Dental Hygienist Visits

First and foremost gum disease is an infection. Bacteria live in tartar also known as calculus which is the hard chalky material that can become stuck around your teeth. This is mostly made up of old food that has stayed in sheltered areas and hardened. Some of the tartar will be present above the gum line and yet more will cling below the gum. Once tartar is established it is impossible to remove at home. This tartar forms a physical barrier to the gum doing its job properly- that is covering and holding our teeth, however, that’s only part of the story. Our bodies sense the threat from the bacteria and the toxins they produce and send the bodies ‘soldier’ cells to the area to try and neutralize the bacteria.

Unfortunately, this inflammation is damaging to the gum itself. This extra blood in the area causes the gums to swell, appear redder and bleed easily.. This bleeding is often the most obvious sign, sometimes the only sign that there is an issue with your gums and should not be ignored. One of the big problems with gum disease or periodontal disease is that it can be very quiet and you may be unaware of it. Gums disease is often not painful apart from some specific types until very late in the condition when dramatically some teeth may feel a little loose. As mentioned before you may notice your gums are red or bleed when you brush. They may also appear shiny- in a healthy state gums usually will be pink and slightly dimpled.

You may notice your gums shrinking back or receding. This may uncover darker tooth near the gum line or dark triangles may appear between the teeth. A bad taste in the mouth and bad breath are common. Teeth may become sensitive as they aren’t covered tightly by gum thereby exposing root surfaces. At the early stages, gum disease is known as ‘gingivitis’ and is entirely reversible. Later on, inflammation becomes more entrenched in the jaw bone supporting the teeth and becomes ‘periodontitis’ which causes permanent damage to the bone supporting the teeth. Gum disease or periodontal disease is present in 50% of the population to some extent. It is advanced almost to the point of tooth loss in 5-20% of people. Some people are more at risk than others. Common risk factors are listed below

• Poor oral hygiene- lots of bacteria! Smoking Diabetes
• Cardiovascular disease
• Some medications especially if they are sweet or reduce saliva
• Epilepsy medication
• Stress
• obesity
• Osteoporosis Host response
• overactive immune system
• Pregnancy
• long term contraceptive pill use
• Age
• Genetics

Gum disease causes inflammation, swelling and bleeding in the gums. This along with the bacteria present and their toxic byproducts causes ‘bad’ breath. Longterm the gum will begin to breakdown and the bone underneath will begin to erode. This creates areas of gum that are adjacent to the tooth but not attached like it ought to be. This situation is called ‘pocketing’. Pockets of up to 3mm in depth are normal and natural but anything beyond this indicates gum breakdown.

In the short-term local medicaments can help such as chlorhexidine mouth wash commonly sold under the ‘corsodyl’ or ‘kin’ brands. Antibiotics are reserved for more acute, painful flare-ups. Both of these treatment options are rather like polishing barnacles stuck to a boat- in reality the barnacles have to be removed! The good news is that for the most part gum disease is a slowly progressive condition so if gum disease or periodontitis is diagnosed you usually have time to treat it. The main thrust of gum disease treatment is to remove the tartar stuck to the teeth where the bacteria live.  This is done every six months usually as part of a routine scale and polish. Once gum disease is established a more extensive cleaning is required. This is called periodontal treatment or periodontal scaling. Often this necessitates so-called ‘quadrant’ cleaning which means splitting the cleaning into the mouths four corners over four visits, top left, top right, lower left and lower right. This allows the dentist or dental hygienist to spend more time on a smaller area, often numbing the area. All hard tartar will be cleaned off your teeth above and below the gum line and any rough surfaces which are attracting food smoothened. Occasionally some teeth will be so damaged that they may need to be extracted to preserve the health of the others. Any food traps or overhanging/ deficient old dental work ought to be remedied. Extensive oral hygiene instruction will be given. Perfect cleaning and home care into the future are essential to maintain the gum improvement. All being well gums will tighten up, stop bleeding and become pinker/less red. Teeth that previously were loose ought to tighten up to some degree. Very occasionally a person may be suffering from an aggressive, rapidly damaging form of gum disease or may not improve as anticipated with the treatment offered and a good home effort. Even more rarely extensive gum disease can affect someone at a younger age. In a these specific situations a referral to a gum specialist may be advised. This is called a periodontist and they are available in Cork.

Gum disease is not in general reversible however it can be stabilized. Many patients can quite happily eat, smile and live with a large amount of supporting bone missing around their teeth. It’s never too late. A periodontist may be able to conduct gum surgery and rebuild some bony defects. In the absence of this more radical option the gum can form a softer bond to the tooth which can be perfectly adequate. Extracting some teeth that are too far gone can reduce the bacteria and disease levels in the mouth generally. It may also make it much easier to clean the remaining teeth. Even if a large number of teeth must be lost keeping some healthy strong teeth can help with their replacement.

It has long been suspected and studied that some people are more susceptible to gum disease than others. Factors that may be a concern are your own body’s reaction to bacteria – that is our inflammatory or immune response, ability to heal and even the way our gums formed initially. Other factors you mightn’t think of as affecting your gums are genetic factors linked to your likelihood to be good at oral hygiene routines and resistance to addictive behaviours such as smoking.

Unfortunately at the moment an agreement on the risk factors you may inherit from your parents is lacking. Many variations in genes both common and rare can cause an increased risk of gum disease. It is important to note that if one person has no risk factors and another has all the genetic risk factors and both have perfect oral hygiene, attend the dentist regularly and generally look after their health then their gums will likely be similarly healthy. It sounds easy- as we all know it’s not!

Gum disease is not contagious and will not be passed from one person to another.

The studies to date have shown that chewing sugar-free gum does reduce plaque levels a little which could be expected to improve gum condition. It would have to be considered a VERY small help without a huge amount of evidence.

Good nutrition is important for every part of the human body and gums are no different. Like skin, the gum is constantly turning over and being replaced. Anything that impedes that process like smoking, being run down or lacking in the basic building blocks will reduce the quality and quantity of new gum made.

A well balanced diet with plenty of fresh vegetables will help keep your gums in good condition. Some supplements that also may help are zinc for our immune system, calcium, magnesium and silica for strong bones, vitamin C for healing and soft tissue health and Coenzyme Q10 for blood supply and energy production. Foods high in zinc include red meat, shellfish, a variety of beans, nuts, seeds and dairy. Dairy, seafood and green leafy vegetables are great for calcium.

For magnesium try green leafy vegetables, nuts, seeds and beans and dark chocolate. Silica-rich foods include brown cereals, green beans and spinach. Vitamin C can be found in citrus fruits, broccoli and cauliflower, kiwi, peppers of all colours and sweet potatoes amongst others. Coenzyme q10 is found in meat, fish and whole grains however it is hard to eat enough to increase your bodies level and a supplement may be of benefit, especially to older people as levels reduce with age.