Gum disease is common amongst adults and is a gradually progressive condition related to bacteria which are normally present in the mouth but are allowed to proliferate to an uncontrolled degree causing on-going irritation of the gums, leading to inflammation and loss of gum tissue.
We all have bacteria on our skin and in our mouth, and generally they cause us little or no harm unless they get out of control. A blocked skin pore or sebaceous gland opening, for example, can allow bacteria to proliferate to the point where they cause a spot or pimple. In the mouth many bacteria are trapped within plaque which is the sticky mucilaginous film that occurs on the teeth. The stickiness comes from salivary proteins, and these plus sugars from food and drinks provide a substrate for many different types of bacteria to take advantage of. Products of these bacteria can irritate the gums around the necks of the teeth if the plaque is allowed to remain there long enough, so it is only by regular daily brushing and flossing to remove this plaque that we can keep gum disease at bay.
If plaque removal is inadequate the gums will show a reaction that is in the beginning quite subtle and often not noticed or is disregarded. The first signs of gum inflammation or gingivitis are that the gums lose their “orange peel” or slightly stippled surface appearance and become red rather than the normal pink colour. The gums may become slightly loose and swollen, and often bleed when touched with a toothbrush or even without any provocation at all. If you notice these signs then it means your oral hygiene is inadequate and you need to improve it, because at this early stage gum disease is reversible provided you take steps to reduce the bacterial populations in the plaque on your teeth by adequately removing that plaque. Some people on seeing blood in their saliva will refrain from brushing thinking that they may do harm, but in fact this is completely wrong. By not brushing you only allow more plaque to accumulate and inevitable worsening of the gum condition. Brushing may make the gums bleed but you should disregard this and brush anyway, but effectively rather than just brushing hard. There is no need to exert excessive force on the brush but simply enough to loosen and remove the sticky plaque. If your gums are sore or tender you could use a slightly softer brush but you need to use the correct brushing technique which your dentist can show you.
Many people are surprised or even indignant when told by their dentist that they have gum disease as a result of inadequate oral hygiene and say “Well I clean my teeth every day so why should I have gum disease?” The problem is that, although they brush their teeth, they don’t do it effectively enough. Many people only perform a fairly perfunctory brush of their teeth in the mornings when they are not really quite yet awake, and again the evening when they are tired and about to go to bed, so even if they brush twice a day they are not necessarily doing it effectively. In order to remove all dental plaque it is essential to first reach all surfaces of all the teeth. This means you need to look in the mirror as you brush and floss to make sure of what you’re doing, and you need to clean in a methodical manner so that no teeth are missed. It is usually recommended that if using an ordinary manual brush you direct the bristle or filaments at an angle of 45 degrees to the gum edge and make some brisk short strokes to loosen debris here, and then follow up with brush strokes vertically from the gum margin up to and beyond the incisal or biting edge in order to scrub away plaque. Horizontal brushing should be practiced only on the tops or chewing surfaces of the teeth and not across the face of front teeth since this tends to wear away tooth enamel over time leading to increased sensitivity.
It is best to start brushing at one corner of the mouth and work your way round that arch of teeth with vertical strokes and also pushing the brush in between the teeth as far as possible. That way you can be sure not to miss out any teeth. Because most people’s teeth are close together it is often not possible for the toothbrush to adequately clean the sides of the teeth and this is why you should floss. Dental floss can be waxed or un-waxed and of varying thickness, and it is a case of finding out which type best suits you best bearing in mind that the purpose of it is to dislodge plaque from the sides of the teeth by scraping it from the gum towards the biting edge with a length of floss held taut between the fingers. Waxed floss is easier to get between the teeth if they are tight together, but un-waxed tends to spread its filaments under pressure and may be slightly more efficient at removing plaque. It is damaging to the delicate gum tissue to force floss hard down below the gum margin, so you only pull it gently down below the edge of the gum until slight resistance is felt, and then, holding it tight against the tooth surface you slide the floss upwards (or downwards on an upper toot) scraping off the plaque as you go. Use a fresh area of floss for each side of each tooth as you progress around the arch in a methodical manner.
If oral hygiene remains inadequate over an extended period of time then damage to the gums becomes gradually worse, often causing pockets to develop around the teeth and then subsequent loss of periodontal fibres and shrinkage of the gums, not only away from teeth surfaces but also in terms of vertical height so that the roots of the teeth become progressively exposed. Eventually even the supporting bone of the teeth is affected by the inflammatory process and is lost to varying degrees, and it is at this point where clinical loosening of the teeth may be noticed. This stage is called periodontitis and treatment is concerned with stemming the tide of tissue loss but can rarely manage to completely reinstate the gums to their original condition because of the extensive damage.
Certain conditions or lifestyle factors may predispose you towards getting gum disease, such as smoking and diabetes, or if you have a weakened immune system due to HIV infection or chemotherapy, but gum disease is completely avoidable if you take the time and trouble to keep those bacteria under control.
Contact us if you have swollen or bleeding gums or loose teeth. Cleaning teeth carefully each day can help prevent gum disease.