Frequently
Asked Questions

Bacterial plaque on the teeth can provoke the inflammation of the gum line, a condition known as gingivitis. The gums (the gingiva) react to the presence of dental plaque by becoming inflamed – and this can happen after only a few days. This inflammation – usually involving reddened or swollen gums – is the body’s response to the bacteria that have been allowed to accumulate on the teeth. Gingivitis is a common inflammation. If optimal oral hygiene at home is practiced and if the bacterial plaque is removed regularly, gums can recover within a few days. However, if gingivitis is not addressed, the symptoms can worsen and lead to the more serious gum disease of periodontitis. During pregnancy, there is an increased tendency for gingivitis because of hormonal changes. Pregnant women should pay special attention to good oral hygiene and see a dentist at an early stage during their pregnancy.

Periodontitis is a gum disease. It is a chronic inflammatory disease that is triggered by bacterial microorganisms and involves a severe chronic inflammation that causes the destruction of the tooth-supporting apparatus and can lead to tooth loss. It can also lead to other health problems. Periodontitis always begins with inflammation of the gums, known as gingivitis. This inflammation – usually involving reddened or swollen gums and bleeding when brushing teeth or biting on food – is the body’s response to bacteria that have been allowed to accumulate on the teeth. This inflammation can then spread to below the gums and along the roots of the teeth. This can cause permanent damage to the tissues (or “periodontal ligament”) around the teeth and to the supporting bone. Teeth start to loosen and can eventually be lost. This can then lead to problems with chewing food and with speaking, as well as causing aesthetic damage to your smile. In many people, this is a gradual process that takes place over many years. However, some young adults have a very active form of the disease, which causes early loosening and loss of the teeth. Around 40 percent of people suffer from periodontitis. Among adults, it is estimated that around 70% of tooth loss is caused by periodontitis. The good news is that – if detected and treated – the process can be halted and gum health can be restored. The word “periodontitis” comes from “periodontium”, which means “surrounding (peri) the tooth (odont)”. The periodontium includes all the components that hold the tooth in the jawbone: the gum (gingiva), the bone, the anchoring fibres, and the anchoring structure on the surface of the root (cementum). In a healthy tooth, the periodontium surrounds the entire root.

Periodontitis is a gum disease. It is a chronic inflammatory disease that is triggered by bacterial microorganisms and involves a severe chronic inflammation that causes the destruction of the tooth-supporting apparatus and can lead to tooth loss. It can also lead to other health problems. Periodontitis always begins with inflammation of the gums, known as gingivitis. This inflammation – usually involving reddened or swollen gums and bleeding when brushing teeth or biting on food – is the body’s response to bacteria that have been allowed to accumulate on the teeth. This inflammation can then spread to below the gums and along the roots of the teeth. This can cause permanent damage to the tissues (or “periodontal ligament”) around the teeth and to the supporting bone. Teeth start to loosen and can eventually be lost. This can then lead to problems with chewing food and with speaking, as well as causing aesthetic damage to your smile. In many people, this is a gradual process that takes place over many years. However, some young adults have a very active form of the disease, which causes early loosening and loss of the teeth. Around 40 percent of people suffer from periodontitis. Among adults, it is estimated that around 70% of tooth loss is caused by periodontitis. The good news is that – if detected and treated – the process can be halted and gum health can be restored. The word “periodontitis” comes from “periodontium”, which means “surrounding (peri) the tooth (odont)”. The periodontium includes all the components that hold the tooth in the jawbone: the gum (gingiva), the bone, the anchoring fibres, and the anchoring structure on the surface of the root (cementum). In a healthy tooth, the periodontium surrounds the entire root.

