Gum Health (Periodontal Health)


What is gum disease?

Gum diseases, including gingivitis and periodontitis, are serious infections of the gums, which if left untreated can lead to tooth loss. The word periodontal literally means "around the tooth." Periodontal disease is a bacterial infection that affects the gums and the bone supporting the teeth. Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque causes the gums to become inflamed.



What is a Periodontist?

A periodontist is a dentist who specialises in the prevention, diagnosis, and treatment of periodontal disease, and in the placement of dental implants. Periodontists receive extensive training in these areas, including three additional years of education beyond dental school. They are familiar with the latest techniques for diagnosing and treating periodontal disease, and are also trained in performing cosmetic periodontal procedures.


Diagnosis of gum disease

City Dental ClinicYour periodontist, dentist or dental hygienist diagnoses periodontal disease during a periodontal examination. This type of exam should always be part of your regular dental check-up. A periodontal probe (small dental instrument) is gently used to measure the pocket or space between the tooth and the gums.


The depth of a healthy pocket measures three millimeters or less and does not bleed. As periodontal disease progresses, the pockets usually get deeper. The pocket depths, amount of bleeding, inflammation, tooth mobility, etc. to make a

diagnosis that will fall into a category below.


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Types of gum disease


Gingivitis is the mildest form of periodontal (gum) disease. It is often caused by inadequate oral hygiene, which leads to plaque buildup.

Other factors that may contribute to gingivitis include diabetes, smoking, systemic diseases and conditions, stress, inadequate nutrition, puberty, hormonal fluctuations, pregnancy, HIV infection, and the use of certain medications.

The bacteria in dental plaque irritate the gums and cause infection. When your body launches an immune response against these invaders, the gums become inflamed. People with gingivitis usually experience little or no discomfort. Therefore, it is important to recognize the symptoms, such as gums that are red, swollen or bleed easily. Gingivitis is reversible with professional treatment and good home oral care. However, if gingivitis is left untreated, it can advance to periodontitis.


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Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.


There are many forms of periodontitis. The most common ones include:

Chronic periodontitis: results in inflammation within the supporting tissues of the teeth followed by progressive loss of periodontal attachment and bone. This is the most frequently occurring form of periodontitis and is characterized by pocket formation and/or recession of the gingiva (gum). It is prevalent in adults, but can occur at any age. Progression of attachment loss usually occurs slowly, but periods of rapid progression can occur.

Aggressive periodontitis: occurs in patients who are otherwise clinically healthy. Common features include rapid attachment loss and bone destruction, and familial aggregation (seen in other family members).

Signs of gum disease

Gum disease is often silent, meaning symptoms may not appear until an advanced stage of the disease. However, warning signs of gum disease include the following:

  • Red, swollen or tender gums or other pain in your mouth
  • Bleeding while brushing, flossing, or eating hard food
  • Gums that are receding or pulling away from the teeth, causing the teeth to look longer than before
  • Loose or separating teeth
  • Pus between your gums and teeth
  • Sores in your mouth
  • Persistent bad breath
  • A change in the way your teeth fit together when you bite
  • A change in the fit of partial dentures

Maintaining healthy gums

Oral hygiene instruction is helpful and educational information meant to teach and guide our patients to prevent new cavities, and to maintain healthy teeth and gums. Your periodontist, dentist or hygienist will instruct you on the proper methods of brushing and flossing. At your follow up visits, we will further monitor your progress in maintaining good oral health, and help review and reinforce techniques of cleaning at home.


The following are some of our recommendations:



Brush your teeth twice a day and use a soft bristled toothbrush (safer on your gums) with a fluoride toothpaste. Direct the bristles towards the gum at a 45 degree angle and use a circular motion that moves the brush bristles ‘away’ from the gums. On the top arch, this would mean you are brushing in a circular direction which is top-down and on the bottom arch, you would be brushing in a bottom-to-top circular motion. Concentrate on 1-2 teeth at a time and repeat the process until all the front and back surfaces of the teeth have been cleaned. Finally, brush the chewing surfaces of the teeth with a horizontal motion. Take care to not speed through brushing, taking at least 2-3 minutes to do a thorough job and don't brush too hard because this can cause gum recession. Replace your toothbrush as soon as the bristles are worn or splayed as they become less effective at that stage. This is usually after about three months.


If you are using an electric toothbrush, angle the bristles at 45 degrees to the gum line. There's no need to scrub. Hold the brush in position and after a few seconds sweep the bristles away from the gum. Repeat around the outer and inner surfaces of all teeth, finishing with the chewing surfaces.



