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Periodontal disease – everything you need to know about dental negligence and gum disease

Periodontal disease can be devastating, resulting in damage to and, if left untreated, the loss of teeth. Not only does this have an obvious physical impact on a person, but also the psychological impact of losing your teeth is well known. Therefore, to find out that it could have been avoided only makes things worse.

Here we explain what you might need to know about dental care, should you have experienced injury as a result of periodontal disease.

Click on any of the below links to find out more about any of your questions:

When should a dentist spot gum disease, and what are the symptoms?

When you attend a dental check-up, your dentist will be able to see if you have any dental problems.

When attending your dentist for a check up, the dentist will normally:-

  • examine your teeth, gums and mouth;
  • enquire about any problems or symptoms you may have had since your last visit;
  • provide advice about oral hygiene, and smoking and alcohol use.

Your dentist should also carry out a Basic Periodontal Examination (BPE) which is an assessment of the periodontal tissues. This mean that they will be giving a quick overview of the health of your gums.The dentist will carry out the examination by probing your gums and you may recognise that they will give a numerical score 0-4 for each the difference sections of your mouth.

The symptoms of periodontal disease, which a dentist should raise concerns about, include:

  • red and swollen gums that may be highly painful and bleed when cleaning;
  • bad breath that won’t go away – this is because periodontal disease causes ‘pockets’ in the teeth and gums which trap food and bacteria, which can then omit an odour;
  • painful abscesses that discharge pus, which is released when your gums try and fight the bacterial infection;
  • receding gums and sensitivity – which is a sign that the supporting tissues around your teeth are damaged;
  • loose teeth.

If you are concerned that you may be suffering from periodontal disease, you should speak to your dentist about this. If, upon speaking to them, you are still concerned that they are failing to diagnose the disease, you should seek a second opinion as soon as possible.

In addition, you should ensure that you adopt good oral hygiene practices. Regular brushing, as well as use of dental floss or interdental brushes will help to maintain a healthy mouth. Your dentist will be able to provide you with oral hygiene advice and show you how to use interdental brushes.

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What should the dentist say to a patient if they have diagnosed gum disease?

The dentist should inform the patient of the diagnosis and what they have found.

The dentist should also set out what treatment is required and the cost of the treatment options, as well as discussing with the patient the need to be proactive in improving their oral hygiene.

Robin Seymour, an expert in periodontal disease, demonstrates his process when dealing with a diagnosis of gum disease:

“As a specialist, I am frequently referred patients who are suffering from periodontal disease.

Once I have checked their medical history (including smoking history), I go on to complete a full dental examination followed by a detailed periodontal examination. The latter includes assessing the patient’s oral hygiene, the extent of inflammation in the gingival tissues, and full mouth probing pocket depths. In addition, radiographs are taken to assess levels of bone supporting the remaining teeth. The analysis of all these investigations allows me to make a diagnosis of the patient’s periodontal condition, which of course is shared with the patient.

Bacterial plaque is the major cause of periodontal disease and it is essential that the patient is made aware of this as well as the role that they play in arresting the disease and ensuring a successful outcome of treatments. The patient’s methods of plaque removal need assessing and modifying accordingly. The emphasis should be on thorough methodical tooth brushing and use of specific brushes or other devices for cleaning in between the teeth. Some patients may also find antiseptic mouthwashes useful.

If a patient smokes then they should be encouraged to stop as smoking will have an adverse effect on the outcome of periodontal treatment.

With regards the extent of disease that a patient may have, I find it useful to share with them the radiographic findings with the emphasis on bone levels and to demonstrate in their mouth a periodontal pocket. This is readily done with a dental probe which does help to illustrate the extent of loss of periodontal tissues.

Once good plaque control has been established (which should be checked at every visit), the next stage of treatment can commence. This next stage of treatment for moderate to advanced periodontal disease is referred to as root surface instrumentation (RSI).

