By Dr. Rafia Mustafa : Gum Disease

Gum Disease: All You Need To Know

Before we go in the depth of gum disease, we need to understand how it is caused. It initiates with a biofilm of plaque which adheres to teeth and contains many microorganisms. Plaque is a sticky substance made up of left over food particles and saliva which mixes in your mouth. It cannot be rinsed or wiped off but it can be removed by brushing effectively. It is possible for plaque to collect on irregular and rough surfaces of the teeth, hence it is important to clean the teeth with toothbrush at least twice daily.

WHAT CAUSES IT:
Streptococci predominates in plaque for first two days and if it’s not cleaned between 6 to 10 days spirochetes appear in plaque and it leads to tooth decay and gum disease.
Gum disease starts with gingivitis, the dense plaque associates with the progression of gingivitis to periodontal disease. If plaque is not removed or cleaned for many days then it starts to become calcified by mineralization of plaque deposits hence forming calculus.
Supragingival calculus (above the gums) can form as early as within two weeks if plaque is not cleaned and left on the teeth surfaces while subgingival calculus (below the gums) takes many months to form.
The deposition of calculus makes it difficult to maintain adequate oral hygiene. Calculus contains bacterial toxins which start to destroy the gums and eventually bone if it’s not cleaned professionally by the dentist.

PROGRESSION AND RISK FACTORS:
Progression from gingivitis to periodontitis can occur when there is a change in the microflora in your mouth. Gingivitis doesn’t always progress to periodontitis, it depends on host defence and plaque maturity. Some individuals may have periodontal disease with the minimal amount of plaque while others don’t with a large amount of plaque also.
Risk factors includes tooth surface and position which can lead to more or less amount of plaque accumulation, overhands of fillings, dental appliances, trauma.
Systemic factors include smoking, diabetes, obesity, immune status, pregnancy, stress,age and nutritional deficiencies.
Smoking increases the risk of periodontal disease with boneloss and attachment loss in the gums.

MECHANISM OF PROGRESSION:
Inflammation of periodontium
Pocket formation
Bleeding gums
Alveolar bone resorption
Gingival recession (localised or generalised)
Tooth mobility and eventually tooth loss.

TREATMENT AND CURE:
Unfortunately, you cannot reverse the damage which has been done already but you can manage the condition by:
• Maintaining good oral hygiene and tooth brushing.
• Interproximal cleaning of teeth with floss and interdental brushes.
• Deep scaling and root planning to remove calculus.
• Re-evaluation to assess the response to the treatment.
• Reinforce oral hygiene instructions and provide further treatment.
• Antibiotics if necessary.