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About PeriodontalDiseases

Approximately 80% of the population have some form of periodontal disease, also known as gum disease or pyorrhoea. These diseases are often painless until the much later stages, and therefore can go undetected until it is too late to save the teeth. If left untreated, gum disease can destroy the bone and tissues that surround and support the teeth, causing them to become loose and painful, and eventually be lost, even though the teeth themselves may be healthy. Other signs and symptoms of gum disease include bleeding gums, bad breath or a bad taste, swellings and abscesses, receding gums, and loose and drifting teeth, although not everybody has these symptoms, and some people have none of them. The end point is loose teeth that can’t be saved and are eventually lost. There is also increasing evidence to support the relationship of gum disease being a risk factor for heart disease, diabetes, rheumatoid arthritis and other inflammatory diseases and aspects of general health.

The Cause

The main cause of gum disease is bacteria found in dental plaque. This is the sticky white film that forms on your teeth daily. The bacteria produce toxins, or poisons, that irritate the gums and cause them to become inflamed, so they may swell, turn red and bleed easily, particularly when brushing. This inflammation is known as gingivitis, and can be resolved with effective oral hygiene and scaling.

However, in some cases and if left untreated, the bacteria start to cause inflammation of the supporting tissues around the teeth and therefore gradually destroy the gum, bone and ligament that hold the teeth in place. This is known as periodontitis. The gums separate from the teeth, causing gaps known as pockets.

If plaque is not removed effectively, it becomes hard and forms calculus, which is the yellow chalky substance you may have had scaled away by your dentist or hygienist, also known as tartar. Likewise, plaque can fill the pockets, which you cannot then remove because you cannot clean more than 3mm below the gum line. Calculus therefore forms underneath the gums, in these pockets, creating a constant irritant and contributing to further destruction, bone loss, and eventually tooth loss.

Not everybody gets gum disease to the same degree. Some people may clean their teeth very well, and have severe disease, while others may not brush well at all, and have no problem. Each individual has a different susceptibility to the bacteria in their mouths. Factors that can contribute to greater destruction include smoking, stress, general health, some particular medical conditions, such as diabetes, certain medications, genetic factors and poor nutrition.

If left untreated, the bacteria start to cause inflammation of the supporting tissues around the teeth and therefore gradually destroy the gum, bone and ligament that hold the teeth in place. This is known as periodontitis. The gums separate from the teeth, causing gaps known as pockets.

The aims of treatment

As already mentioned, even though mostly painless until the latter stages, gum disease doesn’t just go away, and will eventually lead to tooth loss if left untreated. The main aim is to stabilise the condition and prevent any further destruction, as well as helping to improve your general health. A tooth with less bone around it to support it can still function well, provided it is not at risk of losing further support.

In some cases, it may be possible and appropriate to attempt to reform, or regenerate, bone. Likewise, previously destroyed gum tissue (recession) can also be replaced. These procedures are mostly surgical in nature, and are usually delayed until the overall condition is stabilised to a degree. They are not always necessary in order to treat the disease successfully.

How to treat it

The first stage of treatment is almost always what is referred to as non-surgical treatment. This involves three stages:

  • Oral hygiene instruction – it may sound simple, but cleaning your teeth and gums effectively is not an easy task to achieve. We need to teach you how to be able to carry out effective homecare in order to treat the disease, and make sure that it remains stable once treated. Whatever treatment we carry out will not be effective unless you are able to achieve a high standard of oral hygiene, because you are battling against the cause of the disease, i.e. Plaque, everyday.
  • 2
  • Mechanical cleaning – this involves removal of all the plaque, bacteria, toxins, inflamed tissue and hard calculus deposits above and below the gumline, along with smoothing any restorations, such as fillings, which may be acting as plaque traps. The root surfaces are cleaned and smoothed with special instruments, and also in some case with a laser. The procedure is carried out using local anaesthetic, so that it is completely painless. The amin side effects to expect once the anaesthetic wears off include some pain or soreness, which is easily relieved with over-the-counter painkillers and mouthwash, sensitivity to hot and cold, and some recession. All except the latter are transient, and soon settle down.
  • 3
  • Reassessment – this is carried out two months after the completion of active treatment. At this stage, the pockets are re-measured. The hope is that the gum “sticks” back to the tooth, thereby eliminating the pocket, and therefore the area around the tooth that can harbour infection. It may be that some pockets remain following initial therapy, and reassessment will help determine why this is the case and decisions can then be made about what can be done about it. This may involve further oral hygiene instruction, further scaling, use of antibiotics, or surgical management.

Other treatment

For mild and moderate periodontal disease, non-surgical treatment is often all that is required. However, for some cases of moderate and advanced periodontitis, surgical treatment may also be required following initial therapy. These procedures are also carried out using local anaesthetic, and allow us to move the gum out of the way so that we can visibly see and access the deposits that need to be removed. Frequently, we also reshape the gum and bone, in order to achieve an end-point that allows you to be able to clean as best as possible, and therefore help to keep the area stable once treated. Again, we use lasers for a lot of this process, making the side effects such as pain and bruising far less likely.

Other surgical procedures include bone regeneration, gum grafting to treat recession, preparation of soft and hard tissues for placement of dental implants, removing roots from teeth that have several roots in order to prolong the life of the tooth, lengthening the crown of teeth in order to facilitate placement of crowns or improve appearance, and placement of dental implants.

Completion of treatment

Once active treatment is completed i.e. all pockets eliminated, and the disease stabilised, we usually enrol you into a maintenance program. This is to ensure that the disease remains stable so that you won’t need to go through such an intensive course of treatment again. Once an individual is shown to be susceptible to the destructive effects of plaque, then that person is always susceptible in the future, and areas may be prone to sudden bursts of further destruction which are unpredictable in nature. Maintenance visits therefore allow us to detect any new disease, or relapse, early enough to manage it simply i.e. nip it in the bud. Further scaling and reinforcement of oral hygiene are also carried out during these visits.

Initially, maintenance often starts off on a 3-4 monthly basis. However, they are prescriptive to you. Therefore the aim is to gradually increase the time between them, but with the knowledge that they can be carried out more intensively if for some reason you were undergoing a period of rapid destruction.

Eventually, maintenance can be carried out by your own dentist or hygienist with guidance from the periodontist. Treating gum disease in this way is less costly and better for your health than replacing lost teeth. A very high standard of plaque control, along with regular check-ups with both your dentist and periodontist will significantly improve the chances of retaining your teeth for life.

Dr. Rana Al-Falaki BDS (Hons), MFDS RCSI, M.ClinDent (Hons), MRD RCS (Eng)
Specialist in Periodontics


I have been referring my periodontal patients to Rana and have been very impressed with the service and treatment my patients have received. The end results have been better than expected and I would thoroughly.... More

I had been struggling with gum disease for years. I can’t believe the difference and how much better everything felt once I saw Rana. I was so worried and nervous that I would lose all my teeth, and she put me at ease and looked after .....More

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