You can clean between your teeth with dental floss, interdental brushes or tape. Dental tape is slightly thicker than floss and many people find it easier to use. Flossing removes plaque and food particles from between your teeth and under the gumline, areas a toothbrush can’t reach. You should clean between your teeth at least once a day with floss.


The following suggestions may help:

  1. Break off about 30cm of floss, and wind most of it around one of your middle fingers. Wind the remaining floss around the middle finger of your other hand. As you use the floss, you will take up the used section with this finger.
  2. Hold the floss tightly between your thumb and forefingers, with about an inch of floss between them, leaving no slack. Use a gentle ‘rocking’ motion to guide the floss between your teeth. Do not jerk the floss or snap the floss into the gums.
  3. When the floss reaches the gumline, curve it into a C-shape against one tooth until you feel resistance.
  4. Hold the floss against the tooth. Wipe the tooth from base to tip two or three times. Repeat on the other side of the gap, along the side of the next tooth.
  5. Don’t forget the back of your last tooth.


When flossing, keep to a regular pattern. Start at the top and work from right to left, then move to the bottom and again work from right to left. This way you’re less likely to miss any teeth. At first it also helps to look in the mirror. The order in which you brush and floss doesn't matter as long as you do each thoroughly.



Interdental Brushing

The interdental brush is used to clean in between your teeth. Used at least once daily, it removes plaque and food debris where your toothbrush cannot reach. Turning the brush on insertion will help access. Move the full length of the brush in and out a few times in each space. For spaces at the back of the mouth, bend the brush in a slight curve. This will help you access the more difficult-to-reach areas. Different colour-coded sizes are available to help clean different sized spaces. Do not force the brush in to a space. Guide it in gently or use a smaller size. Change the brush when the filaments are worn.



Use either a fluoride or antiseptic rinse as directed by your periodontist or hygienist.


Twice-daily brushing and regular flossing are excellent for maintenance between dental visits, but a healthy mouth and beautiful smile require routine general and preventive care to stay that way. Our Clinic offers hygiene care that includes regular oral examinations and cleanings.

Gum disease and the relationship with systemic conditions

Research has shown that periodontal disease is associated with several other diseases. For a long time it was thought that bacteria was the factor that linked periodontal disease to other disease in the body; however, more recent research demonstrates that inflammation may be responsible for the association. Therefore, treating inflammation may not only help manage periodontal diseases but may also help with the management of other chronic inflammatory conditions.

1. Gum disease and diabetes
Diabetic patients are more likely to develop periodontal disease, which in turn can increase blood sugar and diabetic complications.

People with diabetes are more likely to have periodontal disease than people without diabetes, probably because people with diabetes are more susceptible to contracting infections. In fact, periodontal disease is often considered a complication of diabetes. Those people who don't have their diabetes under control are especially at risk.

Research has suggested that the relationship between periodontal disease and diabetes goes both ways - periodontal disease may make it more difficult for people who have diabetes to control their blood sugar.

Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. This puts people with diabetes at increased risk for diabetic complications.


2. Gum disease and cardiovascular disease
Several studies have shown that periodontal disease is associated with heart disease. While a cause-and-effect relationship has not yet been proven, research has indicated that periodontal disease increases the risk of heart disease. Scientists believe that inflammation caused by periodontal disease may be responsible for the association. Periodontal disease can also exacerbate existing heart conditions. Patients at risk for infective endocarditis may require antibiotics prior to dental procedures. Your periodontist and cardiologist will be able to determine if your heart condition requires use of antibiotics prior to dental procedures.

Additional studies have pointed to a relationship between periodontal disease and stroke. In one study that looked at the causal relationship of oral infection as a risk factor for stroke, people diagnosed with acute cerebrovascular ischemia were found more likely to have an oral infection when compared to those in the control group.


3. Gum disease and respiratory disease

Research has found that bacteria that grow in the oral cavity can be aspirated into the lungs to cause respiratory diseases such as pneumonia, especially in people with periodontal disease.

Gum disease and pregnancy

Your teeth and gums can be affected by pregnancy, just like other areas of your body.  Most commonly, pregnant women can develop gingivitis, or pregnancy gingivitis, beginning in the second or third month and can increase in severity through the eighth month of pregnancy. During this time, some women notice swelling, bleeding, redness, or tenderness in the gum tissue.

