Untreated gum disease, also known as periodontal disease, is the main cause of tooth loss and ranks high among the most prevalent oral health issues globally. Dental implants are typically not a good idea when gum disease is present. The reason being, infection poses a threat to the stability of the jawbone implant in this scenario. But it doesn't rule out getting an implant. First things first: gum disease treatment. Dental implants can restore lost tooth structure, but they won't "cure" gum disease. Safe placement of the implant can only occur after the gums have been restored to health through treatments like scaling and root planing.
In this article, we will address the most frequently asked questions regarding dental implants and gum disease. Covering topics ranging from daily oral care to advanced treatments such as All-on-4 or All-on-6, we will explain what you need to know to protect your gum health and achieve a healthy smile.
Can you live your whole life with gum disease?
Although gum disease can be managed with regular monitoring, it is a condition that can persist throughout a person's life. The condition typically begins with a mild infection of the gums, known as gingivitis; if not addressed, the infection can progress to the bone, resulting in periodontitis. With periodontitis, the bone that supports teeth deteriorates, causing the gums to recede, the bone to weaken, and the teeth to loosen. This is a painless procedure that the patient might not even notice until their teeth start to jiggle.
There are serious consequences for dental health if gum disease goes untreated for an extended period of time. In cases where periodontal disease is not adequately addressed, the following complications may arise:
- Tooth loss: Periodontitis, if left untreated, can lead to tooth instability by eroding the bone that supports the teeth. The majority of tooth loss cases can be attributed to gum disease. So if the infection is not controlled, you are likely to lose your teeth over time.
- Bone loss and difficulties: When teeth are lost or bone resorption occurs, the jawbone naturally regresses. Potential treatments, like implants, become more challenging when bone density decreases.
- Loss of Aesthetics and Function: When teeth fall out, it can ruin a smile and make you look older and sadder than you actually are. Missing teeth or loose dentures also make it difficult to chew properly.
How to fix receding gums without surgery?
Although periodontitis-induced gum recession is notoriously difficult to treat, there are ways to manage the infection and stop additional recession:
- Deep cleaning (curettage):
During a comprehensive cleaning, your dentist will smooth out the root surfaces and remove calculus and plaque from the gum pockets. The gums will no longer be inflamed and will be able to cling firmly to the tooth surface. Eventually, gum recession will come to a halt as the pocket depth decreases.
- Laser treatment:
While treating periodontal disease, lasers can be an effective tool in certain instances. The infected gum tissue can be cleaned and bacteria killed with laser-assisted procedures like LANAP. Laser treatment is a modern option that can help control gum disease without the need for surgery.
Once the inflammation is under control, your gums can regain their healthy state and tighten again around the teeth.
How far can gums recede before teeth fall out?
The most common reason for missing teeth is the gradual deterioration of the bone that supports them. Gum recession is an indication of underlying bone loss. Given this, it's hard to say with certainty "when the gum recedes by so many millimetres, the tooth will fall out." However, noticeable receding gums are a sign of advanced bone loss and drooping teeth.
Over time, periodontal disease causes the bone that surrounds teeth to progressively dissolve. As the bone support decreases, the gums move away from the teeth and the teeth begin to appear longer than normal. In addition, deep periodontal pockets form between the tooth and gum. These pockets are too deep to be cleaned with a brush or dental floss and the bacteria accumulated in them accelerate bone destruction. As a result, the tooth loses most of its bone support and becomes loose. The patient might feel a shift in the tooth's position when biting down on hard objects; in severe instances, the tooth could even fall out on its own.
Can i get my teeth fixed if i have gum disease?
When you have gum disease, you must treat the infections in your gums before you can get restorative or cosmetic treatments done on your teeth, like fillings, veneers, crowns, or implants. So yes, you can have your teeth straightened even if you have gum disease, but it is essential not to leave active gum disease in the mouth before a cosmetic or permanent procedure.
It may be necessary to extract teeth if periodontal disease has caused extensive damage to them.
