Gum Disease; Causes, Diagnosis, and Treatment Blog

28 September 2016

Gum Disease

Gum disease is a broad term that most people use when describing the inflammation of the gums. What most people do not know is that gum disease can actually be divided into two parts; Periodontal Disease (Periodontitis), and Gingivitis. Continue reading on more information on these two conditions, as well as their causes, diagnosis, and treatment.


Gingivitis is the most common form of gum disease; it is usually caused by a lack of brushing and flossing. The gums become swollen, red, and irritated, and may cause pain or sensitivity in the mouth. Gums will bleed easily when touched, especially when attempting to floss or brush. Gingivitis is common and completely reversible with proper professional dental cleanings and good home care. However, if left untreated, Gingivitis can turn into Periodontitis, or Periodontal Disease.

Periodontal Disease (Periodontitis)

Periodontitis, or Periodontal Disease, is an advanced form of Gingivitis. When Gingivitis is allowed to progress and the patient does not return for their routine cleanings and does not maintain proper home care, they develop Periodontal Disease, which is caused by bacteria in the mouth and under the gums. Patients with a large buildup of bacteria usually have large amounts of calculus in their mouth, which is essentially plaque that has hardened due to the excess amount of bacteria. In some cases, the Periodontitis escalates to such a point that the bone has recessed, and the teeth are held in place only by the calculus in the mouth.

Symptoms of Periodontal Disease:

  • Considerable bleeding of the gums, even when untouched.
  • Deep pockets between tooth and gum
  • An unpleasant smell
  • Looseness of teeth
  • Recession of gums
  • Discomfort and pain in teeth and gums
  • Large amounts of calculus buildup

When left untreated, the bacteria begins to eat away at the bone. The pockets, or spaces between the gum and the tooth, are measured by a Dental Hygienist in order to determine the severity and progression of the Periodontitis. This is often referred to as Perio Charting.

Depending on the diagnosis, a deep cleaning, or “scaling”, is recommended for the patient. Rather than returning for a cleaning every six months, patients with Periodontal Disease return for their scaling. During this deep cleaning, antibiotics are placed underneath the gums to stop the growth of bacteria. Due to the amount of time required for scalings and placement of antibiotics, scalings tend to be more expensive than normal cleanings. This deters many people from coming in and getting their scalings done. Many do not understand the difference between the two, and ask to have a regular cleaning done. It is not uncommon for dentists or dental hygienists to refuse to do this, though do not be alarmed; this is not your dentist choosing not to help you. It is quite the opposite. In refusing to do anything but a scaling on someone, dentists and dental hygienists are looking out for the patient’s health. A normal cleaning will do nothing to prevent the progression of Periodontitis.

It is important to remember that while Periodontitis can be treated to prevent its progression, it cannot be reversed, unlike Gingivitis. It is important to maintain scalings and antibiotic placement. If the condition is allowed to worsen, tooth loss is imminent, as the weakened and recessed bone becomes unable to hold the teeth in place.

Causes of Periodontal Disease:

  • Failure to brush or floss adequately; improper home care
  • Progression of gingivitis
  • Smoking (and other use of tobacco products)
  • Genetic predispositions
  • Diabetes
  • Chemotherapy
  • Excessive use of prescription medications

There have&

Covid-19 and your care

We have now received clear guidance as to what dental procedures we can safely carry out and at what stages during the pandemic.

Below is a summary of the guidance as we understand it, although this may modify over the next few days as some small inconsistencies are clarified.

The government has set five different risk levels for the pandemic 1-5 (low to high), although this changes on a daily basis.

The treatments that we can carry out safely in dental practice will change with the risk level.

Treatments are significantly limited at level 4.

During the next few weeks, we will attempt to contact each patient that has contacted us with a significant dental problem during lockdown, and we hope to book an assessment appointment for those patients in the week commencing 8th June.

Practice doors will be locked at level 3, 4 and 5. Entry to the practice will be limited to pre-booked appointments.

There will be very clear criteria provided in due course as what is required before arriving at the practice, and what the procedure will be upon arrival. We will endeavour to ensure that each person knows exactly what to expect at their visit as this will be quite different to what you have been used to.

The appointment diary will be structured to take into consideration those patients who are shielding, may have underlying medical issues and so on.

The first week is expected to be a slow start as we ensure that the new protocols are working effectively for everyone’s safety. These protocols will be audited and modified until required.

At level 4 we should be able to carry out the following:

Dental assessment (initially restricted to patients who have current urgent need, or did and contacted us during lockdown).

X rays but only for patients who tolerate them well.

TEMPORARY re cementation of crowns. (We cannot dry the tooth effectively enough to cement a crown permanently with the restrictions we face).

Fabrication or repair of removable dentures.

Simple dental extractions. If a tooth breaks, it is probable we will have to leave the roots in place until we are at a lower level of risk. Naturally, we will assess the risk very carefully prior to treatment.

Tightening of loose dental implants if possible, without using a high-speed handpiece (drill).

Temporary fillings.

Draining of a swelling/abscess.

Provision of antibiotics.

Trimming of sharp orthodontic wires (not reliable re cementation of loose brackets, or replacement of missing brackets).

Treatment is only to be offered after careful assessment.

Cosmetic orthodontics

Cheshire Dental Centre provide many of these treatments. We may now be able to progress some of our Quick Straight Teeth cases. We will be in touch with each patient shortly, but please allow us to contact you; we hope that it is understandable that we will be prioritising patients with urgent dental need.

The PPE (personal protective equipment) requirements for the above are not too onerous, and we will not look too different to normal. As you are aware, the cross-infection control at Cheshire Dental Centre has always been exemplary and one of our top priorities.

Although we have been organised with the new PPE guidelines well in advance there may be the occasional time where we are awaiting stock. All practices are attempting to source the necessary PPE we need to keep you and us safe, but supplies are scarce and consequently very expensive.