Treatment Periodontal disease

Periodontal disease is an inflammation or infection of periodontal tissues, gingiva, alveolar bones, periodontal ligaments which are supporting tissue that holds the tooth in placed

There are two main types of periodontal disease.

Gingivistis

  • This is inflammation or infection of the gums only.
  • Most people have gingivitis at some time or other.
  • Untreated gingivitis may lead to periodontitis.

 

The symptoms of gingivitis include swollen gums, mouth sores, a bright red or purple appearance to the gums, shiny gums, gums that are painless except when touched, and bleeding gums. Often the first signs of gingivitis have no symptoms except for visual symptoms and are likely only to be diagnosed by a dental professional.

Plaque which has been deposited on the teeth for a long period of time is likely to cause gingivitis. Plaque develops on the exposed portions of the teeth, is sticky in substance, and is made up of food debris, bacteria, and mucous. The unremoved plaque deposits build up along the gum line of the teeth first, where it typically turns into a harder substance known as tarter. Plaque and tarter are likely to irritate, inflame, and infect the gums causing gingivitis. Plaque turns teeth yellow, and eventually brown in its thickest build up.


Treatment of Gingivitis

1.Homecare

  • Careful brushing at least twice daily
  • Regular and thorough use of dental floss

2. Regular professional cleaning

  • Scaling and Polishing at least twice yearly

 

 

Dental scaling

is a basic professional cleaning using special hand instruments or Ultrasonic scalers vibrate at a frequency that breaks down bacterial cell membranes and as such, because the bacteria are what make the plaque and calculus stick, the ultrasonic scaler removes a lot of both plaque and calculus.

Hand instruments are used to complete the fine hand scaling that removes anything the ultrasonic scaler left behind.

Dental scaling

is a basic professional cleaning using special hand instruments or Ultrasonic scalers vibrate at a frequency that breaks down bacterial cell membranes and as such, because the bacteria are what make the plaque and calculus stick, the ultrasonic scaler removes a lot of both plaque and calculus.

Hand instruments are used to complete the fine hand scaling that removes anything the ultrasonic scaler left behind.

Although the final result of ultrasonic scalers can be produced by using hand scalers, ultrasonic scalers are considerably faster and often less irritating to the client.

Dental polishing

Following the scaling, many dentists polish the teeth. While not as critical as scaling, polishing simply provides that fresh-from-the-dentist feeling that many people associate with having their teeth professionally cleaned.

Your dentist will apply pumice (sand-like substance) to a polishing bur attached to the dental drill.

Running the device across teeth surfaces helps polish them and remove any remaining plaque.


Periodontitis

  • This is a destructive infection that can affect all the periodontal tissues, that is, the gums, the bone and the periodontal ligaments.
  • Chronic periodontitis develops slowly, other kinds of periodontitis develop more rapidly.
  • This is a common disease - at least 50% of adults show some symptoms of periodontitis.
  • It is the major cause of tooth loss.

When periodontitis progresses to the advanced stage, pockets deepen and may fill with pus. There may be swelling around the root, and you may experience sensitivity to hot or cold or feel pain when brushing your teeth. As bone loss increases, your teeth may lose so much support they become mobile, fall out, or need to be removed to preserve the overall health of your mouth.

Periodontal disease is caused by one or more of the following:

  • Puberty and pregnancy can make people more susceptible to periodontal disease.
  • Medical problems such as diabetes and blood or genetic disease.
  • Smoking is known to contribute to periodontitis and other oral diseases.
  • Medications such as birth-control pills, and drugs for treating heart disease.

Periodontitis

Advanced Periodontitis


The treatment for a periodontitis

  1. Home care
    ​As with the treatment of gingivitis, correct and regular cleaning at home by the patient is essential.
  2. Professional treatment
    This can include one or more of the following:
    • Non-surgical treatment
      • Scaling and root planning : This is an important part of the treatment. It may take many visits to complete and have to be repeated. 2.1.2 Medications (antibacterial) : The use of antibiotics to treat periodontitis remains open to debate. Our periodontist may recommend using topical or oral antibiotics to help control bacterial infection. Topical antibiotics are generally the treatment of choice. They can include antibiotic mouth rinses or insertion of threads and gels containing antibiotics in the space between your teeth and gums or into pockets after deep cleaning. However, oral antibiotics may be necessary to completely eliminate infection-causing bacteria.
    • Surgical treatment
      If you have advanced periodontitis, your gum tissue may not respond to nonsurgical treatments and good oral hygiene. In that case, your periodontitis treatment may require dental surgery, such as:
      • Flap surgery (pocket reduction surgery)
      • Soft tissue grafts
      • Gingivectomy
      • Bone grafting
      • Guided tissue regeneration
      • Bone(Osseous) Surgery
  3.  ​Etc

Scaling and Root Planing

Scaling is a type of cleaning that removes plaque and calculus from the teeth at and slightly below the gumline. Root planing smooths and decontaminates root surfaces, so the supportive tissues can better re-attach to the tooth surface. We may use local anesthesia because this procedure goes deeper than regular cleaning.

