on healthy patients, there are no risks involved.

Alternatives to dental prophylaxis

There are no alternatives.

Cost of dental prophylaxis

This is a very low-cost procedure, especially when compared to the potential cost of neglect.

Results of Nontreatment

This can vary significantly from person to person. Some people experience little to no build-up of debris that leads to surface stains, whereas others accumulate stains and other build-up relatively quickly.

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About the Author:

Dr Aust is married to Mrs Dr Aust and has two children and a dog Max. You can read more here.

He is sharing his expertise with you. Download 5 Things I Learned After Treating Over 10,000 Patients from here.