Delay or failure to diagnose and or treat periodontal (gum) disease


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Our specialist dental negligence lawyers have helped many people make successful claims and receive compensation for their injuries as well as for any corrective treatment that may be required. Your claim will be handled by true professionals who understand your anxieties and concerns, and have both the legal and dental expertise to help you through this difficult time.

What is periodontal disease?

Periodontal means ‘surrounding the teeth’. Therefore, periodontal disease affects the soft tissue (the ‘gums’) and bone around the teeth. Although many people refer to periodontal disease as ‘gum’ disease, we will use the proper term here.

There are many different types of periodontal disease, but this information relates to the most common, adult-type of periodontal disease.

Adult-type periodontal disease is a slowly progressive disease of inflammation and infection that affects the gums and bone around the teeth. If allowed to progress to the end stages of the disease, it will (and does) cause tooth loss.

What is gingivitis?

In the very early stages of periodontal disease, only the top of the gums, around the teeth are inflamed. This superficial inflammation of the gum is called gingivitis.

Gingivitis is caused by bacteria and food particles (‘plaque’). If plaque is left on the gum surface around the teeth for even just a couple of days, it irritates the gums, makes them red and swollen and then they bleed easily. These are the symptoms of the superficial inflammation, which is called gingivitis.

Gingivitis can be easily cured by better/more thorough tooth brushing. If the gums are brushed gently and thoroughly to remove the plaque, although they will initially bleed more because they are inflamed, this will gradually stop and the gums will become healthy again.

However, if left unchecked, gingivitis will develop into periodontitis, which affects the deeper layers of gum and the bone around the teeth.

What causes periodontal disease?

Like gingivitis, the main cause of periodontal disease is poor oral hygiene and the sustained build-up of plaque on the gums around the teeth. What begins as reversible superficial inflammation starts to affect the deeper gum layers and then the bone.

What happens in periodontal disease?

In the early stages of periodontitis, the deeper inflammation and swelling in the gum tissues pulls the gums away from the teeth. The spaces that develop between the root and the swollen gum are called ‘pockets’.

The periodontal pockets are very difficult to clean with normal tooth brushing technique and so they begin to get infected as the plaque and bacteria levels continue to accumulate.

The body’s reaction to any infection is to fight against it. Whilst this is good, in the case of periodontal disease, the body ends up destroying the bone that surrounds the teeth.

If the infection and inflammation is allowed to continue, the bone and tissues that attach the tooth roots to the bone are also destroyed.

If the destruction of the bone continues down the root surface, taking with it the tissues that attach the root to the bone, the tooth begins to feel loose. As the disease process continue, the tooth becomes even less attached to the bone, it will eventually be so loose that it falls out (if it hasn’t already been extracted because of pain and recurrent infections).

Symptoms of periodontal disease

In the early stages, the gums will look red and swollen and will bleed easily, sometimes just even when eating. You may also notice bad breath.

As the inflammation spreads deeper, involves the bone around the teeth and causes pockets to develop, in addition to the bad breath, you may also notice a nasty taste in your mouth and slightly wobbly teeth.

As the periodontal disease continues, the pockets deepen and you may begin to experience infections in the gums, which require antibiotics. You may also require root canal treatment to deal with the severe toothache and abscesses caused by these deep infections.

If the disease is allowed to progress, the infections get worse and the teeth begin to wobble. Ultimately, this continues until they are either extracted because of pain and recurrent infections or they may actually fall out of the gum!

Diagnosis of periodontal disease

A dentist can usually diagnose gingivitis just by looking at the gums around the teeth. There really is no excuse not to bring the need for better tooth brushing to your attention and perhaps also, refer you to a hygienist to help you get your gums back to health.

Although the advanced stages of periodontal disease are equally obvious (swollen gums and pockets with infection oozing from them and teeth moving with the slightest touch), the early stages of periodontal disease may require a little more effort to recognise the changes in the gums and the early formation of pockets.

That said, even the early loss of bone and attachment can be seen on a routine dental x-ray. When these are taken, it is not just the teeth that should be checked for signs of tooth decay.

Any dental x-ray offers an opportunity to check the bone levels. Any areas of bone loss should be noted and included in a treatment plan to improve oral hygiene both by simple, daily measures and also professional hygiene therapies.

During routine examinations, dentists should not only carefully look at the gums around the teeth, they should use a specially blunted periodontal probe to measure any loss of attachment down the root surface.

Initially, the dentist checks six specific teeth around the mouth to screen for periodontal pockets and loss of attachment. If these teeth have pockets and are therefore affected by progressing periodontal disease, the dentist should arrange to carry out a more detailed examination around every tooth in order to identify all the affected areas.

Treatment of periodontal disease

Once the areas of periodontal disease and their severity have been diagnosed, the dentist should form a treatment plan to address the underlying cause of the periodontal disease (poor oral hygiene) with professional help (usually from a dental hygienist) to clean the deepest periodontal pockets and try to encourage reattachment of the bone and gum to the root surface.

If the periodontal disease fails to respond and improve with simple and professional hygiene measures, the dentist may refer to a periodontist for specialist review and/or treatment.

Occasionally, gum surgery is required to surgically clean and/or reduce (or if possible, remove) the periodontal pockets. The aim of gum (‘gingival’) surgery is to remove the deeper areas of infection and make it easier to improve and maintain better hygiene around the gum and periodontal tissues.

Dental negligence claims arising from the delay or failure to diagnose and/or treat periodontal disease

The most common claims involving the delay or failure to diagnose and/or treat periondal disease include the following:

  • Delay or failure to recognise the visual signs of gingivitis
  • Delay or failure to explain the diagnosis of gingivitis or give preventive care and/or advice
  • Delay or failure to investigate any reported symptoms of periodontal disease
  • Failure to take x-rays/to take clear and clinically beneficial x-rays
    Failure to adequately review any x-rays taken
  • Failure to recognise the radiographic signs of periodontal disease
  • Delay or failure to explain the diagnosis of periodontal disease or give preventive care and/or advice
  • Delay or failure to refer for professional help with oral hygiene
  • Delay or failure to refer for specialist review and/or treatment
  • Over-reliance on antibiotics to treat recurrent periodontal infections without any active intervention
  • Failure to monitor areas of periodontal disease

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