Up to 90% of adult Singaporeans have some form of gum disease.

Gum disease can range from the mildest (gingivitis) to the most severe (periodontitis). Gum disease can affect every tooth (generalised) or just some teeth in the mouth (localised).

How to prevent gum disease (gingivitis)

Brush your teeth with a toothbrush and fluoride toothpaste twice a day, or after every meal, to minimise plaque buildup. Use interdental aids like an interdental brush or floss daily. 

Maintenance of good oral health also involves regular six monthly visits to the dentist for scaling. Cessation of smoking and tobacco use further reduces risk factors.

Types of gum disease

1) Gingivitis (mild gum disease)

The early stage of gum disease is gingivitis – an inflammation of the gums immediately surrounding the teeth. The first symptom of gingivitis is bleeding on brushing. In some cases, bad breath is noted. Pain is usually not a presenting symptom. 

Gum disease is called the ‘silent’ enemy because it may present with no symptoms at all. By the time symptoms arise, the disease may have advanced considerably. Gingivitis is reversible with proper oral hygiene and simple treatment like scaling and polishing.

2) Periodontitis (severe gum disease)

Unattended gingivitis over a long time, progresses to periodontitis. This is where the disease attacks the deeper parts of the supporting structures of the tooth such as the surrounding bone and attachments. 

In addition to the symptoms of gingivitis, patients may complain of loose teeth, changes in tooth position, gum boils, longer looking teeth, or dull ache in the gums and teeth. Periodontitis is irreversible with just brushing alone and needs dental intervention.

Causes of gum disease

Bacteria in plaque are the cause of gum disease. These bacteria do not cause periodontal disease when removed daily by proper brushing. However, when there is inadequate oral hygiene, bacteria accumulate to form hardened deposits called tartar. Tartar cannot be removed by brushing and requires scaling.

Plaque bacteria produce toxins that irritate the gums. When bacterial toxins accumulate over time (as happens when plaque is not removed) the body mounts a response by producing enzymes. Toxins and enzymes dissolve bone and surrounding tissue holding the teeth.

Periodontal disease is a chronic disease and if untreated gets worse over time resulting finally in tooth loss.

Risk factors of gum disease

Risk factors for gum disease such as gingivitis and periodontitis include:

  • Genetic susceptibility

  • Puberty, menopause when hormonal changes occur

  • Smoking, stress, diabetes. Poorly controlled diabetics are at risk of developing gum disease

  • Medications like anti-depressants, oral contraceptives, some heart medications

  • Compromise of immune system e.g. AIDS, leukaemia, cancer treatment

Smoking also increase the risk of getting periodontitis (periodontal disease) and can lessen the success of some treatments. Uncontrolled diabetes also increases the risk of infection.

Symptoms of gum disease

The early stages of periodontal disease may be pain-free and so patients may not be aware of any problems. Hence, it is important to have your dentist check for gum disease! 

It is also good to be aware of the following "red-flags":

  • Bleeding gums when brushing or flossing

  • Red or swollen gums

  • Receding gums

  • Shaky teeth

  • Teeth appearing to drift apart from their original positions

  • Persistent bad breath

Treatment for gum disease

The main goal of treatment is to reduce bacteria around your teeth and prevent the gum disease from getting worse.

Non-surgical treatment includes scaling and root planing. Scaling involves scraping away tartar from above and below the gum line. In root planing, tough tartar and bacteria deposits along the root surfaces are removed with special instruments while the patient is on local anaesthesia.

You will be taught how to clean around your teeth and gums properly. Treatment for gum disease will only work if you are able to do this well.

Deep cleaning around the teeth, usually performed under local anaesthesia, will also be done by your dentist or dental hygienist. This helps to remove bacteria below the gum line. The number of visits required will depend on the extent and severity of the gum disease.

Patients with more severe gum disease may be advised to undergo gum surgeries. This is done only after initial rounds of deep cleaning have been carried out to reduce bacteria and inflammation, and after the patient is able to clean his/her teeth to a high standard.

Gum surgery serves to remove residual tartar in deep, unresolved periodontal pockets. The aim is to control the disease progression and make the area easier to clean at home. The periodontist may sometimes suggest bone or tissue grafts to encourage new growth of bone or tissue to replace the damaged areas.

Finally, after the gum disease has been brought under control, you will continue to be seen at regular intervals so that we can help you maintain this stability and monitor for any disease recurrence. When no further specialist care is required, you will be discharged back to your private dentist or the polyclinics to continue your routine check-ups there.

Gum disease can affect overall health

The effects of periodontal disease are not limited to the mouth. Researchers have found that people with periodontal disease are almost twice as likely to suffer from coronary artery disease as those without periodontal disease.

Additional studies point to a relationship between periodontal disease and stroke. Periodontal disease can exacerbate existing cardiac conditions.

Pregnant women with periodontal disease are seven times more likely to have pre-term deliveries and babies who are of low birth weight. Thus, it is important for pregnant women to have a periodontal evaluation.

Ref. H24 (ed)

Check out other articles on oral care:

Wisdom Tooth: When to Extract

Root Canal Treatment: How Painful Is It?

Gum Disease: Causes, Symptoms and Treatment

Am I Too Old for Braces?

Tips for Fresher Breath

How to Choose the Right Toothbrush