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Overview of Gum disease

 

Gum disease or periodontal disease is the inflammation of the tissue supporting and surrounding the tooth. The teeth are held in the mouth by the root, which is embedded in your jawbone. The roots are connected to the bone by hundreds of thin “elastic threads” called periodontal ligament. The bone is covered by the gum, also called gingiva, which is attached to the bone thru periosteum. The top part of the gum (gingival crest) next to the tooth is not attached forming a little pocket, which should measure less than 1 mm in the healthy individual.

 

In order to successfully treat periodontal disease or gum disease we have to understand the reasons of the disease.  Our oral cavity is always populated by bacteria even in the healthiest individuals.  It takes a 24-hour period for these harmless bacteria to turn pathogenic and cause periodontal inflammation.  This inflammtion will lead to gum disease.

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 If the teeth and gums are not properly cleansed, then the remaining bacteria along with the food remnants will build on the tooth and below the gum. This bacterial build up is called plague. Bacterial plaque, a sticky, colorless film that constantly forms on your teeth, is the main cause of gum inflammation and periodontal disease. Plaque is not just food debris. it contains millions of bacteria and very toxic in its nature. As plaque builds, it becomes calcified and hard and dental calculus (tartar) appears, depositing on the teeth. Tartar build up spreads below the gum, destroying bone and ligaments supporting the tooth.
Dental pockets (periodontal pockets )start to develop.

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The pockets (empty space defined by the root of the tooth, the level of the bone and the top edge of the gum) appear. These pockets trap the bacteria and plaque, and are the perfect incubators for it, leading to the progression of gum inflammation disease and gum disease


The deeper the pockets, the harder for you to clean out the food debris. More plaque builds up, leading to more tartar and calculus, the bacterial count in hundreds of millions, gum inflammation progresses.

The gum inflammation increases. Your body starts to produce special enzymes in response to the bacteria to combat the onset of gum disease. These enzymes are trying to fight the bacteria, but along with bacteria it also starts to destroy the bone surrounding the teeth.

X-ray showing calculus and bone lose on both left and right sides of the mouth

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Gum disease symptoms

Gum disease symptoms include

  • Bleeding gums during brushing
  • Red, swollen or tender gums
  • Bad breath or bad taste in the mouth
  • Tartar or calculus build up on the teeth
  • Receded gums, teeth may look elongated
  • Discharge from the pockets around the teeth
  • Teeth that seem loose or have changed position
  • Teeth that are sensitive to cold or hot
  • Changes in your bite or the way they fit


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Stages of Gum Disease
 
If left untreated, gum disease progresses thru different stages, causing more and more destruction, and making each next step more difficult to treat. The following illustrations, courtesy of OralB company shows the diagrams of gum disease development.

 

HEALTHY GUMS

  • Firm and light pink
  • Hug the teeth tightly
  • Don't bleed when brushed
  • Pocket depth when measured is no more than 2mm

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HEALTHY GUMS

  

 

 

 

 

 

GINGIVITIS

First stage of periodontal disease which involves soft tissue only: bone has not been affected at this point.

  • Gums bleed when brushed or probed
  • Inflammation and redness present
  • Possible bad breath

 

 

 

 

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GINGIVITIS

MILD PERIODONTITIS

This is the second stage of periodontal disease where bone starting to get affected

  • The bleeding and swelling is more pronounced
  • Pocket depth reach 3-4mm
  • Bad breath/taste
  • Loss of firmness and texture
  • Bone loss may be evident on x-rays

 

 

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MILD PERIODONTITIS

MODERATE PERIODONTITIS

  • Gum line starts to recede and teeth appear to be longer
  • Sensitivity may appear
  • Abscesses or gum boils may appear
  • Teeth may shift and spaces can form between teeth
  • Redness and bleeding is very apparent
  • Further inflammation and loss of texture
  • Mobility of teeth
  • Pocket depths 4-6mm
  • Significant bone loss is detected with x-ray

 

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MODERATE PERIODONTITIS

ADVANCED PERIODONTITIS

  • All of the above symptoms are very pronounced
  • Pocket depths exceed 6mm
  • Severe mobility and bone loss
  • Possible need for extractions 

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ADVANCED PERIODONTITIS

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