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Periodontal (gum) diseases such as gingivitis and periodontitis are infections that must be treated as they can result in tooth loss if ignored. They arise when the bacteria in plaque causes the gums to become irritated. Gingivitis is the lesser of the two and, while causing little discomfort, can be identified when your gums become red, swollen and bleed easily. Left untreated, gingivitis can develop into periodontitis where plaque spreads and grows underneath the gum line and the toxins produced by the bacteria irritate the gums. Gums become detached from the teeth and form infected pockets which develop as the disease progresses, destroying gum tissue and bone which, in turn, causes teeth to become loose and require extraction.
Inadequate oral hygiene is often the cause of gingivitis but it is reversible with proper dental treatment and good oral attention at home. Non-surgical treatment includes scaling and root planing (cleaning of the root surfaces), antimicrobials and host modulation. If the tissue around your teeth is not responding effectively to non-surgical treatment, you will need periodontal surgery to correct this.
In the first phase of your treatment, special instruments will be used to carefully and thoroughly clean (debride) and polish each tooth and its root surfaces. The aim is to clean deep below the gum line and remove all deposits, right to the base of the gum pocket. This is usually completed over several appointments using local anaesthetic to minimize discomfort.
After a healing period of several weeks, you will be required to return for a review appointment to assess your response to the initial treatment. There can be great variation between individual‘s reactions to periodontal treatment, due to the different inflammatory responses to plaque and calculus within the population. Occasionally (less than 10% of the time), the areas of inflammation do not respond to scaling and root planing. In these instances, gum access surgery may be required to allow deeper access and visual observation of the root surface, and facilitate the removal of plaque and calculus.
Given your susceptibility to gum disease, you will always be at risk of further periodontal destruction. As such you will require gum assessments for the rest of your life. Any treatment we undertake will not change your body’s inflammatory reaction to the presence of plaque, and thus we can never fully ‘cure’ your gum disease. However, if all the plaque or calculus is removed, there can be no inflammatory response, thus it is possible to maintain the health of your teeth and gums for the long term.
Regular reassessment visits are essential for people with periodontal disease. With continual monitoring, we can prevent the recurrence of periodontal disease in areas where plaque is inadvertently left on the teeth. Eventually a regular interval will be established which is best optimised for you to maintain your gums free of plaque and bleeding. This will be shared between your general dentist and our periodontal clinic.
Dr Khai Nguyen is CARE Dentistry’s resident Periodontist. Growing up in Sydney, Dr Nguyen completed his Bachelor of Dental Surgery and Doctorate in Clinical Dentistry (Periodontics) at the University of Sydney. He is also a Fellow of the Royal Australasian College of Dental Surgeons in the specialist stream of Periodontics.