Gum disorders

Gum disease describes swelling, soreness or infection of the tissues supporting the teeth. There are two main forms of gum disease: gingivitis and periodontitis. Other rare conditions like cancer or auto-immune inflammation can affect the gums as well.

The human mouth can contain millions of bacteria which cause inflammation of the gums (gingivitis).  This can progress to periodontitis when the gums pull away from the teeth forming spaces called pockets. These pockets can harbour more bacteria leading to more inflammation. If not treated, the bones and tissue that support the teeth are destroyed. Teeth may become loose and may need to be removed.

It is a colony of bacteria that forms on the teeth and appears like a soft white substance above and below the gums. Plaque can be easily removed with careful home brushing techniques

Calculus (tartar) is calcified bacterial plaque that can form within 24 hours of plaque formation. It is yellowish above the gums and black or brown below the gums. Calculus is hard and tenacious and usually requires professional assistance rather than home cleaning for effective removal.

Gums disease can affect everyone if bacteria are allowed to build up on teeth but only susceptible people develop periodontitis where pockets develop and bone supporting the teeth is destroyed. The UK Adult Dental Health Survey of 2009 shows that 45% of the whole UK population has periodontitis.
The following groups get more severe gum disease than others:

  • People who smoke.  Gum disease can be 5 – 8x more severe in smokers
  • People with poorly controlled diabetes
  • People with a family history of gum disease

You may have early gum disease if:

  • Your gums are red and swollen
  • Your gums bleed easily when you brush or eat hard foods. Bleeding gums are not normal
  • You have bad breath

With severe disease you may notice that:

  • Your teeth may become wobbly
  • Your gums may recede making the teeth look longer
  • Spaces may open up between the teeth or some teeth may become more prominent

Early intervention will improve the success of any treatment and will help prevent the loss of your teeth. There is strong irrefutable evidence that advanced periodontitis can have an effect on your cardiovascular system or your blood sugar. Early management of periodontitis may help your general as well as dental health.

Teeth are classed as having a poor prognosis if they have any of the following:

  • Advanced bone loss of greater than 60%
  • Advanced mobility
  • Advanced recession greater than 5mm
  • Advanced furcation involvement in molars. This is bone loss extending into the space between the roots in molars with multiple roots.

Gum treatment

In most people the treatment aims to prevent the disease from getting worse and cannot reliably replace the bone support your teeth have already lost. Early intervention will improve the success of any treatment.
Treatment is based on controlling the bacteria growth on the teeth and below the gum line. It can comprise of one or more of the following.

  • Plaque control advice
  • Non-surgical debridement
  • Periodontal surgery
  • Regenerative surgery
  • Mucogingival surgery
  • Crown lengthening surgery
  • Root resections or hemisections
  • Crowns and bridges
  • Extractions in severe cases.

•Any bleeding or swelling of the gums should reduce or disappear
•Teeth will last longer
•Your breath will become fresher
Healthier gums mean that you should be able to keep your teeth longer. The improvement will depend on how good your cleaning becomes and how severe your disease was to begin with.

Several long term clinical trials have proven the high success levels of periodontal (gum) therapies in maintaining teeth for decades. There is also evidence to show that treated gum disease can reduce the risk of cardiovascular disease and can improve blood glucose level in diabetic patients.

​Gum disease progresses painlessly on the whole and most patients do not notice the damage it is doing. Over a number of years, the bone supporting the teeth can be lost leading to mobility or drifting of the teeth, as well as, gaps appearing between the teeth. If the disease is left untreated for a long time, treatment can become more difficult. Moreover, this disease can affect implants and lead to failure of implant treatment if it is not managed, monitored and maintained.

Non-surgical debridement (previously known as scaling and root planing or deep scaling) is thorough disinfecting of the teeth above and below the gums to remove plaque and calculus as much as possible leading to an improvement of gum health. Electronic instruments and hand instruments are usually utilized for debridement. As your gums heal following the treatment, the swelling will reduce and the gums may appear to have shrunk. Sensitivity to hot and cold foodstuffs occurs in most cases but is mostly transient. A frequent complication is mild discomfort and a slight fever after this therapy which is short lived. Antibiotic tablets are considered to improve the response to treatment in the severe or resistant cases.