Alternative to dentures with gum disease
A removable denture wearer may experience a much reduced chewing force (about one tenth) compared to natural teeth. Lower jaw prostheses are often displaced by tongue movement, and upper dentures can also reduce the sense of taste because they cover the palate. In addition, as the jawbone melts over the years, the fit of the prosthesis deteriorates and the retention of the prosthesis decreases.
Since implants transmit load to the bone, they help prevent bone resorption that will start after tooth extraction. Because of this, your jaw line will not "collapse" and your face will remain flawless.
If you are missing all of your teeth or have had them extracted, the All-on-4 treatment can be a permanent solution to your denture problems. After the infected teeth are extracted, the surface is cleaned, increasing the likelihood of success for implants, even in cases where periodontal disease has been previously treated.
Dental implants with no gums
Even in a mouth with almost no intact gum and bone, dental implant treatment can be performed with the right preparation. In cases of severe bone loss, bone grafting may be required before the implant. The jawbone is strengthened by placing artificial bone powder or grafts taken from the patient's own bone in the melted bone areas. After sufficient bone volume is provided, implants can be safely placed.
In cases of complete edentulism, implants are positioned using existing bone with advanced techniques such as All-on-4 without the need for bone grafting. If the gum tissue is also very reduced, gum grafting can be performed with tissue taken from the palate to partially cover the exposed root surfaces. This lessens sensitivity and enhances the visual appeal to a certain degree.
Can you get veneers with gum disease?
Laminate veneers, also known as leaf porcelain, are not a good choice for patients with active gum disease because they are cosmetic. The precision of the measurements and the veneer's fit to the gum margin are compromised when the gums are inflamed and swollen. Furthermore, the gums will keep receding if the disease is left untreated, which means that the veneer edges will become visible quickly or worse, you may lose both the tooth and the veneer. Because of this, getting your gums healthy again should be your first priority before getting veneers.
All-on-4 dental implants and gum disease
The All-on-4 procedure is typically conducted in cases of "terminal dentition," when teeth are irreparable. In this treatment, all bad teeth in the mouth are first extracted, so that the sources of infection in the tooth roots are removed. Immediately afterwards, 4 implants are placed in the jaw in the same session and temporary fixed teeth are inserted. In other words, on the day the patient gets rid of the infected teeth, he/she gets his/her new teeth without being toothless.
Traditional dental practice dictated waiting to place implants in patients whose gums were actively inflamed. But this opinion has been changed due to the successful results achieved with the All-on-4 technique. Researchers found that implants can fuse and stay healthy even in a mouth with periodontitis, provided that the infected teeth are extracted.
To ensure the longevity of the implants after All-on-4, the patient must follow the care instructions to the letter. As one implant surgeon said: "You can either smoke or you can have teeth; you can't have both." Smoking accelerates periodontal disease and severely reduces implant success. Therefore, anyone undergoing All-on-4 treatment should avoid smoking, especially during the healing process (first few months).
Prevention & maintenance
Just like with real teeth, plaque can collect around dental implants. The difference between a natural tooth and an implant is that a natural tooth is surrounded by periodontal connective tissue, whereas an implant fuses directly with the bone. Nevertheless, bacteria can cause inflammation around the implant, which leads to bone loss called peri-implantitis. For this reason, regular dental exams and excellent oral hygiene are of the utmost importance.
Sources:
1 Gum bleeding and early tooth loss: Periodontal disease and dental implants in Ehlers-Danlos syndrome- Marcel Hanisch, Johannes Zschocke, Ines Kapferer-Seebacher
2 D'Ambrosio, F. Periodontal and Peri-Implant Diagnosis: Current Evidence and Future Directions. Diagnostics 2024, 14, 256. https://doi.org/10.3390/diagnostics14030256
3 Influence of Implant Surfaces on Peri-Implant Diseases - A Systematic Review and Meta-Analysis Author links open overlay panel Ahmad Hussein, Maanas Shah, Momen A. Atieh, Sara Alhimairi, Fatemeh Amir-Rad, Haitham Elbishari https://doi.org/10.1016/j.identj.2024.10.007