Periodontal Disease

Gum disease can be divided into two types: mild and severe.

Gingivitis is a mild inflammation of gum disease caused by plaque build-up. Gingivitis is fully reversible and can be prevented by maintaining effective oral care at home i.e. regular tooth brushing and daily flossing. However, if not treated, gingivitis can progress to more advanced gum disease called periodontitis.

Periodontitis is a severe form of gum disease which is initiated by bacterial infection in the pockets around teeth and results in tooth loss.

• Red and tender gums,
• Swollen gums,
• Bleeding gums,
• Receding gums,
• Loose or drifting teeth,
• Bad breath or bad taste,
• Puss or discharge from the gums,
• Sensitive teeth,
• Or some patients may not notice anything.

It is vital not to ignore the first signs of gum disease before it turns into a more severe and irreversible form of gum disease and before it is too late for treatment. Multiple researches have shown that if gum disease is left untreated it can have a detrimental effect on your oral health and general wellbeing.

Some factors can significantly increase your risk of having gum disease:

• Poor oral hygiene routine – inability of regular and effective removal of plaque bacteria from the tooth surfaces, gum margins and any appliances including dental implants, partial dentures, crowns, bridges and orthodontic appliances.
• Smoking
• Stress
• Poor general health including any underlying immuno-deficiencies such as Diabetes, HIV, Arthritis.
• Medications for various conditions g. depression, high blood pressure or epilepsy.
• Poor diet.
• Malocclusion and habitual teeth grinding.
• Defective dental work i.e. partially broken teeth, over-filled teeth.
• Hormonal changes i.e. pregnancy, oral contraceptives or menopause

During your initial consultation we listen to your concerns and what you are hoping to achieve with the treatment. In order to correctly diagnose and treat we will ask about your detailed medical history, your symptoms and will take a full mouth indices of your oral cavity and appropriate radiographs (if needed) to help us to determine the condition of your gums, teeth and supporting structures. This information is vital and will give us a better understanding of the disease, ensure that no aspect is missed and a correct diagnosis made. Following this comprehensive examination by our dentist as well as our hygienist and therapist, a diagnosis will be made and a proposed treatment plan provided including the costs.

The main objective of the treatments we provide is to not only to stabilise the gum disease and to prevent any further progression and tooth loss but also to inspire the patients to play a key part in their journey to having a healthy mouth and body.

Depending on the severity and extent of your gum disease, there are different types of treatments available.

• Tailored oral hygiene instructions including correct toothbrushing, interdental cleaning and correct use of chemical agents i.e. toothpaste and oral rinse
• Non-surgical Periodontal Treatment consisting of supragingival and subgingival scaling and debridement using hand and mechanical instruments,
• Laser Bacterial Reduction with diode laser 940nm,
• Laser Assisted Periodontal Treatment with diode laser and Waterlase iPlus 2.0 2780nm (Er,CR:YSGG)
• Antimicrobial Therapy with the Minocycline Periodontal gel
• Referral to periodontist for periodontal surgery (more invasive and painful treatment

Types of treatment (in more detail):

• Non-Surgical Periodontal Treatment also called Root Surface Debridement requires a special technique of removing the plaque and calcified tartar deposit from the surfaces of the root and periodontal pockets using hand and mechanical instruments. This initial treatment aims to reduce the inflammation and bacterial load in the diseased periodontal pockets which in turns will allow the gums to heal and stabilise the disease.
• Laser Bacterial Reduction with diode laser 940nm – multiple studies confirm that laser energy is absorbed by bacteria responsible for gum disease, reducing their number and stopping the infection before they cause physical irreversible destruction of gum and bone around the teeth.
• Laser Assisted Periodontal Treatment with diode and Watrelase iPlus 2.0, 2780nm- this combination of both laser technologies eliminates the infection rather than managing periodontal disease.
• Antimicrobial Therapy with the use of Minocycline 2%w/w Periodontal gel – used to treat moderate to severe gum disease and prescribed always in conjunction with mechanical root surface debridement however, it does not provide a cure for gum disease. Topical antibiotic will, in some instances, help to reduce the systemic bacterial load but this is case specific and will pose a thread of antibiotic resistance or other side effects.
• Surgical Periodontal Treatment – often very invasive and painful performed by the periodontist

All our periodontal treatments are performed under local anaesthetic to increase our patients’ comfort and to allow us to thoroughly carry out the treatment. Depending on the severity of the periodontal disease it might be necessary to split the treatment into two or more sessions if we believe it will be beneficial to the patient’s comfort.

