Periodontal Disease

Healthy periodontal tissue is the framework to a beautiful smile.

To understand periodontal disease, one needs to appreciate periodontal health.

Healthy Gingiva

Under healthy conditions the gum has a pink, orange peel, stippled appearance without any signs of bleeding. The interdental papillae are the knife-shaped gingiva closing the contacts between our teeth. the gum thickness that rests on the underlying bone measures approximately 1 – 3 mm (healthy periodontal pocket). Genetics determine if one is born with thin scalloped gum or thick flat gingiva. Thin gingiva is less resistant against trauma and more susceptible to recession.

Periodontal disease is primarily caused by plaque or bacteria but genetic predisposition and systemic factors such as diabetes as well as smoking may also have an effect. The capability of the body’s immune system to fight off the bacterial infection is important and immune system fluctuations may spark flair ups of the disease.


Gingivitis is a common and mild form of periodontal disease that causes irritation and/or inflammation of the gums around your teeth. Although it is a mild condition, if not treated promptly, it can lead to a more severe case of periodontal disease – Periodontitis.

Gingivitis is most commonly caused by bad oral hygiene and can usually be prevented or reversed by maintaining good home oral hygiene – brushing twice a day and flossing daily – and keeping to regular check-up appointments with your dentist.

Signs of Gingivitis include:

  • Swollen or puffy gums
  • Bright red or dark red gums
  • Bleeding gums when brushing or flossing 
  • Bad breath
  • Receding gums
  • Sore/tender gums

Risk Factors:

  • Poor oral hygiene
  • Smoking or chewing tobacco
  • Older age
  • Dry mouth
  • Poor nutrition/diet
  • Dental restorations that don’t fit properly or crooked teeth that are hard to clean
  • Conditions that decrease immunity, such as Leukaemia, HIV/AIDS or Cancer treatment
  • Certain medications or taking a large amount of different medications
  • Hormonal changes such as pregnancy
  • Genetic factors
  • Some medical conditions such as viral and fungal infections

If you notice any signs or symptoms of gingivitis we urge you to take it seriously and schedule an appointment with your dentist as soon as possible. The sooner you seek care, the better the chances of bringing the condition under control and preventing regression to periodontitis.


When Gingivitis is left untreated it can progress to Periodontitis, which is induced by bacteria and is a chronic inflammatory disease which permanently destroys connective tissue and bone that supports teeth. The extent of the condition is established in a clinical examination by inspecting the soft gum tissues around the teeth and by taking X-rays. In severe cases, teeth are replaced with dental implants. These procedures are performed by Periodontists.

Periodontitis, if left untreated or already in an advanced state, can cause tooth loss. Recent research has als proven that the bacteria responsible for periodontal disease can enter the blood stream and affect your heart, lungs and other parts of your body, causing greater complications such as respiratory disease, pre-diabetes, coronary artery disease and strokes.

There are several different types of periodontitis. The more common types include:

  • CHRONIC PERIODONTITIS is the most common type, affecting mostly adults, though children can be affected, too. This type is caused by plaque build-up and involves slow deterioration that may improve and get worse over time but causes destruction in the gums and bone and loss of teeth if not treated.
  • AGGRESSIVE PERIODONTITIS usually begins in childhood or early adulthood and affects only a small number of people. It tends to affect families and causes rapid progression of bone and tooth loss if untreated.
  • NECROTIZING PERIODONTAL DISEASE is characterized by the death of gum tissue, tooth ligaments and supporting bone caused by lack of blood supply (necrosis), resulting in severe infection. This type generally occurs in people with a suppressed immune system — such as from HIV infection, cancer treatment or other causes — and malnutrition.


Patients with periodontitis are often asymptomatic. When present, physical signs and symptoms may include:

  • Swollen gums
  • Discoloured gums
  • Bleeding gums while brushing, eating or even spontaneous
  • Long appearance of teeth (receded gums)
  • Increased spacing between teeth
  • Pus between teeth and gums
  • Increased tooth mobility and spontaneous loss of teeth
  • Bad taste in the mouth and halitosis (bad breath)
  • Painful chewing

Risk Factors

Risk factors that could contribute to periodontitis include:
  • Gingivitis
  • Poor oral hygiene
  • Smoking and chewing tobacco
  • Hormonal changes such as pregnancy and menopause
  • Substance abuse
  • Obesity
  • Poor diet
  • Genetics
  • Certain medications that cause dry mouth or gum changes
  • Systemic diseases such as diabetes, HIV/AIDS and cancer

Examination and bacterial testing

Once a periodontal examination has been performed, we will have a good idea of how advanced the periodontitis is. Periodontitis is caused by specific groups of bacteria and every patient has different levels of each of the bacteria present in their mouth. Microbial testing allows us to take samples of the infection and to send it away to the laboratory for testing to see exactly which bacteria each patient presents with so that specific medication can be prescribed. These bacteria are most often immune to broad-spectrum antibiotics; thus, it is essential to establish the exact bacteria and concentration levels before an antibiotic is prescribed.



Emerging evidence supports an increased risk for diabetes onset in patients with severe periodontitis. This may be due to elevated systemic inflammation (acute-phase and oxidative stress biomarkers) resulting from the entry of periodontal organisms and their virulence factors into the circulation. There is a direct and dose-dependent relationship between periodontitis severity and diabetes complications.

The Heart


Certain bacteria causing periodontitis are structurally equipped to attach and penetrate the blood vessel walls. Within the blood vessel wall, the bacteria can multiply, to elicit an inflammatory immune response and causes blood vessel cell death. The result is hardening and narrowing of the blood vessel walls, called Atherosclerosis.

  • Atherosclerosis leads to heart attacks and strokes. 
  • It accounts for 29% of deaths worldwide.
  • 2nd leading cause of death after infectious diseases and parasitic disease.

General Health

In periodontitis the bacteria on the tooth root and gum causes an immune inflammatory response resulting in swollen damaged gums. With brushing and eating the plaque enters the bloodstream and travel to distant sites throughout the body affecting the health of the internal organs.



There is currently no known cure for periodontitis, however the condition can be brought under control and maintained with regular check-ups with your Periodontist. The sooner the condition is picked up, the less invasive the treatment will be. If you notice any signs or symptoms of periodontitis we urge you to take it seriously and schedule an appointment with your Periodontist as soon as possible. The sooner you seek care, the better the chances of bringing the condition under control and preventing further complications.

Depending on the severity of the condition, Periodontitis can be treated with either a non-surgical deep cleaning, or a surgical deep cleaning procedure.


With a non-surgical deep cleaning, the areas that present with mild periodontal infection (probing depths of 5- 7mm) are anaesthetised and then scaled and root planed with special instruments that reach below the gum line, to clean out the plaque where your toothbrush cannot reach and to help the gum attach to the teeth. This takes place in the dental chair and lasts around 1 ½ hours. After the deep cleaning you are provided with a script for post-operative medication and care instructions. A re-evaluation will then take place approximately 8 weeks after the deep cleaning to reassess the areas by way of charting and comparing it to your original chart. This will give a good indication on your healing progress. Once your periodontal health is stable and remains stable for a period of 3 months, you will be placed on a periodontal maintenance program.



In cases where patients present with severe infection and bone loss (pocketing of 7mm or more), it is recommended that a surgical deep cleaning be done.

With a surgical deep cleaning, the gum is gently lifted away from the tooth and bone structure to gain access to the very deep infection. The infected tissues are then removed, and the sites thoroughly cleaned. Once thoroughly cleaned and disinfected with a local antibiotic, a bone regenerative product is then placed to stimulate new bone growth in the areas where the bone defects are. This new bone growth takes place over a period of 9 – 12 months. Once the product has been placed, the gum is resecured into place with sutures and the procedure is complete.

This procedure could take 2 – 4 hours, depending on the severity of the case and number of sites infected. A script for post-operative medication will be given along with post-operative care instructions. The removal of the sutures will then take place approximately 14 days after the procedure. A re-evaluation appointment will be scheduled within 8 weeks following surgery to reassess the areas by way of charting and comparing it to your original chart. This will give a good indication on your healing progress. Once your periodontal health is stable and remains stable for a period of 3 months, you will be placed on a periodontal maintenance program.