What is gingivitis

Gingivitis is the disease of the gums caused mainly by the accumulation of dental plaque. Plaque forms through the build-up of food debris, components of saliva and oral bacteria. Correct daily brushing removes it from the teeth and so helps to maintain oral health. When the teeth are not brushed properly, however, dental plaque increases, calcifies from the salts in saliva and leads to the formation of calculus (tartar), which makes further deposition of dental plaque easier.

Whereas healthy gums are pink in colour and firm and resilient in texture, in gingivitis they become red, soft and oedematous, and they bleed on brushing. At this stage there is not yet any destruction of the supporting tissues of the tooth, and a dental cleaning combined with good oral hygiene resolves the problem.

Particular mention should be made of pregnancy gingivitis. This is the marked inflammation of the gums that appears mainly in the 2nd and 3rd trimester of pregnancy. Pregnancy modifies the degree of inflammation, and the clinical picture worsens because of hormonal fluctuations. On some occasions, at around the 3rd -4th month of pregnancy, small swellings appear on the gums between the teeth. These «pregnancy tumours» are an intense red colour and can reach a size of up to a few centimetres. The symptoms of pregnancy gingivitis often alarm the expectant mother. A dental cleaning and good oral hygiene are usually enough to deal with the problem. The swellings usually subside partly or completely after childbirth, and it is rarely necessary to proceed to their surgical removal.

What is periodontal disease

In many cases where gingivitis is not treated, it progresses to periodontitis. The gums continue to be red, swollen and to bleed easily, but at the same time the bone supporting the tooth is destroyed. The loss of bone leads to the formation of periodontal pockets, empty spaces between gums and teeth that favour the retention of dental plaque and the formation of calculus. The destructive process intensifies as the pockets gradually become deeper and the number of bacteria and the amount of calculus they contain increases. At the advanced stage of periodontitis most of the bone supporting the tooth has been lost. The tooth shows increased mobility and eventually has to be removed. Periodontal disease is the main cause of tooth loss in those aged over forty. In this age group, one in three people suffers from some form of the disease.

Because its progression is slow, however, and is not accompanied by particularly marked symptoms, many people are unaware of their problem.

Periodontitis and general health

The bacteria of the periodontal pockets, and of the oral cavity more generally, pass into the bloodstream during brushing and can cause damage to other organs of the body. Recent research has linked periodontal disease with an increased incidence of cardiac problems and preterm births, as well as with the worsening (poorer control) of diabetes mellitus.

Periodontal treatment can halt the course of the disease, stabilise the condition and restore the mouth to health, avoiding tooth extractions and the problems that arise from them. As regards diabetes mellitus in particular, it has been found that a reduction in glycaemic levels is observed after periodontal treatment.

How gingivitis and periodontitis are prevented

Correct brushing 2 times/day and the use of dental floss or an interdental brush of the appropriate size prevent the accumulation of dental plaque. However, certain areas of the mouth are hard to reach and dental plaque inevitably collects there, calcifies and forms calculus (tartar), which is difficult to remove with a toothbrush and at that point can only be removed by the dentist.
For this reason, preventing periodontal disease requires regular visits to the periodontist for examination and scaling (cleaning) of the teeth. The frequency of visits varies from case to case, but it is advisable that they take place at least twice a year.

Non-surgical periodontal treatment

Non-surgical periodontal treatment is a «deep cleaning» carried out on the gums using ultrasonic and hand instruments, after local anaesthesia has been given in the area. The aim is the removal of bacteria, food debris and calculus (tartar) from the surface of the teeth and from the periodontal pocket, so that it can heal. Two appointments are usually required, since one half of the mouth is treated at each appointment. In certain cases, however, four appointments may be needed, if one quadrant of the mouth is treated at each appointment.

After non-surgical treatment we expect a reduction or even elimination of bleeding from the gums, a reduction in the mobility of the teeth, a reduction in the depth of the periodontal pockets, and an improvement in the colour and texture of the gums.

It is not a painful procedure, and if there is minor irritation of the gums in the first few days after treatment, this is managed with simple painkillers. A relatively common side effect of the treatment, however, is increased sensitivity of the teeth to cold and hot stimuli, owing to the removal of calculus from the surface of the teeth, which subsides within a few days.

Approximately 6 weeks after the end of non-surgical treatment, a further appointment takes place, at which the healing of the periodontal lesions is assessed and the patient then moves into the supportive therapy phase. In some cases of advanced problems, however, it may be necessary to proceed to surgical periodontal treatment.

Surgical periodontal Treatment

Surgical periodontal treatment is applied to usually isolated teeth with an advanced periodontal problem. Its aim is to improve access for the removal of bacteria and calculus (tartar), while in some cases it may also be accompanied by an attempt to regenerate the lost tissues (bone - gum regeneration) using bone grafts and resorbable barrier membranes.

Supportive therapy – Maintaining the result

After the end of periodontal treatment, and in order to achieve stabilisation of the periodontal condition, supportive therapy is required. This consists of regular review appointments, which in the first year after treatment are scheduled every 3-4 months, and at which a simple cleaning is carried out to maintain the result of the treatment. If the patient follows the oral hygiene instructions faithfully and the condition of the mouth remains stable, from the 2nd year the appointments become less frequent and are scheduled every 6 months. It is a very important process, because those who do not follow a supportive programme after treatment have an increased likelihood of recurrence or worsening of periodontal disease.