Find out how swollen gums are managed, which could affect your teeth’s supporting bone structure if not treated early.

We all want healthy teeth, but for our teeth to be healthy, we need to take care of our gums and jaws as well.

Periodontal disease refers to the chronic bacterial infection of the teeth’s supporting structure. The most common types of periodontal disease are gingivitis and periodontitis. Gingivitis, where only the gums are affected, is a reversible condition, but periodontitis is an irreversible condition that affects both the gums and bone structure.

What symptoms to look out for

* Red and swollen gums, which might be accompanied with abscesses/pus.
* Bleeding, especially while brushing
* Shaky teeth with “weak bite”.
* Teeth drifting/spacing.
* Gum recession or “teeth getting longer”.
* Non-specific low-grade discomfort/pain.

However, some people may not show any symptoms, even though they have underlying periodontal problems, so it’s still important to visit your dentist regularly.

What causes periodontal disease?

Bacterial plaque is the main cause. At first, it forms as a clear film on the tooth surface. Over time, it turns into a hard substance called tartar, which is a harbour to accumulate even more bacteria. Normal brushing or flossing cannot remove tartar.

As bacteria accumulates, gingivitis (inflammation of the gums) occurs. Proper cleaning and removing the plaque from simply brushing regularly/properly to scaling the teeth can reverse the swelling.

However, if the condition is not treated in time, it may progress to periodontitis. The gum attachment to the tooth is lost gradually, and plaque advances along the tooth surface deeper into the gums. The result is irreversible destruction to bone and connective tissue.

Periodontal disease refers to the chronic bacterial infection of the teeth’s supporting structure… Gingivitis, where only the gums are affected, is a reversible condition, but periodontitis is an irreversible condition that affects both the gums and bone structure.

What are the risk factors?

Although periodontal disease can occur to anyone at any age, risk factors linked to periodontitis include:

* Smoking.
* Hormonal changes during puberty or pregnancy.
* Uncontrolled diabetes.
* Medication such as antidepressants and antihypertensives.
* Immunosuppression from AIDS or cancer.
* Genetic susceptibility.
* Halitosis (bad breath).

How is it treated?

The first step is a thorough examination to assess the level and architecture of the remaining bone structure. This usually includes taking a set of radiographs.

Next is initial periodontal therapy (IPT), which includes removing the tartar and plaque from beneath the gum line. This process, called scaling and root planing, is usually done under local anaesthesia. After the procedure, teeth may become temporarily sensitive, but this can be managed by using densensitising toothpastes. Gum shrinkage and gaps may occur when the inflamed gums issue is resolved.

In severe cases, surgery may be required. This involves surgical access to areas that are otherwise difficult or impossible to clean thoroughly during IPT. In certain situations, bone graft materials may be used to encourage the supporting tooth structures to regenerate.

After active management, it is important to ensure there’s a structured regimen to maintain periodontal health. The frequency of maintenance can range from three to nine months. During maintenance visits, your dentist will carry out a full periodontal assessment before removing any plaque.

Dr Low Yi Han, a periodontist, practises at Thomson Specialist Dentistry

This article first appeared in Thomson Medical’s Celebrating Life magazine.

Photo: iStock

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