Periodontitis (Gum Disease)
 

What are the Signs and Symptoms of Gum Disease?

To answer this, it is easier if we divide things up into healthy gums, gingivitis and periodontitis.Whilst this is the progression that gum disease takes, it is important to understand that all three can exist in different parts of a single mouth and gingivitis is often superimposed when periodontitis is present.

The features of healthy gums are:

  • Pink
  • Firm
  • Stippling (not always present)
  • Healthy Gum margin – a sulcus of 1-2mm (the groove between the gum and the tooth)
  • No bleeding on brushing or gentle probing.

Signs and symptoms of gingivitis are:

  • Reversible/ visible plaque
  • Bad breath
  • Supra-gingival calculus
  • Bone support unaffected
  • Swollen/ inflamed gums
  • Red
  • Sore gums (not always)
  • Bleeding on brushing and gentle probing
  • Largely aerobic bacteria (grow best in the presence of air).

Signs and symptoms of periodontitis are:

  • Features of gingivitis except loss of support for the tooth (ligament and bone) has occurred
  • Pocket formation- a space next to the tooth of over 4mm
  • Sub-gingival calculus
  • Tooth mobility (later)- loose teeth, or movement of teeth and a change in the way your teeth come together
  • Tooth loss
  • Largely irreversible
  • Largely anerobic bacteria (grow best with out air).

How do I Know I have got Gum Disease?

Your dentist is the best person to see to determine if you suffer from gum disease. If you have any of the signs and symptoms or answer 'yes' to the risk factors that we've discussed, then the likelihood is higher and you should arrange an appointment to be checked and treated if necessary.

How does the Dentist Check for Gum Disease?

The screening process:

At your first appointment and your recall examinations, your dentist will do something called a BPE (basic periodontal examination) or a CPITN (chart of periodontal index of treatment need); they are just different names for the same thing. When a dentist says they are going to check your gums, this is what they are doing- a screening test for gum disease.

The mouth is divided into 6 areas, the front 6 teeth on the top and on the bottom and the back 6 teeth on either side on the top and on the bottom. By gently probing around your teeth (this can be a little sore or sensitive, especially if your gums are swollen), they will record the worst situation for each area using a special probe that has a black band on it to allow them to see if you have any pockets (areas of attachment loss), that need to be investigated further.

This is how they will score your mouth:

0- Means you have a healthy area.

1- Means you have no pocketing, (black band can still be seen fully on the probe) but some bleeding in that area suggesting some plaque is present.

2- If you score a 2, it means you have no pocketing but you do have a plaque retentive factor- that is something that makes cleaning more difficult- such as a build up of calculus, some decay or a poorly shaped filling.

3- If the black coloured band sinks to a point where it is only partly visible in deepest pocket in the area, then it means your gums are swollen and giving this reading, or you may have early gum disease.

4- If the black band disappears fully, this indicates a probing depth of over 6mm. This tells us you have suffered some attachment loss.

* If we award you a star, it means that the amount of recession on your tooth (how much root is exposed) added to the probing depth is over 7mm. So try not to think of being awarded a star in the conventional sense.



If you are interested, ask your dentist… “What are the scores of my BPE?”

If you are mainly 0’s that is excellent.

1’s and 2’s are very common too but indicate room for improvement.

Most people will score a 2 for the build up behind their front lower teeth. Here you have salivary glands under your tongue that turn plaque very quickly into hard calculus (sometimes called tartar) which you cannot remove with a toothbrush; you need to see a dentist to remove it. A similar thing happens near your first molar teeth on the top, because another salivary gland opens here from your cheek.

If you score 0-3’s then routine scaling and oral hygiene is generally all that is needed.

If you score a 4 or * then the dentist will need to do a full periodontal analysis. This is a much more detailed chart, that provides an accurate picture of exactly what is going on with your gums.

Think about it like this, when you are brushing your teeth you can only get the bristles of your brush to clean just under the gum say up to 2mm. That means if you have a 7mm pocket, you have an area of 0.5 cm under your gum, which is not being cleaned every time you brush your teeth.

This ‘pocket’ is full of bacteria, which isn't being removed and therefore multiplies. It is this bacteria that slowly eats away at the support for your teeth, causing more and more damage that can’t be reversed. So when you have a situation where pockets have developed, deep cleaning and monitoring is essential to remove this bacteria and help slow the progress of the disease.

X-rays, of course, also help us identify gum disease.

What X-rays are Necessary? What do they Show?

Two common screening X-rays that allow us to determine if you have some gum disease or periodontitis are:
  • Bitewings. These show us clearly if there has been any early bone loss as well as decay and any plaque retentive factors (things that make cleaning more difficult).

The normal level of bone support for a young healthy adult - this lies just below where the enamel stops (the whiter cap on the top of the tooth) i.e. where the tooth and root join. The further your bone support is down the root i.e. away from this point- the more attachment loss you have suffered and the more severe your periodontal disease.

Dentists classify the level of your disease by the amount of bone that has been lost and where the bone has been lost from. See- How severe is my gum disease.

  • OPG. This provides a great general screening view of the whole mouth and jaws, showing the full extent of all the roots of the teeth- though the quality and clarity of the image isn’t as good as if PA’s are taken. It is sufficient in my opinion for most general dental situations, though certain specialists may like to supplement the view with other X-rays.

  • Peri-Apical X-rays. Bitewings will only show us if there has been a small amount of loss of attachment of your teeth- so it may be necessary, if the disease is more severe to take a full view of the tooth, which this X-ray allows.