Periodontal surgery is a minor surgical procedure done under local anaesthetic for persistent non resolving sites of inflammation after non-surgical debridement. It is usually carried out for  patients with a high level of plaque control.  Periodontal surgery has the following benefits:

  • better visualization of the roots and removing any calculus or bacterial plaque under the gums
  • reducing any pockets and inflammation around the teeth
  • slowing the progression of bone loss
  • reducing the risk of tooth loss 

The risks of this treatment are:

  • pain swelling and bruising and responds to simple painkillers and usually resolves over a few days
  • increase in dental sensitivity to temperature
  • gum recession and the appearance of longer teeth
  • infection of the gums or the root end of the teeth
  • persistence or relapse of pocketing
  • temporary increase in mobility which reduces with time

Low plaque levels have been shown to maximise the healing outcome, therefore, monthly hygienist visits are usually necessary after periodontal surgery for 3 months. The site of the surgery is assessed about 12 weeks from the date of the surgery.

Video: What is periodontal surgery?

Regenerative surgery is a form of minor surgery to achieve the benefits laid out above but with the added aim of encouraging bone growth with regenerative pharmaceutical products originating from animal, plant or synthetic origins. Animal based products are harvested from specially reared animals which have been tested to ensure freedom from infectious agents. Use of animal based products has been well documented in the scientific literature since the 1990s with no recorded side-effects and results in a superior outcome to the use of plant or synthetic regenerative products.
This surgical procedure can result in the regeneration of supporting tissue around teeth in certain situations and improve their prognosis. However, the suitability of this approach depends on the anatomy of the bone around the treated teeth which will be fully visualized during the surgical treatment. Use of regenerative agents is considered only if the bone has an appropriate 3D shape, otherwise, the site is dealt with in a conventional manner as described in the point  above.
The risks of the procedure are similar to Periodontal surgery.
Monthly hygienist visits are usually necessary after periodontal surgery for 6 months to ensure that that level of plaque is minimised on the teeth during healing which has been shown to maximise the treatment outcome. The site of the surgery is assessed about 6 months from the date of the surgery

This is a form of plastic surgery used to correct the effects of recession caused by periodontitis or poor developmental anatomy or traumatic toothbrushing. It is usually indicated to improve the gum thickness to reduce the risk of further recession, reduce dental sensitivity, in some cases cover the roots. In severe cases, it can improve the life span of the teeth treated. The ability to achieve root coverage reduces with increasing extent of recession.
Mucogingival surgery usually involves transfer of a small amount of gum from the palate to the area in question. This will provide an area of tough and thick gum that will be easier to maintain clean and in turn reduce the risk of the recession worsening. Whereas, the donor site in the palate will heal very readily with new tissue.
If a large amount of tissue is required, acellular dermal matrix is used instead. This is a pharmaceutical product obtained from a human tissue origin which is freed of cells and as such there is no recorded risk of transmission of infection or tissue rejection. Acellular dermal matrix has been used in medicine and dentistry for over ten years to repair hernias, breast reconstruction and for dental root coverage.
Mucogingival surgery is a safe and delicate procedure with a high success rate particularly if gentle tooth-brushing techniques are employed. The only complications are pain swelling and bruising in the first week postoperatively and tend to be self-limiting in most cases with use of standard over the counter painkillers.
There are certain instances when this proposed procedure fails due graft necrosis. This usually occurs due to failure of establishment of new blood supply caused by a disruption of the graft during the healing period by lip pulling for example. Following graft necrosis, the gum returns to its initial position prior to the surgery but in very rare cases it can worsen.
Low plaque levels have been shown to maximise the healing outcome, therefore, monthly hygienist visits are usually necessary after periodontal surgery for 3 months. The site of the surgery is assessed about 12 weeks from the date of the surgery.

This is the removal of one or more roots of a molar or premolar tooth. It is indicated where one or more roots have severely lost bone support or have been unsuccessfully treated with endodontic therapy. This procedure can help to retain a tooth that would otherwise be lost
The roots that left supporting the tooth must have a good bone support and successful endodontic treatment. Endodontic treatment is usually recommended prior to root resection.
Root resected teeth have a success rate of 50% -90% over 10 years depending on the quality of the endodontic treatment, the presence of a protecting crown and the extent of bone support remaining on the supporting root(s).

