Periodontal Disease – the silent disease

29 November 2019

Periodontal Disease, also known as gum disease, is the most common cause of tooth loss amongst adults.

Patients need be aware of periodontal disease which includes conditions such as gingivitis and periodontitis. Failure to diagnose or treat periodontal disease is an increasing area of litigation in dentistry. It is caused by bacteria which collect on the teeth and affects the gums, bone and other supporting tissues of the teeth. According to data published on the NICE website in 2018, studies indicate that around 50-90% of the adult population suffer from some degree of gingivitis and almost half of adults in the UK already have a degree of periodontitis.

Gingivitis is the inflammation of the gums mostly caused by the bacteria in dental plaque. Left untreated, it can progress to periodontitis. Periodontitis is chronic inflammation involving the supporting tissues around the teeth and can cause irreversible tissue damage. The gum detaches from the tooth neck, damaging the periodontal ligament and the thickened ridge of bone that contains the tooth sockets (the alveolar bone). An abnormal gap develops between the tooth and the gum. You may hear your dentist refer to this gap as ‘pockets’ or ‘pocketing’. The pockets contain plaque which cannot be removed with normal tooth-brushing and it can cause the tooth to loosen very slowly over time and eventually fall out. Left untreated, it can cause recurrent gum abscesses and the loss of multiple teeth.

If you hear your dentist mentioning ‘pockets’ or ‘bone loss’ or ‘gum infection’ without discussing its significance, and they don’t talk to you about periodontal disease and what it means, they may be breaching their duty of care.

Gum disease warning signs – What should I look out for?

You might experience a little bleeding whilst brushing your teeth, although you might not, particularly if you smoke. So in the early stages of the condition, you might not have any symptoms at all. At the point where you have an abscess, or notice that your teeth have drifted or become wobbly, you are likely already in the advanced stage of the disease. Some people only find out they have periodontal disease when they change dental practices or see a different dentist. For others, it’s at the point when teeth are already lost and they go to see a specialist about dental implants or other restorative treatment.

Particular risk factors include:

  • Poor oral hygiene
  • Genetic disposition
  • Cigarette smoking
  • Poorly controlled diabetes
  • Poor diet
  • Stress
  • Pregnancy
  • Malpositioned teeth
  • Crowns/bridgework/fixed orthodontic appliances

Managing the early stages of periodontal disease is relatively straightforward so dentists should be alive to the issue of gum disease. At every routine examination, your dentist should be performing a Basic Periodontal Examination (BPE) as a screening tool to indicate the level of further examination needed and provide basic guidance on treatment. If you have periodontal disease, your dentist should be discussing an adequate treatment plan with you and obtain your informed consent to that treatment. If you have periodontitis, you are likely to require specialist cleaning by a dentist or a hygienist using instruments that will clean the tooth’s root surface below the gum. Your dentist should be closely monitoring your periodontal condition at every appointment.Sometimes, you might need a referral to a specialist periodontist.

If you have received inadequate care from a dentist, this does not necessarily mean that you will have a claim for negligence. We are always happy to have a no-obligation discussion with you to find out about your circumstances and our team of expert solicitors will help you understand the options available to you.

For further advice on litigation in dentistry, please call us on 01483 543210 or alternatively email one of our dentistry claims solicitors.

By Natalie Hirst