I explain to the patient what this treatment involves and its purpose. RSI is normally carried out under local anaesthesia and involved debriding the periodontal pocket which has become contaminated with bacterial plaque and its products. Such treatment can be carried out by me or a therapist, using a combination of hand and ultrasonic instruments. If this treatment is successful (which is contingent upon good compliance with plaque control), then the gingival tissues will stop bleeding and start to shrink. It can take many months for the gingival tissues to heal completely and during this time, I continue to monitor the patient’s periodontal status on a three-monthly basis.

Some periodontal pockets do not respond to RSI and may require a surgical approach.

Throughout all treatment sessions and those which monitor outcomes, the patient’s plaque control is assessed as the outcome of any periodontal treatment is contingent upon the patient showing good compliance with their day to day plaque control.”

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Can gum disease be caused by having other types of dental treatment?

Whilst gum disease cannot be caused by other types treatment, having treatment such as braces before the gum disease has been brought under control can aggravate and cause further damage. The same is true for having cosmetic work or implants whilst the disease is still active.

A dentist can also contribute to causing gum disease by providing ill-fitting fillings or crowns, or by providing a denture without explaining about the increased risk of gum disease that comes with having a denture.

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What treatment should follow a diagnosis of gum disease?

If you have been diagnosed with gum disease, then you should be fully informed of the nature of the disease, the risks, and methods of self-prevention. These self-prevention methods will include oral hygiene advice, advice about quitting smoking, and dietary advice.

A detailed assessment of the gums should be carried out, along with the taking of radiographs and the provision of thorough cleaning of the teeth and gums, which may need to be done under local anaesthetic.

Following assessment, periodontal treatment (such as scaling, root planing and antibiotic therapy) should be commenced. If there is no significant improvement a referral should be made to a periodontal specialist.

There is no cure for periodontal disease, but early intervention can prevent the disease from developing further.

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Do you need to be a regular attender at the dentist in order to qualify for a negligence claim?

If you don’t go to the dentist regularly, a claim is unlikely to succeed, as the defence will likely assert that the dentist was not given an adequate opportunity to diagnose or provide treatment.

However, every case turns on its individual facts and if you consider you may have a claim we can advise you on likely prospects.

As such, it is important that you attend regular check ups as advised by your dentist.

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I have attended a new dentist and they have diagnosed gum disease, can I claim if the previous dentist has retired?

By law, all dentists must be registered with the General Dental Council (GDC) and must have appropriate indemnity and insurance arrangements in place in order for patients to seek compensation which they may be entitled to.

Therefore even after a dentist retires they will still be responsible for the treatment which was carried out when they were practicing as a dentist.

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What restorative treatment might be required to address the impact of gum disease?

  • You may require a referral to a hygienist and this may involve a thorough clean of the teeth to remove any hardened plaque, which is also known as tartar.
  • In some cases you may require root planing (debridement): a deep clean under the gums which removes the bacteria from the roots of your teeth. This treatment can be uncomfortable and you may require local anaesthetic before undergoing the treatment.
  • If your gum disease is very severe, then you may require periodontal surgery.

The cost of attending with a hygienist on a regular basis and undergoing some of the above treatments can be very expensive.

Hygienist appointments are not normally covered on the NHS. However, if you are receiving dental care on the NHS then periodontal treatment should be provided in general practice. If you have gum disease and are receiving NHS dental care then they should provide you with NHS treatment options.

Furthermore, the cost of replacing teeth lost due to gum disease is expensive, especially if you require dental implants rather than a bridge or denture. It is also worth knowing that implants would not usually be provided on the NHS. Instead the NHS would normally offer dentures, which many consider an insufficient substitute for natural teeth which can even make the problems with gum disease worse for the remaining teeth, resulting in further tooth loss.

When bringing a claim for dental negligence, we would seek to recover treatment costs as part of your claim.

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What could happen to my teeth?

Unfortunately if treatment is not sought in a timely manner then you could be at risk of losing teeth or several teeth.

The loss of teeth can also impact upon individuals mental health. We have acted for patients who feel very self conscious when they have lost teeth, and this also can have an impact on their social life as they are unable to eat certain foods and may not be able to go out for a meal with friends.

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What information do I need to bring a claim for negligence? What’s the process?

Our team has put together a guide on the process of making a dental negligence claim here.

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