It is a complex treatment that centres around cleaning and disinfecting the root canals of a tooth and filling them with a rubber based filling material. It has a high success rate for retaining teeth. The most common complications are non-resolution of root end infections or tooth fracture as a result of the treatment.

Crown lengthening gum surgery is a form of gum surgery required to increase the length of the teeth. This is usually considered around teeth requiring crowns and it will increase the retention of the crowns and reduce the risk of failure due to fracture of the teeth or de-bonding of the crowns. The risks of the procedure are pain swelling and bruising which is standard with any surgical procedure and usually lasts for a period of 10 days. The teeth will also look longer and with larger gaps, as a result of moving the gums. Sensitivity to temperature can occur after the procedure but it usually resolves with time.  Occasionally, uneven healing occurs resulting in and uneven gum line. This is usually corrected by repeating the procedure.

Tooth splinting is a technique use to join teeth together that would otherwise be loose or likely to drift during normal function. Splinting can be directly done in the mouth using white resin materials or indirectly with laboratory made crowns.
It is important to note that splinting can complicate plaque control brushing regimes and it is important to maintain regular visits to the hygienist to avoid calculus build up around the splints but also to detect fracture or staining of the splints.
The life span of splints varies. The need to replace them depends on chewing forces, staining effects of the dietary foodstuffs and progression of bone loss.

This is an essential component of any periodontal or implant treatment. It consists of regular visits to general dentist , hygienist or periodontist. The frequency of these visits depend on the general risk factors and the patients response to treatment.

​During these visits, you will have:
Oral cancer screen
Periodontal (gum) screen
Plaque levels assessed and your brushing regime reviewed if plaque accumulation is noted
Calculus and plaque will be debrided
Deep gum pockets and areas of gum bleeding will also be debrided
Local anaesthetic is recommended for deep pockets to ensure thorough debridement
Fluoride varnish is applied to any sensitive teeth or any teeth with high risk of decay

There is overwhelming evidence to show that patients who adhere to a maintenance program retain their teeth and implants longer. Moreover, teeth with a poor prognosis survive longer if patients adhere to a strict maintenance program.

Gum recession

Gum recession is the shrinkage of gums that occurs around teeth or implants. It causes teeth to look longer than normal and can have aesthetic or health implications.

Gum recession is caused by:

  1. Periodontitis or its treatment
  2. Orthodontic tooth movement
  3. Abnormal jaw shape
  4. Trauma from tooth-brushing for example
  5. Peri-implantitis affecting dental implants
  6. Toothwear from dietary acids or toothbrushing
  7. A combination of the above factors.

Gum recession is associated with:

  1. Poor smile aesthetics due to longer looking teeth
  2. Dental sensitivity
  3. Root end infections called apical periodontitis requiring root canal treatments or extraction of teeth
  4. Periodontitis leading to bone loss around teeth and making replacement of teeth complicated
  5. Drifting of the teeth and appearance of gaps.

It is important to note that gum recession should be monitored and treatment should be considered if recession is increasing or one of the four factors above is noted. At present, no research groups have been able to predict when recession progresses so early treatment is advisable to prevent complications.

Gum recession can be corrected with a variety of ways such as:

  1. Mucogingival surgical techniques to cover exposed roots
  2. Mucogingival surgical techniques with tissue grafts or biological materials to assist with covering roots in advanced cases that were previously thought to be untreatable
  3. Using restorative materials such as gum veneers or crowns
  4. Using orthodontic repositioning of teeth can also be recommended

These techniques are only effective after removal of the cause of the recession particularly traumatic tooth brushing. Several studies have demonstrated the long term effects of this treatment in correcting gum recession and preventing re-occurrence.


Peri-implant gum disease refers to inflammation around implants presenting as swelling, soreness or infection of the tissues surrounding implants. There are two main forms of peri-implant gum disease: mucositis and peri-implantitis.