If you are pregnant, or planning to become pregnant, you need to know that your periodontal health may affect the pregnancy and ultimately the health of your baby. Pregnant women who experience periodontal disease during their pregnancies may be twice as likely to develop preeclampsia.  Additionally, studies have suggested that women who experience periodontal disease during pregnancy may be at risk of having a premature or low birth weight baby. The good news is that researchers are making strides to find out exactly how periodontal disease affects pregnancy outcomes. Some studies have suggested that treating periodontitis during pregnancy may reduce the risks of a preterm birth. Preventing gum problems from developing during the stresses of pregnancy also appears to be important in improving the health of mother and baby.If you are already pregnant and have been diagnosed with periodontal disease, treatment by your dental professional may reduce your chances of having a preterm, low birth weight baby. Talk to your dentist or periodontist for more information. If you’re considering pregnancy, it’s a good idea to include a periodontal evaluation as part of your prenatal care. 


Treatment options for gum disease

Non-surgical therapy
Periodontal health is often accomplished through non-surgical periodontal treatment, including scaling and root debridement (a careful cleaning of the root surfaces to remove plaque and calculus [tartar] from deep periodontal pockets), followed by adjunctive therapy, as needed on an individual basis. Most periodontists would agree that after scaling and root debridement, many patients do not require any further active treatment. However, the majority of patients will require ongoing maintenance therapy to sustain health. Non-surgical therapy does have its limitations, however, and when it does not achieve periodontal health, surgery may be indicated to restore periodontal anatomy damaged by periodontal disease and to facilitate oral hygiene practices.


Periodontal surgery
Your bone and gum tissue should fit snugly around your teeth. When you have periodontal disease, this supporting tissue and bone is destroyed and pockets develop. Eventually, if too much bone is lost, the teeth will need to be extracted. If you're diagnosed with periodontal disease, your periodontist may recommend periodontal surgery. Periodontal surgery is necessary when the tissue around your teeth is unhealthy and cannot be repaired or stabilized with non-surgical treatment.

Your periodontist has measured the depth of your periodontal pockets. A surgical procedure may be recommended because you have pockets that are too deep to clean with daily at-home oral hygiene and a professional care routine.

During this procedure, your periodontist folds back the gum tissue and removes the disease-causing bacteria, before securing the tissue into place. In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. This encourages the gum tissue to reattach to healthy bone.


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A regenerative procedure may be recommended in selective cases, when the bone supporting your teeth has been destroyed. These procedures can reverse some of the damage by regenerating lost bone and tissue. During this procedure, the gum tissue is folded back and the disease-causing bacteria are removed. Membranes, bone grafts or tissue-stimulating proteins can be used to encourage your body's natural ability to regenerate bone and gum tissue.


Cosmetic gum procedures

In addition to procedures to treat periodontal disease, periodontists also perform cosmetic procedures to enhance your smile.


Crown lengthening
Periodontal procedures are available to lay the groundwork for restorative and cosmetic dentistry and/or to improve the aesthetics of your gum line. You may have asked your periodontist about procedures to improve a "gummy" smile because your teeth appear short. Your teeth may actually be the proper lengths, but they're covered with too much gum tissue. To correct this, crown lengthening may be performed. During this procedure, excess gum and bone tissue is reshaped to expose more of the natural tooth. This can be done to one tooth, to even your gum line, or to several teeth to expose a natural, beautiful smile. Your dentist may also recommend crown lengthening to make a restorative or cosmetic dental procedure possible. Perhaps your tooth is decayed, broken below the gum line, or has insufficient tooth structure for a restoration, such as a crown or bridge. Crown lengthening adjusts the gum and bone level to expose more of the tooth so it can be restored.


Before Crowns After Crowns





Soft tissue grafting
Exposed roots are the result of gum recession. Perhaps you wish to enhance your smile by covering one or more of these roots that make your teeth appear too long. Or, maybe you're not bothered by the appearance of these areas, but the exposed roots are sensitive to hot or cold foods and liquids. Your gums may have receded for a variety of reasons, including aggressive tooth brushing or periodontal disease. You may not be in control of what caused the recession, but prior to treatment your periodontist can help you identify the factors contributing to the problem. Once these contributing factors are controlled, a soft tissue graft procedure will repair the defect and help to prevent additional recession and bone loss.
Soft tissue grafts can be used to cover roots or develop gum tissue where absent due to excessive gingival recession. During this procedure, your periodontist takes gum tissue from your palate or another donor source to cover the exposed root. This can be done for one tooth or several teeth to even your gum line and reduce sensitivity.


Before Crowns After Crowns






Ridge augmentation
Sometimes when you lose one or more teeth, you can get an indention in your gums and jawbone where the tooth used to be. This happens because the jawbone recedes when it no longer is holding a tooth in place. This "defect" can be filled with a procedure called ridge augmentation, recapturing the natural contour of your gums and jaw. A new tooth can then be created that is natural looking and easy-to-clean.



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