Anatomy
Periodontal literally refers to the structures anchoring the teeth to the jaw bone. Peri means around and odontal refers to the teeth in Greek.
There are four connected elements which make up the structures of the periodontal tissues:
- The root surface of each tooth
- The sulcus where the gums meet the tooth at the neck of the tooth
- The periodontal ligament directly covering the root of the tooth
- The bone surrounding and encapsulating the tooth
This is an unique environment forming a boundary protecting the interior of the body (the bone for example) and the outside (the mouth). Dentists and doctors consider the mouth or the oral cavity to be an external environment.
Healthy gums
Pink in colour with a firm consistency and a smooth contour. Probing depth measurements are 1-3mm deep. Bleeding and suppuration are absent. Maintenance is still required to prevent infection and deterioration.
The effects of oral bacteria
Oral bacteria do not behave in the same manner as bacteria on the skin or in the gut. They exist in a community and they are found everywhere in the mouth on both soft tissues and hard surfaces. They coat the surfaces of your teeth, fillings, dentures and gums. They exist in a biofilm environment when they stick to the hard surface of a tooth. They can only be removed by physical methods or ablation. Mouth rinses will not remove the bacteria.
It is important to understand the behaviour of oral bacteria and how they cause disease in order to understand your treatment plan and your aftercare instructions.
Oral bacteria residing at the sulcus level will invade and cause infections of the gums if they are not removed periodically. Some individuals are more susceptible than others. There are lifestyle and medical conditions which can lead to more severe or extensive disease. For successful treatment outcomes all such factors should be addressed as well as carrying out treatment procedures. Untreated severe periodontal disease can eventually lead to the loss of the gum attachment and the jaw bone affecting the survival of the tooth.
Common diseases and anatomical aberrations of the gums
Gingivitis
Infection and inflammation affecting only the superficial layers of the gum tissues. This is easily managed with an improvement in daily toothbrushing skills and professional visits with your dentist or hygienist.
Periodontitis
Infection and inflammation affecting the deeper structures of the periodontal tissues. Here the patient requires professional care as it is not possible for the bristles of the toothbrush to reach into the deep areas to clean out the locus of infection. The gums peel and separate from the roots of the teeth and unzips forming a pouch. The diseased roots are now exposed to saliva and bacteria.
You may have had periodontitis for many years without realising it. Warning signs of disease may include:
- Splayed or drifting of the upper front teeth
- Bad breathe or halitosis
- Wobbly teeth
- Bleeding gums when you are brushing or eating
- Receding gums
- Red swollen gums
- Any change in the fit of partial dentures
- Any change in the way your teeth fit when you bite
If you are aware of these symptoms please contact us or your dentist. Not everyone has has symptoms. Often the disease is discovered during a regular dental check up or visit with your hygienist.
Pain or discomfort is often a very late feature of the disease when the patient is about to lose a tooth.
How do we gauge the severity of the disease?
We gently insert a periodontal probe into the sulcus to measure the depth of the periodontal pouch. Probing depth measurements of 4-6 mm indicate moderate disease. Measurements of 7mm or more indicate severe disease and at this level the tooth anatomy is generally a lot more irregular thus requiring specialist care. In context the average root is approximately 10-12 mm long. The disease is detected when your dentist or hygienist slides the periodontal probe into sulcus during a screening check of your gums during a routine visit.
Untreated or uncontrolled periodontitis will eventually progress to the loss of the affected tooth.
It is estimated that approximately 50% of adults in the United States aged 30 years old or older have some form of periodontitis, about 40% have moderate to severe disease. The findings are from the 2009-2010 NHANES study using a full mouth methodology. Click here to take you to the study abstract.
Click here to watch a short film of the effect of periodontitis from a patient's perspective.
Gum recession
The gums have stripped away and the root surfaces are visible and naked. This can occur due to a variety of factors but the most common reasons are toothbrushing trauma and/or gum infections.
Excess gums
Occasionally a tooth may be covered with too much gums.
Pigmented gums
Some patients dislike the brown colour of their gums which may be quite intense.
Irregular gum contours
Uneven gum and tooth shapes are difficult to keep clean making such areas prone to infections. Sometime they may affect the appearance of your smile.
Mouth ulcers
These can be very sore and painful. Some will heal quickly but some requires a co-ordinated management plan in conjunction with your doctors.
Treatment sequence
Non-surgical care often precedes periodontal surgery as so that the gum tissues are in a better state at the time of surgery for the most optimum treatment outcome. The gums will not heal in the presence of a large amount of infection. (For patients who require surgery and who are biologically ready for surgery at the time of initial consult, we will offer surgery directly.)