Depending on its severity, gum disease can be classified either as gingivitis or periodontitis.
Gingivitis is the milder form of the condition, consisting of an irritation of gum tissues which is reversible with treatment to help remove and control the cause – bacterial plaque.
Symptoms of gingivitis include bleeding gums, especially as a result of brushing or flossing, and red, swollen or tender gingival tissue.
Though this stage of gum disease is reversible, management is important because if left untreated gingivitis can progress to periodontitis, a more severe form of the condition.
Periodontitis is a more severe version of gum disease, in which the inflammation that in gingivitis affects only the gums has spread to the periodontal ligament – the tissue which holds the tooth in the socket – and the supporting bone.
Periodontitis can cause irreversible loss of both soft tissue and bone, which in extreme cases can threaten the stability of the dentition – indeed, in the UK, more teeth are lost through gum disease than as a result of caries.
Receding gums as a result of periodontitis can result in dentine hypersensitivity, since the cementum coating of the newly exposed tooth root is soon lost and as a consequence dentine tubules can be left patent to the oral environment.
A characteristic of periodontitis is a loss of attachment of the gingival tissues to the teeth, resulting in deep pockets between teeth and gums.
Since all gum disease is caused by plaque, poor oral hygiene is the chief predisposing factor. However, other conditions and behaviours can increase the risk of suffering from gum disease: • stress and inadequate coping • poor nutrition • pregnancy • HIV/AIDS • diabetes • smoking • drinking alcohol.
Diagnosing gum disease
Since gum disease often progresses painlessly, patients may well be unaware that anything is wrong. It is therefore important to question them regarding symptoms of gum disease, for example bleeding gums, particularly if they are in a high-risk group. The basic periodontal examination (BPE) provides a convenient measure of the condition of the gingival tissues.