While everyone yearns for a perfect set of pearly white teeth, the gums are often neglected. Bervin Cheong discovers that a beautiful smile is not just about teeth alone.

The general idea is that every person with a beautiful smile has perfect, straight white teeth, and this misconstrued notion is widely propagated in the media and advertisements. It has come to a point where everyone is demanding a flawless set of ivories when visiting the dentist. However, what is not discernible is what matters most, it seems.

The gums are hardly seen when a person smiles, and because of this, a large number of people tend to neglect their gums. While this may be a case of either ignorance or indifference, it still remains a huge problem in oral health.

Aesthetically, the gums affect a smile in so many different ways. Healthy teeth are important but they are counterproductive if your gums are unhealthy. Many people do not realise that although the gums may not be visible to others in a smile, they play an important part in holding teeth to the jaw.

Once gums start bleeding and receding, only then do people realise that their smile might be affected, but by then, it is almost too late as they are in the late stages of gum disease. Ultimately, the teeth will begin to fall out, no matter how healthy your set of teeth may be!

Getting To Know Our Gums

The gums are the soft tissues covering the bones of the jaw as well as part of each tooth, and they are seen as the pink portions above or below our teeth. It is said that healthy gums are firm to the touch and they have well defined, pointed tips at the junction between two teeth.
A patient in the advanced stages of gum disease with plaque and tartar
causing advanced bone loss and thus, a receding gumline.Very much akin to the foundations of a strong building, the gums keep the teeth snugly in place without moving, and they hold the teeth firmly to the underlying bone. Thus, if the condition of the gums is compromised, the teeth are affected as well.

A periodontist practising in Malaysia, Dr. Jeanette Chua, says that the prevalence of gum disease is pretty high in Malaysia due to the fact that awareness is very low compared to other countries such as the United States. She adds that a large number of the population do not really know how to maintain and keep their teeth clean in the correct manner.

When The Problem Takes Root

Gum disease, also known as periodontal disease, is an infection of the gums and supportive tissues around the gum, which is caused by bacteria that form a sticky, colourless plaque on the teeth and gums. When not removed regularly either by brushing or flossing, this plaque develops into a hard, rough deposit that is yellow in colour – called tartar.
Before: Pictures showing the reddish unhealthy gums before first phase
periodontal deep scaling and antibiotic treatment followed with oral
hygiene instruction, and one month after, where the gums are pinkish and healthy.After
Build-up of plaque or tartar irritates the gums; as the bacteria produces toxins, the gum tissues breakdown and the gums pull away from the teeth. This forms more pockets of space for bacteria to accumulate and eventually the bones begin to get destroyed and the teeth start to loosen.

While the gums are not usually seen when someone talks or smiles, advanced gum disease asserts itself visibly, and certainly makes an ugly social statement. Dr. Chua confirms that one of the common signs of gum disease is bad oral odour, which is caused by the bacteria in the oral cavities. She also adds that when teeth become loose, their position and length shifts – producing an uneven gum line and gaps between the teeth, which is clearly seen in a smile. Worst yet, are when the gums begin bleeding and swelling as a result of inflammation of the tissues caused by the bacteria.
However, with that being said, more often than not, gum disease is a silent disease. It produces no symptoms initially and hence most are unaware they even have it. The best way of detecting gum disease is of course, to visit a dentist. With regular check-ups, the infection can be caught early and treated. This offers the best results.

To Root Out The Problem

Treating gum disease begins with proper diagnosis, says Dr. Chua. Without the correct diagnosis, there is no such thing as treatment, as addressing it symptomatically without eliminating the cause, would only result in a recurrence of the disease.

She further states, "You have to find a good dentist to ensure that diagnosis is done early. If there is true periodontitis present, it needs to be treated early enough so that is doesn’t get worse, where you end up having major problems."

Gum disease can be detected during a regular dental check-up, but an in-depth examination is needed to determine the extent of the disease. This may be done by a periodontist (a dentist who specialises in the diagnosis, treatment and prevention of gum disease), and usually medical history is looked into because various conditions such as diabetes, smoking and ongoing medication can affect gum health. Dental history is taken into consideration and this is then followed by a dental examination.
FrontSideSeries of pictures of both the front and side view of the upper right central incisor
with an X-ray showing severe bone loss due to advanced chronic periodontitis. The tooth was later
extracted with immediate implant placement with own tooth as the
temporary crown over the implant.
After: Picture of the tooth after a dental implant was done.
Non-surgical treatments are used to remove plaque and tartar build up in mild forms of the disease as in gingivitis. Gingivitis is the first stage of gum disease and involves plaque and tartar forming along the gumline, which irritates the gums. In these cases, scaling and root planning is carried out. Scaling is a form of cleaning that removes plaque and tartar from each tooth and below the gumline, while root planning smoothes the surfaces of the root (which makes it more difficult for bacteria to stick on them). Ancillary treatments are also given in forms of antibiotics, bite correction and splinting.

Dr Jeanette ChuaAdvanced stages of gum disease on the other hand, require surgical treatment. If one has periodontitis (whereby the infection has spread to the bone causing destruction), scaling and root planning are not sufficient to reach deep into the site of infection. Surgical tools are needed to open the gums and clean the pockets that have formed due to the destruction of the bone. Reconstructive work is also done to minimise the effects due to tissue destruction and bone loss. These vary from flap surgery and bone surgery to tissue and bone regeneration, as well as bone or soft tissue grafts.

Nevertheless, treatment of gum disease is a lifelong commitment and the most effective way of treating it is to make it a way of life. No matter how thoroughly the teeth are cleaned by the dentist, a person still needs to follow up with good oral hygiene practices and regular maintenance with a dentist. The role of the dentist is only to help control the disease by removing the cause of it, but it is really up to a person to maintain the care of their teeth and gums, so as to avoid recurrence of the disease.

Changing Gums

When talking about cosmetic gum surgery, Dr. Chua says that this is done very often for root coverage procedures or crown lengthening. In fact, quite a fair number of cosmetic gum procedures are now performed in Malaysia, whether as an adjunct to the treatment of gum disease, or purely for cosmetic reasons.

However, she also says that unlike in the United States where the citizens are fully aware of the options available to them with regards to cosmetic procedures for gums, most Malaysians do not even know that the appearance of their gums can be changed.

Gumming It The Right Way

As cliché as it may sound, prevention is better than cure. And where gum disease is concerned, there is no better or less costly way of treating it than preventing it from occurring in the first place.

Dr. Chua comments that there is no way to prevent gum disease, except by practising good oral hygiene, together with regular examination and maintenance by a dentist – and the sooner, the better. It is better to start at a young age and acquire the right brushing techniques and methods of keeping teeth clean before you get to the stage when you become susceptible to gum disease.
Good dental hygiene coupled with regular maintenance check-ups can ensure that plaque build-up is reduced in the future. Not only will you have healthy teeth but healthy gums as well, and both will give you a marvellous, beautiful smile.

Remember, a beautiful smile is not merely about teeth alone. More so, behind every pretty set of teeth are healthy gums.
So, it is time everyone came back to the basics.