Gum disease can be plaque and bacteria related or it may be non-bacteria related.
Gum disease can be plaque and bacteria related or it may be non-bacteria related.
In this category, plaque bacteria are the main cause of gum disease:
When bacteria dominate the gum tissue around your teeth and as a result the gum becomes inflamed, this is called gingivitis. This inflammation is a natural defence mechanism from your body. It should be considered a signal that your body is giving, alerting you that you are under attack from bacteria.
There are signs and symptoms that you should watch for when suspecting gingivitis. One or a combination of one of these signs and symptoms may indicate gingivitis:
While bacteria are the primary cause of gingivitis, there are other factors that can contribute to its development, such as:
Gingivitis is usually reversible with proper treatment. However, if left untreated, it can progress to a more serious condition called ‘Periodontitis’.
When gingivitis progresses and is not treated, the bacterial invasion leads to deeper inflammation in the gum. This leads to the supporting bone of the tooth getting affected. When this bacterial invasion dominates, the consequence is resorption and recession of the bone around the tooth.
Depending on the location and extent of the bacteria present deep at the gum line, the whole circumference of the bone may be affected or it can be localised to a smaller region around the tooth. As the bone recedes, the gum around the tooth follows suit.
The gum that is well attached to the root surface and lying over the bone, becomes detached from the tooth in the deep areas, this is when a periodontal pocket is formed. That is loose gum around the root of the tooth.
When the bone resorption (bone loss) around the tooth/root reaches a threshold, the tooth can gradually become mobile. The final consequence of periodontitis is severe bone loss and eventual loss of teeth.
Unfortunately, the disease process is usually painless. Therefore, periodontitis remains relatively silent for quite a long time until it may be too late.
The general signs and symptoms of periodontitis are the same as gingivitis. In addition there may be some other additional signs and symptoms that could be good indicators for periodontitis, these include:
From literature, we now know that there are certain factors that may make some people more susceptible to periodontitis, these include but are not limited to:
There is good evidence in literature supporting a poorer immunity response from bacterial attack in diabetics. This is particularly more pronounced in uncontrolled diabetes. Even short periods of glucose fluctuation may have an impact on progression of gum disease.
Stress is one of the factors affecting your immune response. Individuals may harbour periodontal pathogens and chronic stress may lead to compromised subclinical poor immune responses against bacteria, leading to the initiation and progression of gum disease.
The ultimate cause of periodontitis is bacteria. Even in the absence of any other risk factors, chronic poor oral hygiene can lead to the development of periodontitis.
There is substantial evidence that show low levels of Vitamin D can be a contributing factor to the progression of periodontitis. Vitamin D has a strong role in immune response and its deficiency can compromise ones defence against bacteria.
While good personal oral hygiene can eliminate most of the plaque bacteria from the surface of teeth, there is always a thin plaque bacteria accumulation around the gum line. These are the areas that are difficult to clean by individuals. Therefore, professional scaling and cleaning of teeth is required on a regular basis. Ideally, and for those with no history of periodontal disease, the interval should be 6 monthly. This interval is usually shorter when active periodontal disease is present and also after treatment in susceptible individuals.
For example, the presence of multiple cavities on teeth can be a constant bacteria trap. This leads to bacteria growing constantly without being disturbed. Similarly, if dental fillings or a denture is made in a way that appropriate brushing is not possible, those sites will be at high risk of developing gum disease.
In this category, bacteria have no role in occurrence of the gum disease. The presentation of gum disease may be different than gingivitis. The causes include: