The six best treatments for gum disease

One in 10 of us suffer from inflamed gums in midlife. But it’s not too late to reverse the damage

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Until my mid-40s, my approach to gum health was, at best, sporadic. I had always suspected that flossing was one of those health chores that was advisable rather than essential, like regular meditation or eating kale. When I realised that cleaning thoroughly between my teeth every day was just as important as brushing them, it was almost too late.
First, I was told I had gingivitis (the early stages of gum disease) but I figured that increasing the regularity of my trips to the hygienist from twice to four times a year would solve the problem. I still didn’t commit to a daily, non-negotiable flossing regime in between hygienist appointments. I would keep it up for a few weeks, then run out of inter-dental brushes and neglect my gums until I got around to buying more.
Eventually, the hygienist told me that my condition had progressed to a state of periodontitis, meaning that my gums were infected deeply, causing erosion of the bone underneath. Over time this can lead to the loosening and loss of teeth.
The bad news is that while gingivitis can be cured, periodontitis cannot: it is a chronic inflammatory disease that sticks around forever. The good news is that it can be managed to make sure it doesn’t get any worse. If I stick to consistent homecare and regular specialist treatment, I may be able to reach old age with a full set of teeth and no more bleeding gums.
I just wish I’d taken gum health more seriously when I was younger before all these problems (and the accompanying costs, which are pretty big) mounted up. Studies show that between 50 to 90 per cent of all adults in the UK are affected by gingivitis, while almost 50 per cent have some degree of irreversible periodontitis. Smoking, certain medications, diabetes and genetic predispositions can put some people at particular risk.
Here, some of the UK’s top dental hygiene experts offer their advice on how to manage your gum health – and avoid the same mistakes I made along the way…
“The most common cause of gingivitis is oral bacteria that has an inflammatory reaction in the gums,” says Rhiannon Jones, the president-elect of the British Society of Dental Hygiene and Therapy. “The signs will be redness, swelling and bleeding. It is rare for gingivitis to be painful which is often why it is not taken seriously.”
She says: “If left untreated, it can develop into periodontitis which will cause deeper pockets to form which are difficult to clean. The gums will recede and the tooth will become mobile and can be lost due to the loss of bony support.
“Losing teeth affects our ability to eat, and speak and leaves the remaining teeth with a greater workload. Living with missing or mobile teeth can also affect wellbeing and confidence and they are expensive to replace.”
It is also thought to be a factor in more serious conditions. Numerous studies have shown a link between periodontitis and diabetes and there is a growing amount of evidence that suggests a link between periodontitis and cardiovascular disease.
Oral bacteria will develop into plaque without regular cleaning. This starts at home with brushing along the gumline as well as the surface of the tooth – but cleaning between the teeth twice every day is just as important, say experts.
“You wouldn’t be happy with a dinner plate that still had dried, sticky food on 25 per cent of the surface and yet people who do not clean between their teeth have this in their mouths already,” says Jones.
“A quick rinse will not be effective in avoiding gum disease. Someone trying to clean in between their teeth for the first time may notice bleeding but this is due to the inflammation and will resolve quickly if the habit becomes a daily one.
“Floss, interdental brushes and interdental sticks are popular but finding something that will be used every day is the most important first step.”
Even if you have a solid homecare regime, dentists recommend a minimum of twice-yearly visits to a professional hygienist for what used to be known as a “scale and polish”.
“Appointments for PMPR could include removal of hardened deposits of plaque above the gum line initially,” says Roshni Karia, the president of the College of General Dentistry.
“More importantly, they will focus on a tailored oral hygiene programme to help patients manage their own plaque levels towards better oral health. For some patients, cleaning below the gum line is indicated, the extent to which will vary depending on the severity of the disease.”
The PMPR process might sound uncomfortable but I have found it to be entirely painless. My regular visits to a professional also helped improve my homecare routine as they provided demonstrations of how to floss and brush more thoroughly.
Should the bacteria penetrate more deeply underneath the gum, your hygienist is likely to recommend a deep clean, which may be carried out over two separate appointments for each side of the mouth.
“We would numb the mouth with local anaesthetic then disinfect the pocket using specialist tools,” explains Justyna Kamecka, a dental therapist and clinical director at Fulham Dental Clinic in London.
“We would also insert antiseptic medication underneath the gums. This process creates an anti-bacterial environment and reduces inflammation which allows your gums to heal and prevents further progression of the disease.”
If the disease worsens despite the above treatments, there are many factors that could be at play including oral hygiene, smoking or unstable diabetes, says Ian Dunn, a specialist periodontist at the British Society of Periodontology and Implant Dentistry.
He adds: “Without a consistent cleaning regime at home, professional treatment is futile. But if repeated deep cleans fail to reduce the gum pockets and associated inflammation, specialist intervention may be required occasionally but rarely involving antibiotics and in some cases surgery.”
Surgery will involve folding back the gums under local anaesthetic, cleaning out the bacteria and changing the shape of the gum pockets. Occasionally, in specific situations, bone defects can be filled with graft material (either synthetic bone or sometimes bovine bone). Over the following weeks, the body will fill in the area with new bone and soft tissue, increasing the support for the tooth.
“Patients will see very quick changes in gum health with improved home care and treatment but in more advanced cases, full resolution of the disease can take six to nine months,” says Dunn.
Some clinics now offer an alternative to intrusive surgery in the form of LANAP (laser-assisted new attachment surgery). “The advantage of lasers is that they can target bacteria on a microscopic level,” says Kamecka, whose clinic is the only one in London offering Nd:YAG laser treatment (especially designed for treatment of bone loss).
“This allows it to reach the microscopic bacteria that go into the root of the tooth, which can’t be reached mechanically. There is growing evidence that the laser also promotes regeneration of the bone and the gum.”
A course of LANAP treatment can involve six separate 90-minute appointments at a total cost of £3000.
While some studies have supported the efficacy of laser treatment on gum disease, Dunn says more research is needed. “At the moment, it doesn’t appear that laser treatment offers greater benefits than traditional mechanical treatments,” he says.
Teeth straightening treatments, such as Invisalign, are done mostly for aesthetic purposes, but they can help fight gum disease.
“Straight teeth are less likely to get trapped food and bacteria between them,” says Kamecka. “If your bite is not evenly aligned it can put more load on vulnerable teeth and gums, worsening disease in that area.”
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