Following a successful non-surgical periodontal treatment all our patients are undergoing a regular (every 3-4 months) Supportive Periodontal Therapy to maintain the healthy gums and to ensure no relapse occurred. Details of the therapy will be discussed in great depth with your dentist and hygienist and therapist.

Laser therapy has been used in medicine for decades and its multiple beneficial properties have not only resulted in improving gum’s health by significantly eradicating harmful microorganisms responsible for initiating of gum disease but also by reducing post-operative pain, dentine hypersensitivity, bleeding and treatment time. Unlike antibiotics, lasers render their bactericidal properties without common side effects and in addition, laser therapy is safe to treat pregnant women and children and it is also advantageous for medically compromised patients.

Multiple systematic reviews, meta-analysis and our in-house research prove that diode and Waterlase lasers used in conjunction with non-surgical debridement enhance the process of periodontal pockets regeneration and greatly improve the success of periodontal treatment.

Patients with advanced bone and gum disease (periodontal disease) have seen how the laser stops any further progression of the condition and actually initiates regeneration of the surrounding tissues. In the past, this could only be considered with invasive surgical procedures. Another great benefits of using lasers is that during gum (periodontal treatment) the laser can reach areas where other dental instruments are unable to reach.

During periodontal treatment, both lasers can greatly reduce trauma to the surrounding tissues and not only do they seal off blood vessels but also lasers sterilise the affected area too. This minimises the chance of post-operative infection and bleeding. The outcomes are therefore vastly improved where patients are far more comfortable during and after the treatment and adjunctive laser treatment hugely reduced the need of an invasive periodontal surgery and its complications.

Diode laser 940nm – is a soft tissue laser meaning it will not cut through the teeth or any other hard tissues in the mouth. Diode laser uses optical fibres in order to deliver the pulsed laser beam to the diseased tissues. It alters the environment in the gum pocket and effectively removes harmful bacteria including its toxins, helping to promote healthy tissue regeneration. One of the greatest advantages of the lasers is that diode laser actually promote healing. Diode laser is able to project through bends and curves of a tooth, allowing access to challenging to reach sites i.e. in between the tooth root.

Waterlase iPlus 2.0 laser (Er,CR:YSGG 2780nm) - is a all tissue laser and a very accurate, precise and gentle tool using a combination of laser and water-spray technology. It works by exciting the water within cells, thus absorbing the energy causing micro-explosion, which successfully removes the diseased tissues, bacterial toxins and calculus deposit from under the gums. By eliminating toxins and irritants the gums are able to heal and consequently, the pockets are able to regenerate. The effectiveness of Waterlase iPlus treatment is superior to the more traditional non-surgical therapy (root surface debridement) and very often proves to be a more comfortable experience for the patient.

Often, early gum disease can be prevented and reversed with an adequate oral hygiene routine and a regular visit to the dentist and hygienist including:

• Brush your teeth at the gum line using an electric or manual toothbrush twice a day (in the morning and before bed) for at least 2 minutes.
• Before tooth brushing clean in between your teeth daily using an appropriate size of interdental brushes and only in tight spaces use floss.
• When advised, use a single tufted brush and gently push it vertically under the gums. Pay special attention to your dental implants, crowns and bridges.
• Use fluoride toothpaste with a minimum 1450ppm Fluoride and spit the toothpaste out after brushing and do not rinse your mouth with water or mouthwash to maintain the fluoride concentration.
• Attend your check-ups and hygiene visits regularly.
• Reduce the amount and frequency of sugary foods and drinks consumption.
• Do not smoke.
• Reduce the amount and frequency of alcohol beverages.
• Do not take any recreational drugs.
• Have a healthy and balanced diet and if necessary, take vitamins and mineral supplements that will have a positive effect not only on your general wellbeing but also on your gums.
• Reduce stress. Psychological stress not only has a detrimental effect on our general wellbeing but also contributes to poor oral health including teeth grinding, cold sores on your lips, sores in your mouth, jaw problems, fractured teeth and it can also impact your immune system and contribute to gum disease.

In addition to this, numerous studies have shown that people who keep to a normal body weight are 40% less likely to develop gum diseases hence preventing a serious systemic disease.

Remember, if diagnosed early, periodontitis (more severe form of gum disease) can be successfully treated however with more extensive treatment.

If you have any concerns or if you think you may suffer from gum disease please do not hesitate to contact us at our dental practice in Fulham and speak to a member of our team who we will arrange an appropriate appointment for you.