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What’s the Difference Between GUM DISEASE and DENTAL DECAY?

Teeth SmileOver the past week, a few clients have asked the difference between dental decay/holes in the teeth, and gum disease. Are they the same bacteria? Is it because the bacteria are eating the teeth and gums away? Will cleaning the teeth be enough to prevent them from starting or progressing?

Yes, GUM DISEASE and DENTAL DECAY both are very different in their pathology, presentation and treatment, and dentists have devoted many years studying this stuff. So, below is a quick summary of how they differ from each other.

Interestingly, if left unattended, they both have the same outcomes – loss of the teeth. So take good care of them pearly whites!

About Dental Decay and Gum Disease

What does it affect?

Primarily affects the hard structures of the teeth, i.e. the enamel and dentine. When more advanced, it can affect the pulp (nerves and blood supply) within the tooth.

Primarily affects the gums surrounding the teeth. When more advanced, it can affect the ligaments and the bone (alveolar bone) surrounding the teeth.

What are their associated scientific terminology?

Enamel: The outer shell of the tooth (very hard) made of hydroxyapatite

Dentine: the bulk of the tooth under the enamel, including the root

Pulp: the nerves and blood supply of the tooth.

Demineralisation: the dissolution of the enamel and dentine.

Dental caries: cavity formation in the enamel and dentine, cause by demineralisation.

Pulpitis: inflammation of the pulp. (Can be reversible, or irreversible - this is when it is serious)

Endodontics: The study of the root canal system

Prosthodontics: The study of restoring the teeth

Periodontium: 4 separate structures described below:

Gingivae - the gums

Alveolar bone, and Cementum - Bone surrounding the roots of the teeth

Periodontal ligament - attachment of the roots of the teeth to the surrounding alveolar bone

Gingivitis: inflammation of the gums

Periodontitis: disease affecting the periodontium (this is when it is serious)

Plaque: layer of bacteria

Calculus/Tartar: Hardened/calcified plaque

Periodontology: The study of the periodontium

What bacteria are involved?

Streptococcus mutans, Lactobacillus

Lots of them:
A. actinomycetemcomitans, P. gingivalis, P. intermedia, B. forsythus, C. rectus, E. nodatum, P. micros, S. intermedius and Treponema sp.

How does it cause the problem?

The bacteria in the mouth utilizes sugars/carbohydrates from our diet to produce acid. These acids erode/demineralise the enamel and dentine, causing holes in the teeth

The imbalance of bacteria (many theories) in plaque irritates the gums causing inflammation. If left as it is, the inflammation progresses to destroy the periodontal structures.

How does it present?

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In early stages, it starts as a white spot lesion on the enamel.

As it progresses, the white spot lesions start to cavitate and turn into holes.

Sensitivity to hot and cold stimulus

The most common areas affected are the biting (occlusal) surfaces of the teeth and in between the teeth (inter-dental spaces).

In gingivits, the gums will appear red (instead of pink), swollen, and bleeds readily (eg when toothbrushing).

Plaque and calculus present

As it progresses to periodontitis, the attachment of periodontal ligament and alveolar bone is destroyed/lost, resulting in receding gums, pockets, and loosening of the teeth and bad breath.

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How do I know it is serious?

Irreversible pulpitis: occurs when the decay reaches the pulp and infects it.

The tooth is broken down.

The pain usually does not settle (for hours) even when the stimulus is removed. Pain can occur spontaneously.

Swelling on the gums next to the tooth due to an abscess (pus)

Poor oral hygiene - lots of plaque and calculus around the gums and teeth

Swollen gums due to abscess (pus)

Periodontal pocketing (loss of the alveolar bone structure - causing the gums to be unattached)

Subginigival calculus: Calculus forming inside the periodontal pocket

Pain and looseness when pressure is applied on the tooth

What does healthy teeth look like?

No white spot lesions or holes.

Gums are stippled, pink, knife edged, and don't bleed.

Teeth are firm.

How does the dentist treat it?

Early stages:
Fluoride varnishes/gels
Fissure sealants

If the cavity is restorable:
Fill it with a filling
Placed a crown over it

Irreversible pulpitis:
Root canal treatment
Take it out

Remove the plaque and calculus with an ultrasonic-scaler

All of the above
Periodontal surgery
Take it out

How do I prevent it?

Regular visits to the dentist!

Reduce amount and frequency of sweet and sticky foods

Avoid juices and fizzy drinks. These are both acidic and sweet! Use a straw.

Chew sugar free chewing gum (this stimulates saliva flow and can neutralize the acids)

Use a fluoride toothpaste daily. Fluoride helps strengthen the tooth surface

Regular visits to the dentist!

Remove plaque by using an electric toothbrush, interdental brushes, superfloss, waterpik, etc...

Concentrate on the gum margins (where the gums meet the teeth), not just the tooth itself

Quit smoking!

If you wear dentures, keep them clean and don't wear them at night