It is caused by a number of factors but most commonly it is caused by bacterial plaque on the implants or the crown they hold. Bacterial plaque is a bacterial colony formed by bacteria that live in the mouth normally. It is normally visible as a soft white film that forms on teeth and implants but can turn into a tougher hard deposit called calculus or tartar when left for as little as 24 hours in some patients.
Other causes of peri-implant gum disease include mechanical failure of implant components or crown cement irritation.

It is inflammation of the soft tissues around implants that has not resulted in bone loss. It is usually reversible with simple home cleaning methods and professional scaling by a hygienist for example. If left unaddressed it can lead to peri-implantitis

It is inflammation of the soft tissues around implants that has resulted in bone loss. It is generally painless and continues to progress until it results in complete loss of the implant. It usually initially presents as mucositis which leads to bone loss and the gradual formation of spaces around the implants called pockets when the gums pull away from the implants. These pockets can harbour more bacteria leading to more inflammation. If not treated, the bone and tissues that support the implants are rapidly destroyed. Implanted teeth will eventually become loose and will need to be removed. ​

No reliable methods are available currently to predict if an individual patient will suffer from peri-implantitis.  However, patients belonging to the following groups are at a higher risk of developing peri-implantitis:

  1. Patients with high levels of plaque due to ineffective cleaning regimes
  2. Patients with history of periodontitis commonly called gum disease
  3. Smokers
  4. Poorly controlled diabetic patients
  5. Patients with excessive alcohol consumption

You may have early peri-implant gum disease if:

  • Your gums are red and swollen
  • Your gums bleed easily when you brush or eat hard foods. Bleeding gums are not normal
  • You have bad breath
  • You may a salty or metallic taste in your mouth

With severe disease you may notice that:

  • Your implant becomes wobbly
  • Your gums have receded exposing the metallic portion of the implant

Take action if you notice these signs. Contact your dentist who may provide assistance or refer you to a periodontist. Early intervention will improve the success of any treatment and will help delay or prevent the loss of your implants.

In most people the treatment aims to prevent the disease from getting worse and cannot reliably replace the bone supporting your implants. Early intervention will improve the success of any treatment.
Treatment is based on controlling the bacterial growth on the implants.

  • The bacterial plaque can be cleaned away from both above and below the gum line to reduce the gum inflammation by a process called implant surface debridement. This is usually done with a local anaesthetic to make sure that this process is completely comfortable for you and will usually involve the neighbouring teeth.
  • Antibiotic drugs are used for some cases to reduce the bacterial levels but the treatment mostly relies on electronic and hand instruments to mechanically remove plaque off the implant surfaces. Lasers have been utilised in some treatment trials but they do not offer a clear advantage to mechanical plaque removal.
  • Effective daily home cleaning is essential for treatment success. Patients are shown best methods for cleaning teeth and gums to remove plaque on a daily basis. It must be noted that exposed implant surfaces are rougher than teeth making them challenging to effectively clean.
  • These cleaning methods will be different for different people and will be reviewed by your periodontist and hygienist on regular intervals. Without effective home cleaning methods and close monitoring, long term predictability of the treatment is reduced and the risk of relapse becomes greater.
  • In moderate to severe peri-implantitis, surgical treatment may be required to remove inflamed gum tissue or to help reduce further bone loss around teeth. This is usually done under local anaesthetic and it is a painless procedure. Please let us know if you are anxious about this treatment and we will consider the use of sedative technique to create a calming and relaxed atmosphere whilst you are having the treatment.
  • In severe cases of peri-implantitis or in cases that are not responding to treatment, removal to the implant(s) may be necessary to limit the destruction of bone in the surrounding area. This can usually be followed by placement of other implant if necessary after a period of healing.
  • Following active treatment, patients will usually require long term monitoring to ensure stability and early management if relapse occurs.
  • Bleeding, swelling and pus associated with the gums around implants should reduce
  • A reduction in the rate at which bone is lost from around the affected implants which ultimately means keeping the implants for a longer period of time.

Healthier gums mean that you should be able to keep your implants longer. The improvement will depend on how good your cleaning becomes, how well your specific risk factors are controlled and how severe your disease was to begin with.

