The importance of periodontal health and how it can be treated

What is ‘periodontal health’?

The ‘peridontium’ refers to the supporting structures around teeth – namely the gums, ligament that surrounds each tooth and the jaw bone within which they sit. In health, there is a lack of inflammation and a lack of continuous breakdown within these structures.

Why is periodontal health important?

The periodontal tissues are to teeth what foundations are to buildings – their stability is essential in maintaining comfort, stability and position of the teeth within the mouth.

Within the mouth poor periodontal health can result in red and painful gums, wobbly teeth, gum recession and bad breath.

Gum disease is also strongly linked with systemic health in the rest of the body. Poor periodontal health has been shown to significantly increase the risk of many other conditions including diabetes, heart disease and altzheimers.

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How can gum disease be prevented?

Although there are many contributory factors, gum disease is ultimately caused by specific bacteria in the mouth collecting on teeth and gum surfaces. When these bacteria are left undisturbed (not brushed off) they form a sticky film of ‘plaque’ and often hard calculus (tartar) which can cause the break down of the periodontal tissues. This starts with inflammation (swelling and bleeding) of the gums but then progresses to the loss of the attachment of the gum to the teeth and ultimately destruction of the underlying bone.

This process is prevented by stopping these bacteria from collecting on the tooth and gum surfaces. This involves cleaning twice daily with a toothbrush (electric brushes are usually recommended) as well as using aids that clean between the teeth (interdental brushes are usually best) on a daily basis.

Despite a patient’s best efforts at home there are usually areas that cannot be reached via cleaning methods at home and therefore regular professional cleaning with a dentist, hygienist or periodontist is also essential.

What does gum disease treatment involve?

Once gum disease has been established there are ‘phases’ of treatment that are employed to control, and in most cases stop, the disease from progressing. Our Cheltenham and Cotswold Periodontal team use the following phases;

• Phase 1 – Optimising oral hygiene measures and professional cleaning above the gum line (supra gingival debridement). This involves teaching patients how to effectively remove bacterial build up each day at home (tailored oral hygiene advice) as well as professional cleaning using fine vibrating instruments (ultrasonic instruments) to remove the bacteria and calculus (tartar) that has formed.
• Phase 2 – Cleaning below the gum line (sub gingival debridement), sometimes called ‘root surface debridement’ or ‘root planing’. This is performed using even finer ultrasonic instruments that are designed to tuck below the gum without the need for surgery. This treatment is often performed by both hygienists and periodontists (gum specialists).
• Phase 3 – Following review of success of the above treatment an additional phase can then be considered if necessary. This involves more advanced techniques usually involving small surgical procedures to either recontour the gums (to improve access for cleaning) or in some instances bone graft to restore lost bone. These procedures are highly specialist and are therefore performed by a Periodontal Specialist.
• Phase 4 – once all the necessary treatment has been performed and as much disease stability as possible has been achieved, the final phase is a ‘maintenance’ phase. Given that gum disease is a ‘chronic’ condition and has the potential to return if health relapses, it is important to maintain low bacterial levels on a long term basis to reduce the risk of this happening. This involves continuing excellent oral hygiene at home and seeing a dentist or hygienist for professional cleaning and monitoring of the gum health on a regular basis. Regular reviews means that signs of relapse can be detected early and therefore acted upon to before further breakdown / inflammation occurs.

Healthy gum tips:

• Establish a routine – performing cleaning at similar times each day reduces the risk of forgetting / falling out of the habit.
• Maintain regular review / maintenance appointments with your dental team – prevention is much easier than cure, so regular review of the gum health means issues are often identified early and therefore prevent larger issues.
• Invest in a high quality electric toothbrush (these have been shown to be upto 60% more effective at removing plaque) and persevere at perfecting the technique of using interdental brushes (they are fiddly but very effective!).
• Maintain overall health – particularly gut health and glucose (blood sugar) control. These are strongly linked to gum health so can greatly reduce the risk of gum disease if they are optimal.
• Avoid smoking and vaping – any nicotine based product will reduce blood supply to the gums and therefore hugely increase the risk of gum disease. Continuing to use these products will also make treatment much less successful in most cases.

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