Plaque, Gingivitis and Periodontitis

Plaque

Bacteria are normally present in the mouth. Should bacteria remain undisturbed at the margin where the gum meets the tooth, particularly in between the teeth, it may cause periodontitis. They accumulate and multiply in the form of an invisible film known as plaque. Plaque starts to accumulate on the tooth at the gum margin almost immediately following its removal. However, it takes 12 to 24 hours for the plaque to become harmful to the gum tissues. Wherever plaque is not removed, it may cause periodontitis.

Plaque, together with some elements of the saliva, will form tartar (calculus). This is a hard, crust-like material which is deposited on the teeth and on which a further deposition of plaque takes place, thus increasing the amount of calculus. Once formed, calculus cannot be removed by tooth brushing and should be removed by a dentist or dental hygienist with special dental instruments. Other common sites for the formation of bacterial plaque are:

• worn-out fillings;
• poor fillings or crowns with overhanging edges;
• badly decayed teeth;
• wedging of food particles between teeth into the gums during chewing; and
• partial dentures, particularly plastic dentures.

Other risk factors that can affect the severity and speed of development of periodontitis include:

• the use of tobacco products;
• stress;
• genetics;
• hormonal changes e.g., during pregnancy, menopause or post-menopause;
• poor nutrition;
• people older than 55, since more than half of people aged 55 and older have periodontitis;
• HIV/AIDS sufferers;
• xerostomia (dry mouth syndrome); and
• osteoporosis and arthritis, which may make brushing and flossing difficult.

Gingivitis

Gingivitis presents as bleeding gums when brushed or sometimes even when simply touched. The gums gradually become red, swollen and move away from the teeth, forming pockets. There may sometimes be an acute phase (known as ‘trench mouth'), when there may be some pain. Generally, the condition is painless and causes so little discomfort that it is often neglected for many years, until diagnosed by a dentist.

Gingivitis is caused by inadequate oral hygiene, which results in plaque build-up. It can be reversed with professional treatment and good oral home care.

Periodontitis

When gingivitis is neglected, the inflammation may extend deeper into the tissue. Toxins produced by the bacteria in the plaque irritate the gums. The toxins stimulate an inflammatory response in which the body in essence turns on itself and the tissues and bone that support the teeth are broken down and destroyed. The gums separate from the teeth, resulting in the formation of pockets (unnatural spaces between the teeth and the gums). These act as breeding grounds for bacteria and will eventually fill with pus.

More bone and gum tissue is destroyed as the condition progresses. The inflammation thus extends into the bone surrounding the teeth, which may then become loose, drift out of position and will eventually be lost. Gum abscesses may form at any time during this process.

An advanced state of periodontitis can be reached without having experienced any pain or discomfort.

Prevention of periodontitis

• Correct oral hygiene will prevent the formation of bacterial plaque and keep the gums healthy. Learn the correct teeth cleansing technique.
• Visit the oral hygienist regularly to have calculus removed.
• Have regular periodontal examinations and periodic x-rays to reveal otherwise undetectable changes in the jawbone. Remember there will usually be no pain or discomfort to warn you.
• Brush and floss your teeth twice a day.

Treatment of periodontitis

The main reason for treating periodontitis is to preserve the natural teeth and bone. Without treatment, the surrounding tissues of the teeth will be destroyed. Extensive dental treatment, including crown and bridgework, should only be done in a mouth free of periodontitis.

Duration and cost of treatment

This will depend on the nature and severity of the condition. Generally, the fee has a direct proportion to the duration of the treatment and the complexity of the procedures required. Besides repairing the damage that has resulted, your dentist and dental hygienist may have to spend several hours teaching you correct oral hygiene procedures and checking your progress at frequent intervals. Certain cases may be referred to a periodontist (a dentist that has specialised in treating periodontitis).

What does treatment entail?

In order to assess the state of health in your mouth, a dentist must examine your mouth and, if your suspicions are confirmed, a detailed clinical examination must be undertaken. This examination consists of inspection of the gums, measurements of the extent of gum destruction around the entire mouth and taking a set of full-mouth radiographs.

Treatment usually consists of the following:

• learning an effective oral hygiene technique;
• having your teeth scaled and polished;
• root planning, where an attempt is made to decontaminate the surfaces of the roots of your teeth using special dental instruments so that the gum may become re-attached to the tooth surface. This usually requires local anaesthetic; and
• where the periodontal condition is advanced, minor surgical procedures may be necessary to gain access to the roots requiring decontamination, as well as to correct any major changes that may have resulted from the condition.

Each patient will have different problems, which need to be handled on an individual basis.

Can periodontal treatment be guaranteed?

No. It is against the law for members of the dental or medical profession to guarantee treatment. In biological science, response to treatment usually varies. However, once treated, the condition will recur in the presence of plaque.