Treatment methods for peri-implantitis have only been recently reported in the scientific literature and as such we do not have any long term data on the success of treating these cases. Current evidence suggests that bone loss around implants continues after treatment at a rate dependent on patient risk factors and that a minority of patients will loose implants despite the treatment (11%).

Perimplantitis progresses painlessly on the whole and most patients do not notice the damage it is doing. There is strong evidence to show that bone loss is rapid in cases that are not treated. This will lead to recession around implants, exposure of the grey metallic portion of the implant and gaps appearing between the teeth. The longer the condition is left untreated; the more complicated the treatment can become and the higher the risk of total implant failure.

Conscious sedation

​Frequently asked questions:

Conscious sedation techniques are a way of making anxious people feel more relaxed about receiving dental care. Fahd offers several techniques and the dentist who will see you at your assessment visit will help you decide which is best for you.

This is a technique whereby the patient breathes a mixture of nitrous oxide (also known as laughing gas) and oxygen through a special nose mask. It gives a pleasant calming feeling and most patient feel warm, floaty and tingly.
This technique is very safe and there are no after effects and most patients can drive or return to work the same day. This technique is useful of patients with mild to moderate anxiety levels and especially useful for children. ​

A sedative medicine is given through a vein in the arm or the hand. The sedative will make you feel relaxed. You will be able to talk and cooperate with the dental treatment, but most patients cannot remember much about their treatment. Some people take a little time to recover and you will need to stay in the clinic until you are able to walk by yourself. It is important that you have someone with you who can take you home by private transport and stay with you for the rest of the day. This is a mandatory requirement.
This technique is safe and will allow treatment to be completed in over 90% of all anxious patients. It should not be confused with general anaesthesia.

This is a technique that causes complete loss of consciousness and is appropriate for major operations. It is not as safe as the previous conscious sedation techniques and must only be carried out in a hospital setting with an intensive care unit on site. Dental practices do not offer general anaesthesia and we only recommend it in special circumstances such as failure to cooperate with conscious sedation.

The drugs used for sedation normally result in a general light headed feeling or drowsy feeling and a considerable reduction in anxiety. This may last for 24 hours. You will also experience a certain degree of amnesia and may not recall some aspects of your treatment after the administration of the drugs. This only lasts during your treatment session but will not affect memory before treatment or after. After the treatment you may feel that you have fallen asleep because of the induced amnesia. The amnesic effect may also make the treatment session seem a lot shorter than it was. It must be stressed that at no point will you lose consciousness and your ability to communicate with us will be encouraged and maintained. This is a mandatory requirement that the team abides by to ensure that you are comfortable throughout the treatment session. After the administration of sedation, you will be given local anaesthetic to ensure that your treatment is pain free and comfortable.

Before your appointment

  1. You MUST NOT eat or drink anything for two hours prior to your appointment time. Before this you may have a light meal with clear fluids only eg toast and tea, coffee or fruit juice but avoid milk.
  2. DO NOT consume ALCOHOL 24 hours prior to appointment.
  3. You must be accompanied by a responsible adult (over 18 years of age) who must be contactable during your appointment.
  4. If you are taking any medication, ensure that its taken at the usual times
  5. The sedation team will only offer treatment after careful consideration of your medical history and your fitness to undergo this procedure. We may need to consult with your General Medical Practitioner to obtain more information. Any illnesses occurring before the appointment should be reported immediately as this may affect your treatment.
  6. Ensure nail varnish and false nails are removed before appointment.
  7. Please wear loose clothing to facilitate taking of blood pressure etc. and wear flat shoes.

After your appointment

  1. Your escort (a responsible adult) should take you home after treatment by private car or taxi NOT by public transport and look after you for the following 24 hours.
  2. You MUST NOT drive any vehicle, operate any machinery or use any domestic appliance for 24 hours after sedation (remember vehicle insurance is not valid if you drive at this time).
  3. You MUST NOT drink any alcohol, return to work, make any important decisions or sign any legal documents for 24 hours after sedation.
  4. You must NOT breastfeed for 24 hours
  5. You are advised to leave any valuables (eg. Handbags) with the person accompanying you or at home. No responsibility will be taken for any valuables lost on the practice premises.