There is some confusion about the difference between scaling and root planing. Scaling is basically the process of removing dental tartar from the surfaces of the teeth. Root planing is the process of smoothening the root surfaces and removing any infected tooth structure. If you have gum disease or gum pocketing, the gum pockets around the teeth will have deepened, thereby allowing tartar deposits to form under the gumline.

The two processes tend to blur together since during the cleaning process, the dental worker scales away tartar and performs any necessary root planing at the same time. Any roughness can be planed away to result in a silky smooth surface.

The dentist may wish to make the area numb so that the process is comfortable for you. Sometimes if the pockets are not too deep, there may be little or no discomfort during the procedure - even without numbing. The only sensation may be the physical scraping feeling along the teeth as the area is cleaned and smoothened. A root planed root surface free of tartar has a better chance of allowing the gum tissues to heal and reattach to it. As a result, some deep gum pockets can be reduced after a deep cleaning.

What you can expect afterwards

  • Discomfort can vary after root planing, but one can expect it to be more sore afterwards since it's usually in a deeper region under the gums.
  • The teeth themselves can become a bit more sensitive to temperature, and bleeding might occur for a little while.
  • Over-the-counter painkillers such as ibuprofen work very well to alleviate discomfort, but stronger painkillers can be given should you need them.
  • Brushing and flossing can be delayed or done more gently to avoid aggravating any bruised or tender gum areas.

Flap surgery (pocket reduction surgery)

In this procedure, the periodontist makes tiny incisions in your gum so that a section of gum tissue can be lifted back, exposing the roots for more effective scaling and planing. Because periodontitis often causes bone loss, the underlying bone may be recontoured before the gum tissue is sutured back in place. The procedure generally takes from one to three hours and is performed under local anesthesia.
 

Calculus forms in a deep pocket where scaling and root planing cannot reach.

During surgery, the gum is lifted to allow root plaing and removal of diseased tissue.

The new gumline may be lower, which eliminates the pocket and makes cleaning easier.

Gum may be replaced at or near the original gumline to expose less of the tooth.

 

 

Soft Tissur Grafts

When you lose gum tissue to periodontal disease, your gumline recedes, making your teeth appear longer than normal. You may need to have damaged tissue replaced. This is usually done by removing a small amount of tissue from the roof of your mouth (palate) or another donor source and attaching it to the affected site. This procedure can help reduce further gum recession, cover exposed roots and give your teeth a more cosmetically pleasing appearance.


Gingivectomy

Though originally started as a treatment for periodontal diseases, nowadays these procedures are partly cosmetic also. Gum tissue removal may be required under the following two circumstances:

  • Sometimes empty pockets develop between an individual's gums and teeth. These spaces may become breeding ground for bacteria, and food particles may get stuck in them. The problem can be rectified by trimming of gums with gingivectomy.
  • The problem can also be cosmetic with excess gum tissue marring the appearance. Extra gum tissue can also lead to non-cosmetic problems like speech impediments and chewing difficulties. The condition, which can sometimes be caused by medicines, will also make cleaning process a bitcumbersome.

Either scalpels or laser units can be used for gingivectomy. There are also angled blades used in these procedures. Besides these, since medical technologies are evolving fast, specialized tools with a high level of precision are also being used now.


Bone Grafting

This procedure is performed when periodontitis has destroyed the bone surrounding your tooth root. The graft may be composed of small fragments of your own bone or the bone may be synthetic or donated. The bone graft helps prevent tooth loss by holding your tooth in place. It also serves as a platform for the regrowth of natural bone. Bone grafting may be performed during a technique called guided tissue regeneration.

1. The graft material is packed into the area where bone has been lost.

2. The gum is then closed and new bone growth is stimulated by the graft.

3. New bone tissue fills in the crater, providing strong support for the tooth.


Guided Tissue Regeneration

This allows the regrowth of bone that was destroyed by bacteria. In one approach, the periodontist places a special piece of biocompatible fabric between existing bone and your tooth. The material prevents unwanted tissue from entering the healing area, allowing bone to grow back instead.

1. After a cleaning, a special membrane is inserted between the gum and bone.

2. The membrane blocks unwanted tissue, allowing ligament fibres to grow.

3. Once strong ligament fibres attach root to bone, the membrane desolves or is removed.


Bone (Osseous) Surgery

This procedure is used to smooth shallow craters in the bone due to mild or moderate bone loss. After gaining access to the damaged bone with flap surgery, we reshape the bone around the tooth to decrease the craters. This makes it harder for bacteria to accumulate and grow.


Supportive bone around the root is diseased and partially destroyed.


First, plaque and calculus are removed from the infected pocket and the root is planed.


The bone is smoothed and reshaped, reducing the number of spaces where bacteria can grow.


The gum is then closed over reshaped bone at or below the gumline.

 

 

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