Gums that bleed when you brush are never “normal”. It is the first sign of periodontal disease — and, caught in time, it is reversible.

1. Healthy gums

Healthy gums are pink in colour with a lightly stippled, orange-peel texture. They are naturally able to defend themselves against bacteria and viruses.

2. Gingivitis

Gingivitis is the term used when bleeding, pain or swelling appear. Detected and treated in time, it is reversible.

3. Periodontitis

Untreated gingivitis progresses to periodontitis. The bacteria advance and, once past the barrier of the gum, attack the bone that supports the teeth.

That bone is destroyed little by little: after a certain time the teeth become loose and painful, they recede and eventually fall out.

Treatment, step by step

• Learning a proper brushing technique — the foundation of the whole treatment, without which nothing holds in the long term.
• Initial treatment: eliminating the direct causes (tartar, plaque) through scaling and subgingival curettage with root planing; then the indirect causes (defective fillings and crowns, overlapping teeth) to make the ground healthy again.
• Application of the dental laser, which achieves deep decontamination of the tissues.
• Periodic review — maintenance: periodontal disease can start progressing again if cleaning standards are no longer kept up.

What to remember

Periodontics is as much about follow-up as it is about treatment. A patient who is treated and then reviewed regularly keeps their teeth; a patient who is treated but then lost to follow-up often sees the disease return.

Gingival hyperplasia is characterised by an increase in the volume of the gum. It may be accompanied by bleeding and by a bluish-red gum, different from a healthy one. Its causes may be general or local — and that distinction is essential in deciding how to treat it.

General causes

Some cases of hyperplasia originate outside the mouth altogether:

• taking certain medicines;
• a hormonal problem;
• a vitamin C deficiency;
• a blood disorder, such as leukaemia.

In these cases, treatment begins with addressing the underlying cause, referring the patient to a specialist doctor where necessary.

Local causes

The most common cause remains poor oral hygiene, which leads to a build-up of plaque and tartar and, in turn, to inflammation of the gum.

What does treatment involve?

Where the cause is local, treatment generally follows several stages:

• bringing day-to-day oral hygiene back up to standard;
• scaling appointments;
• curettage appointments;
• where necessary, gingival reduction surgery.

Regular review then ensures that the inflammation does not return.