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Dental Plaque and Gum Disease

gum disease

A build-up of plaque and calculus can lead to inflamed and infected gums. Mild gum disease is called gingivitis and is not usually serious. More severe gum disease, called periodontitis, can lead to teeth falling out. Good oral hygiene which includes regular tooth brushing and cleaning between teeth (eg by flossing) can usually prevent gum disease, and treat mild-to-moderate gum disease.

What is dental plaque and calculus?

Dental plaque is a soft deposit that forms on the surface of teeth. It contains many types of bacteria (germs). You can usually remove plaque quite easily by tooth brushing and cleaning between teeth.

Calculus is hardened calcified plaque. It is sometimes called tartar. It sticks firmly to teeth. Generally, it can only be removed by a dentist or dental hygienist, with special instruments.

What is gum disease?

Gum disease (periodontal disease) means infection or inflammation of the tissues that surround the teeth. Depending on the severity, gum disease is generally divided into two types - gingivitis and periodontitis.

Gingivitis

Gingivitis means inflammation of the gums. Most cases of gingivitis are caused by plaque. This is then called plaque-associated gingivitis.

Periodontitis

Periodontitis literally means 'inflammation around the tooth'. It occurs if gingivitis becomes worse and progresses to involve the tissue that joins the teeth to the gums (the periodontium), and/or the supporting bone.

As a consequence of periodontitis, a gap (pocket) develops between the tooth and gum. If left untreated, the tooth may slowly loosen and eventually fall out.

Dentists assess the severity of periodontitis by measuring the depth of the pockets that form between the gum and tooth.
Plaque can be removed from shallow pockets (up to about 3 mm deep) by brushing and cleaning teeth in a normal way. However, deeper pockets need to be treated by a dentist, as normal brushing and cleaning will not reach the bottom of the pocket.

How common is plaque and plaque-associated gum disease?

They are very common.

How is plaque-associated gum disease caused?

Most people develop some dental plaque, but not everyone with plaque develops gum disease. Dental plaque contains many different types of bacteria (germs) and some types of bacteria are associated with developing gum disease. The gums can often resist, or limit, the invasion of bacteria. It is thought that a more marked gingivitis, which leads to periodontitis, is more likely to develop if you have a lot of plaque and/or your defence or resistance against bacteria is reduced in some way.

The following increase your risk of developing marked plaque-associated gum disease:

  • Poor oral hygiene when a lot of plaque and large numbers of bacteria build up.
  • Smoking (which may alter your resistance to gum infection).
  • Having a poor immune system. For example, if you have an illness which makes your immune system less effective, or if you are on chemotherapy, etc.
  • If you have diabetes.

How does plaque-associated gum disease present?

The gums look slightly swollen and reddened.

Moderate gingivitis can cause more marked swelling and reddening of the gums. The gums often bleed a little when you clean your teeth. Discomfort or pain from the gums is rare if you only have gingivitis.

Periodontitis often does not cause any symptoms until an affected tooth becomes loose. However, in some cases, symptoms develop and may include:

  • Halitosis (bad breath).
  • A foul taste in your mouth.
  • Some pus formation in small pockets between the teeth and gums.
  • Pain and difficulty eating.
  • Affected teeth becoming loose and eventually falling out if not treated.
  • An examination by a dentist to detect the presence and depth of gum pockets is needed to confirm the diagnosis of periodontitis.

How is plaque-associated gum disease prevented?

Good oral hygiene (mouth hygiene) helps to keep plaque down and usually prevents gum disease. (Good oral hygiene also helps to prevent tooth decay.) Good oral hygiene means:

Brushing your teeth - for two minutes, at least twice a day. Ideally, brush your teeth either just before eating, or at least an hour after eating. Studies suggest that powered toothbrushes with a rotation-oscillation action (where the brush rapidly changes direction of rotation) remove plaque and debris better than manual brushes.

Cleaning between your teeth after brushing once a day, but ideally twice a day. This is to remove plaque from between teeth. Dental floss is commonly used to do this. However, some studies suggest that small interdental brushes may do a better job than floss.

How do you treat plaque-associated gum disease?

If you have gingivitis

The measures described above to prevent gum disease will often clear mild gingivitis. If gingivitis is more severe, in addition your dentist or doctor may advise an antiseptic mouthwash (and/or antiseptic toothpaste, gel, or spray). These help to kill bacteria in the mouth and help to clear up any gum infection.

Chlorhexidine is a commonly used antiseptic mouthwash. If you are advised to use chlorhexidine, you should rinse your mouth well with water between brushing your teeth and using chlorhexidine. This is because some ingredients in toothpaste can inactivate chlorhexidine. Chlorhexidine may also stain teeth brown when used regularly. This staining is likely to need to be removed by a dentist or dental hygienist.

Staining can be reduced by:

Brushing teeth before (but not after) using the chlorhexidine.

  • Avoiding drinks that contain tannin, within 2-3 hours of using chlorhexidine (for example, tea, coffee, and red wine).
  • Using the 1.2% solution instead of higher-strength solutions.

If you have periodontitis

You should see a dentist.

Gum disease and heart disease

In addition to the benefits to your teeth, good mouth hygiene may have even further benefits. There is some evidence to suggest that poor oral hygiene is associated with an increased risk of developing heart diseases such as heart attack and angina, and other blood vessel-related problems (cardiovascular disease).


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