Receding gums are not always caused by periodontitis. Sometimes, receding gums are provoked by brushing your teeth too vigorously, which injures the gum line. When it heals, the gum line withdraws further until the tooth root beneath the gum is exposed. Even if you change your oral-hygiene habits and clean your teeth less forcefully, gum recession will not be reversed. In periodontitis, the initial damage to the tooth-supporting structure may not be visible and the gums may recede only after the disease has established itself. If you have receding gums, your dentist will be able to examine them and explain whether periodontitis is the cause and offer you the appropriate treatment.

The simple message is that periodontitis is always caused by the build-up of bacteria in the form of dental plaque. A healthy mouth is colonised by more than 700 different species of bacteria, most of which are completely harmless and live in harmony with their “host”. But when we do not clean our teeth thoroughly enough, bacterial deposits build up next to the gums, forming a “plaque” – and this creates the conditions for more dangerous bacteria to flourish. The natural defences of the body are also compromised as a result. If this bacterial plaque, which is soft, is not removed by brushing, minerals are deposited within it and a hard deposit on the tooth called tartar (or calculus) is formed. The presence of tartar encourages the growth of the bacterial plaque towards the roots of the teeth. This leads to a weakening of the attachment of the root to the gum and the creation of a gap – called a periodontal pocket – between tooth and gum. This pocket is an ideal place for harmful bacteria to gather and multiply, which drives disease forward as the bacteria release toxins that further trigger the body’s defence mechanisms. The severity and speed with which periodontitis progresses depends on factors including:

• the number and type of bacteria present
• the strength of an individual’s defences
• the presence or absence of risk factors (e.g. smoking, diabetes)
• genetic factors
• certain types of medication

For example, the more aggressive the bacteria and the weaker the immune response of the patient, the more active will be the disease. And if the patient is a smoker or has diabetes, the body’s defences may be weakened which can speed up the disease process. Some drugs – such as antihypertensive or vasodilating agents and immunotherapy – can affect the inflammatory response to plaque and make patients more susceptible to gingivitis. But it is very important to remember that without the accumulation of bacterial plaque, periodontitis will not occur.

Tooth loss: If the progress of periodontal inflammation is not halted, the supporting structures of the teeth – including the surrounding bone – are destroyed. The teeth eventually loosen and are either lost or need to be extracted. Among adults, it is estimated that around 70% of tooth loss is caused by periodontitis. Problems with eating: Periodontitis weakens the structures that hold the teeth in place. Wobbly teeth can cause problems when chewing. People affected can to some extent adapt and switch their chewing habits to the teeth that can still be used. But if the damage continues – and especially if teeth are lost – people can end up able to eat only soft foods. Problems with speaking: the loose teeth caused by periodontitis can make it difficult to speak clearly. If the visible front teeth in the upper jaw are forced apart because of periodontitis, the gaps that arise can cause problems in speaking (for example, sibilant sounds like “S” may not be pronounced clearly). Singers and musicians who play wind instruments can also have problems if teeth start to move apart as a result of periodontitis. Problems with appearance: People with periodontitis can have problems with their appearance (aesthetic problems). Gums are dark red because of inflammation, teeth look longer because of receding gums, and the roots (which are darker than the crowns of teeth) become visible – all of which can look unattractive. As teeth loosen, they can move apart leaving dark spaces (black triangles) between them, and if teeth are lost as a result of periodontitis there can be unattractive gaps. Bad breath: The bacteria that cause the inflammation involved in periodontitis can also cause bad breath (halitosis). The kinds of bacteria that cause periodontitis thrive in gum pockets and produce foul-smelling volatile sulphur compounds. Bad breath needs to be treated by professional teeth cleaning and good oral hygiene at home. Negative effects on general health: It is now known that untreated periodontal disease can have serious consequences for general health. Periodontitis means an increased risk of suffering diabetes, heart disease, cerebrovascular disease, and complications in pregnancy (pre-eclampsia, premature birth and low birth weight). In fact, periodontitis has been linked with more than fifty diseases and conditions, including chronic kidney disease, Alzheimer’s Disease, rheumatoid arthritis, and certain types of cancer.