Gum Disease, Explained

What Are the Signs?

• Gums that bleed when you brush, floss or use interdental brushes, or blood on your pillow in the morning
• Red, swollen or shiny gums, instead of pale pink and firm
• Bad breath or a bad taste that doesn't go away with brushing
• Gums shrinking back from the teeth, so teeth look longer or feel sensitive at the neck
• Teeth that feel loose, have moved, or have gaps opening up between them
• Pus or a gum boil near the gum line

Gum disease is usually painless until it's advanced, which is why people often don't notice it until a tooth loosens. Bleeding is the earliest sign and the one to act on.

What Causes It?

Plaque. The soft film of bacteria that forms on teeth every day collects along the gum line and between the teeth. If it isn't removed, the gums respond with inflammation, and plaque left for more than a day or two starts to harden into tartar, which can't be brushed off and gives more bacteria a rough surface to cling to. Some things make it worse or faster:

• Smoking, which also hides the bleeding that would warn you
• Diabetes, especially when it isn't well controlled
• Stress, which lowers your resistance to infection
• Some medicines that dry the mouth or cause gum overgrowth
• Pregnancy, because hormone changes make gums react more to plaque
• A family history of gum disease
• Crowded teeth, bridges and braces that are hard to keep clean

Gingivitis or Periodontitis?

Gingivitis is the early stage. Only the gum is inflamed, nothing has been lost, and it reverses completely once the plaque is removed and kept away. Periodontitis is what happens if gingivitis is left: the inflammation spreads to the fibres and bone that hold the teeth, the gum detaches to form pockets, and bone is slowly destroyed. That damage doesn't grow back, which is why catching it at the gingivitis stage matters so much. Not everyone with gingivitis goes on to develop periodontitis, but everyone with periodontitis had gingivitis first. Our guide to periodontal disease covers the advanced form in detail.

How Is It Diagnosed?

At every examination and hygiene visit we check your gums, looking for bleeding and swelling and measuring the depth of the groove between gum and tooth with a fine probe. Healthy gums have shallow grooves; deeper pockets mean the gum has detached. If we find deep pockets, we take X-rays to see how much bone is supporting each tooth, and stage and grade the disease using the British Society of Periodontology system, so you know how advanced it is and how quickly it's moving. It takes a few minutes and doesn't hurt.

How Is It Treated?

Gingivitis usually reverses with a professional clean to remove the plaque and tartar, and better cleaning at home to stop it coming back. We show you exactly where you're missing and which interdental brushes fit your gaps. Most people see the bleeding stop within a couple of weeks.

Periodontitis needs treatment in stages. First, we remove the tartar above the gum line and help you get your home care and risk factors, such as smoking, under control. Then we deep clean below the gum line, usually in four stages, one for each area of the mouth, under local anaesthetic so it's comfortable, at £100 per stage.² A few months later we re-measure the pockets to check they've healed. After that, maintenance visits, often every three months, keep it stable. It can't be cured once bone has been lost, but it can be stopped and kept stopped.

What Does Airflow Do?

Airflow is the brand name most people know for air polishing. Instead of a gritty paste on a rubber cup, it uses a fine stream of warm water, air and powder to lift plaque and stain from the teeth and from just under the gum line, and it reaches around implants, bridges and braces where ordinary polishing can't. It's quicker and gentler, and most people find it more comfortable than scaling alone. A hygiene visit with Airflow is £100, and it's included in every hygiene visit on both of our dental plans. If you're having a standard hygiene visit, air polishing can be added for £30.²

Gum Health and Implants

Gum disease must be under control before implants are placed, because the same bacteria that destroy the bone around teeth can destroy the bone around an implant, and an implant has less natural defence against them. That's why Dr Kalsi treats gum disease first and reconsiders implants once it's stable, and why our implant guarantee depends on attending hygiene visits every three months. If you already have implants, Bronagh O'Dowd, one of our dental therapists, has a special interest in keeping the gum and bone around them healthy.

Keeping It Under Control

Treatment removes what's there; home care decides whether it comes back. Brush twice a day angled into the gum line, clean between your teeth every day, don't smoke, and keep your hygiene visits at whatever interval we recommend. For people with gum disease that's usually every three months, which is why Plan B, at £40.16 a month, includes four hygiene visits a year with Airflow, along with two examinations and two small X-rays. Plan A, at £24.10 a month, includes two hygiene visits and suits healthy gums. Both include 10% off most private treatment, including gum treatment stages.

Questions

This guide is general information, not a diagnosis. A dentist needs to examine you to say what is right for your teeth.