The aim of this leaflet is to describe in broad outline the treatment the Barley Mow can provide if you have gum disease.

Dentists Role

Your dentist has an overall supervising role in management of gum problems.  It is their responsibility to diagnose the problem and arrange suitable treatment and monitor it’s progress, with input from the hygienists.

Hygienists Role

Hygienists undergo an extensive training course that covers oral hygiene education, dietary advice, smoking cessation, anti- sensitivity advice, cleaning of the teeth, and polishing. They can administer local anaesthetics, topical medications and prescribe their own treatment plans.

They have an important role in treating the other main dental disease: decay.

Oral health educators Role

Oral health educators (OHE) are involved in oral hygiene education, dietary advice, and smoking cessation. 

They do not provide ‘hands-on’ treatment. The main benefit from seeing an oral hygiene educator is that they primarily focus on your oral hygiene without feeling any pressure to provide treatment.

Gum Disease

Around 15% of the population are very susceptible to gum problems, 15% are very resistant, and the rest are somewhere in the middle.

Disease severity is affected by how well you brush, smoking history, diabetes and general health.

We cannot repair the damage from gum disease: only stabilise it, so early intervention and ongoing maintenance is very important.

 

The most common gum problems are: 

Minor gum problems - Marginal Gingivitis

These mainly cover swollen, red and bleeding gums where there has been no loss of bony attachment.  Pocket probing depths are normal or slightly increased because the gum is enlarged.  Marginal gingivitis responds well to thorough cleaning and improved oral hygiene measures, such as tooth brushing and flossing.  It is routinely treated because it is known to be the starting point from more serious gum problems.

Moderate gum problems - Early Chronic Periodontitis

Once bony attachment has been lost from around the tooth by the initial attack of gum disease, deeper pockets are created. The disease process can continue uninterrupted in the pockets and between teeth.  Alternatively, marked recession can occur. Often, there is active disease between the teeth where oral hygiene is more difficult, which can cause biofilm to accumulate.

Treatment ideally consists of thorough cleaning by a hygienist and provision of excellent oral hygiene by the patient at home.  Regular ongoing maintenance at 4-6 monthly intervals is usually required as the situation requires monitoring. The more difficult areas need professional assistance

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Serious gum problems - Widespread Chronic Periodontitis

Once gum disease progresses, there can be extensive pocketing, and areas of bone loss from between teeth, and often is increased tooth mobility. Severe cases will often exhibit ongoing gum infections or spontaneous loss of teeth.

Ideally, treatment consists of very thorough hygienist treatment, high-quality oral hygiene at home, and regular ongoing maintenance at 3-4 four monthly intervals.  After a suitable period of time, generally 6—12 months, the areas that have not resolved will be retreated on an ongoing basis.

A specialist referral may be thought useful in some cases.

Smoking

Moderate and serious gum problems can be difficult if not impossible to treat adequately where the patient continues smoking.

However, we accept that stopping is difficult and will provide ongoing maintenance in any case.

The Bottom Line

Long-term studies have shown that the thoroughness of the oral hygiene measures the patient undertakes daily at home are the best predictor of tooth survival. Given this, the importance of good oral hygiene cannot be emphasised too much.

Present treatment protocols are moving towards getting the homecare right in the first instance, to ensure the hygienists active cleaning has the maximum effect.

Generally speaking, no matter how brilliant your dentist and hygienist are, if you do not look after your teeth at home thoroughly and effectively, the treatment will probably not succeed as well as it might. Without the patient taking a pro-active approach, treatment may not achieve any improvement.

Referral

This is probably a suitable point to mention that there are specialists who deal in gum problems (periodontists). 

Regrettably there are none available locally: Bristol, Bath, Cheltenham and Swindon are the nearest and we have a list of them and their websites & locations available on request. However, referral is always an option worth considering if your problems are serious enough.

Generally, the practice would like to see if they can resolve the problem in 12 to 18 months before this option is considered, but if the patient prefers, it is possible to refer when the problem is first diagnosed.