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Periodontal disease is the progressive infection and loss of bone from around your teeth. Periodontal disease starts as gingivitis, the swelling of the gum around your teeth, and left untreated can cause your teeth to drift apart and eventually become so loose that they need to be extracted.

Periodontal disease is caused by the same things that cause gingivitis-plaque and tartar, and food that is not cleaned out from between the teeth. The plaque begins to spread down the roots of the teeth and the gums get infected which causes damage to the bone and fibers (periodontal ligament) which support the teeth. As the disease advances the gums begin to pull away from the teeth, allowing more food and plaque to be trapped under them, causing more damage. In the very advanced stages of the disease the teeth become loose and shift around because of the widespread damage to the bone and ligaments holding the teeth in. Because of this your bite may shift and you may have difficulty chewing, your teeth may look "long" and if you wear a partial denture it may no longer fit

In the early and moderate stages of periodontal disease proper treatment can prevent further damage and save your teeth. As the disease advances, untreated, the chances of saving your teeth become much worse. If periodontal disease is never treated your teeth will eventually need to pulled and full dentures made.

Periodontal disease can also be caused by using smokeless tobacco (snuff). In the areas where the snuff is held against the cheek the tobacco and by-products cause irritation and infection of the gums. The gums begin to recede and periodontal disease affects the teeth in the area. The area is also highly prone to oral cancer.

A Sufferer Writes...

Whilst the major cause of gum disease is poor oral hygiene, associated plaque build-up, and consequent gingivitis, it should be noted that smoking cigarettes can be a significant contributory factor. My hygienist also advises against drinking spirits (but wine is okay, apparently).

But even if you don’t smoke, chew tobacco, drink hard liquor, or suffer from advanced gingivitis, you (and your dog) can get still get periodontitis in adolescence or early adulthood. It’s sometimes called juvenile periodontis, and the causes are various, but there is evidence that genetic factors influence susceptibility. It may manifest itself in a symmetrical formation – e.g. you get pocketing of the gums, bone loss etc, associated with the same teeth on both sides.

Treatment involves gum surgery, regular and costly visits to the periodontist to remove below-the-line plaque and plaque-harbouring tartar, and a meticulous oral hygiene routine which most people would regard as bordering on the obsessive but to sufferers is simply depressing and arduous. This involves the following arsenal of plaque-removing tools and products:

* * * * * * *

1) A good toothbrush with a small head, to allow access to the intricate crevasses of your mouth. It can be manual or electric, but either way it should be ‘soft’ or ‘medium’ – not ‘hard’ which can damage gums and tooth enamel, (notwithstanding its claim to fame as the hardest substance in the human body). Brush for a minimum of 2 minutes, aiming the bristles of the brush at a 45 degree angle to the teeth, so the bristles clean just below the gumline. Do NOT brush up and down, but use small yet firm circular motions. Change your toothbrush every 3 months. Used in conjunction with 2.

2) Toothpaste which contains fluoride and anti-plaque, anti-tartar, etc ingredients.

3) Floss – but dental tape is better, in my opinion. Flossing methods are discussed elsewhere.

4) Interdental brush(es). Miniature ‘bottle'-type brushes for use in gaps between teeth at gum level. They must fit the gaps in your teeth snugly, so you will need more than one size of brush if you have different sized gaps, as most people do.

5) Single-tuft brush. I don’t know the technical name for this, but get one which has the tuft carved into a pointy shape, not flat. You use this to remove stubborn plaque from the tooth-gum interface of each and every tooth. For enhanced effectiveness, dip the brush in Corsodyl anti-bacterial rinse or toothpaste.

6) Plaque-disclosing tablets. These will reveal those stubborn areas of plaque which a toothbrush alone cannot tackle. They stain plaque (and tongue) either blue or red for several hours, so don’t use before going on a hot date, for example. Use once a week at most, less if you can't be bothered and have mastered the ways of plaque.

7) Mouthwash such as RetarDEX, another anti-bacterial agent (but which doesn't stain your teeth brown like Corsodyl can do).

8) Tongue-scraper, to remove the bacterial build-up which forms as an unattractive whitish coating or fur on the papillae of the tongue. (I know someone who uses VERY diluted hydrogen peroxide for this, which dissolves the scum).

9) ‘Superfloss’ – specialist form of floss with stiff end and fuzzy mid-section used to clean under bridges.

* * * * * * *

NB This is a once-a-day regime and to make it more achievable you can do any of the above at any time of day, so long as you do everything once (except 6). NB2, this is by no means a comprehensive list and omits equipment such as water picks, not prevalent in the UK.

Now for the good news.

According to my hygienist, plaque’s molecular structure is such that it breaks down fairly easily when attacked by the above cleaning methods, and is thus rinsed clean away.

A by-product of the above regime is an almost-certain elimination of halitosis.

If you only have tooth decay, consider yourself fortunate in comparison.

If all else fails, and you’re not already bankrupted by the bill for periodontal treatment, you can always get a dental implant.

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