Your teeth are all held in to the jaw bone by tiny ligaments, known as ‘periodontal ligaments’. These ligaments act like springs around a trampoline, connecting the bone and the cementum (outermost layer) of the tooth root. This means that teeth are slightly springy, moving a very small amount when you bite down to chew. If plaque (bacteria in your mouth) is not cleaned off properly, it can build up along the gingival margin (where the gum line and tooth meet). Initially, this causes some reversible inflammation, where the gums may get red and bleed easily, for example when you brush. It is usually painless and is known as gingivitis.
If brushing doesn’t improve and the gingivitis is left to progress, it can develop to periodontitis, which is irreversible. The bacteria can start to move down the side of the tooth onto the cementum of the root, causing damage to the ligaments/springs that hold the teeth in place. Where the ligament is damaged, it forms a ‘pocket’ in which more bacteria can collect, causing damage deeper and deeper down the side of the tooth. In health, the gap down the side of the tooth is less than 2mm, anything more than this could be considered as damage, which can be very difficult to access and clean with your toothbrush. As more and more ligaments are damaged irreversibly, the tooth may become wobbly and eventually could fall out. Infection is also likely in these sites, because bacteria can grow and survive there undisturbed. This can ultimately result in abscesses and significant tooth ache.
The purpose of professional cleaning is to access inside the ‘pockets’ with special instruments that can reach where a toothbrush at home may not. The bacteria are cleaned off the root of the tooth, effectively giving you a ‘clean slate’ to maintain at home. Whilst the damaged ligaments cannot be replaced, professional cleaning (also known as root surface debridement) can help slow down the progression of the disease. The important thing to understand though, is that the key to stopping periodontal disease getting worse is home cleaning. Your dentist or hygienist can talk to you about brushing and how to maintain your teeth at home. By preventing the bacteria building up again on the teeth, it can’t move down into the pockets causing more damage, therefore stabilising the disease. In severe cases, we usually recommend 3 monthly cleans, but eventually when disease is stable this time frame can be reduced. Your dentist will advise you on what cleaning is needed and how often you need to return for treatment.
Want to know more? My blog post on 24/12/2017 is all about how to look after your teeth and gums!