Periodontal disease

Maintaining high standards of oral hygiene at times can be a challenge for some maxillofacial patients, for a number of reasons. However, poor oral hygiene is the primary cause of periodontal disease (gum disease) and, in consequence potential loss of teeth. Understanding this correlation can be a powerful motivation to make an effort to maintain good oral hygiene, particularly if one is likely to need to undergo surgery of the mouth or jaws.

Teeth are held in the jaw bone by tiny ligaments, known as periodontal ligaments. These ligaments act like springs around a trampoline, connecting the bone and the cementum (outermost layer) of the tooth root. This means that teeth are slightly springy, moving a very small amount when biting or chewing. Throughout the day, bacteria build up on the teeth, forming a film known as plaque. If this is not cleaned off properly with a toothbrush, it can move underneath the gum line and start damaging the ligaments.

At first, the bacteria can make the gums inflamed, leading to bleeding during brushing, flossing and professional cleaning. In the early stages, this is reversible and known as gingivitis. The damage can be repaired by improving oral hygiene.

If not dealt with at an early stage, gingivitis can progress to an irreversible form of the disease known as periodontitis (gum disease). Periodontitis is established when the ligament is damaged and it forms a ‘pocket’ in which more bacteria can collect, causing damage deeper and deeper down the side of the tooth. In health, the gap down the side of the tooth is less than 2mm, anything more than this could be considered as damage, which can be very difficult to access and clean with a toothbrush. As more and more ligaments are damaged irreversibly, the tooth may become loose and eventually be unsalvageable. Infection is also likely in these sites, because bacteria can grow and survive there undisturbed. Sometimes there are no symptoms. Periodontal disease is the major cause of tooth loss or removal in the developed world. A similar process can affect dental implants known as peri-implantitis.

At this stage, professional cleaning is essential. The purpose of professional cleaning is to access inside the ‘pockets’ with special instruments that can reach where a toothbrush at home may not. The bacteria are cleaned off the root of the tooth, effectively giving a ‘clean slate’ to maintain at home. Whilst the damaged ligaments cannot be replaced, professional cleaning (also known as root surface debridement) can help slow down the progression of the disease. The important thing to understand though, is that the key to stopping periodontal disease getting worse is daily cleaning at home. For some people surgery can be an option to help manage the disease.

Factors that increase the risk of getting gum disease include smoking, diabetes (in fact, most diseases that supress or make the immune system overactive can manifest as gum disease) and poor oral hygiene. Women find their gums bleed and become more swollen during pregnancy.

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