Periodontics ( Advanced Gum Treatment )
What is gum disease?
Gum disease refers to inflammation of the soft tissue (gingiva) and abnormal loss of bone that surrounds the teeth and holds them in place. Gum disease is the second most common cause of toothache.
What causes gum disease?
Gum disease is caused by a build-up of plaque on the teeth. Plaque is a sticky substance that contains bacteria.
Some bacteria in plaque are harmless, but some are harmful for the health of your gums. If you don’t remove plaque from your teeth by brushing them, it builds up and irritates your gums. This can lead to redness with bleeding, swelling and soreness.
What are symptoms of gum disease?
Early symptoms of gum disease include gum bleeding without pain. Pain is a symptom of more advanced gum disease as the loss of bone around the teeth leads to the formation of gum pockets. Bacteria in these pockets cause gum infection, swelling, pain, and further bone destruction. Advanced gum disease can cause loss of otherwise healthy teeth.
How is gum disease treated?
Treatment of early gum disease involves oral hygiene and removal of bacterial plaque. Moderate to advanced gum disease usually requires a thorough cleaning of the teeth and teeth roots called “root planing” and “subgingival curettage.” Root planing is the removal of plaque and tartar (hardened plaque) from exposed teeth roots while subgingival curettage refers to the removal of the surface of the inflamed layer of gum tissue. Both of these procedures are usually performed under local anesthesia and may be accompanied by the use of oral antibiotics to overcome gum infection or abscess. Follow-up gum treatment may include various types of gum surgeries. In advanced gum disease with significant bone destruction and loosening of teeth, teeth splinting or teeth extractions may be necessary.
How is gum disease treated?
It is a progressive inflammatory disease of the gums and the surrounding tissue around the teeth. It is commonly known as gum disease and was referred to as pyorrhea in the old days. It is estimated that up to 80% of the population above the age of 40 may suffer from this disease with the severity varying drastically from one person to another. Periodontitis is the number one cause of tooth loss after the age of 40.
Certain medical conditions or medications can make you more susceptible to gum disease. They include pregnancy, diabetes, epilepsy, and such medications as chemotherapy, birth control pills, antidepressants, and those for heart problems.
If you notice any of the following signs of gum disease, schedule an appointment immediately:
- gums that bleed when you brush your teeth.
- red, swollen or tender gums
- gums that have pulled away from the teeth
- bad breath that doesn’t go away
- pus between your teeth and gums
- loose teeth
- a change in the way your teeth fit together when you bite
- a change in the fit of partial dentures
Some factors increase the risk of developing gum disease,
They are :
- poor oral hygiene
- smoking or chewing tobacco
- genetics
- crooked teeth that are hard to keep clean
- pregnancy
- diabetes
- medications, including steroids, certain types of anti-epilepsy drugs, cancer therapy drugs, some calcium channel blockers and oral contraceptives
Complications of gum disease
If you have untreated gum disease that develops into periodontitis, it can lead to further complications, such as:
- gum abscesses (painful collections of pus)
- receding gums
- loose teeth
- loss of teeth
Preventing and treating gum disease
Mild cases of gum disease can usually be treated by maintaining a good level of oral hygiene. This includes brushing your teeth at least twice a day and flossing regularly. You should also make sure you attend regular dental check-ups.
In most cases, your dentist or dental hygienist will be able to give your teeth a thorough clean and remove any hardened plaque (tartar). They’ll also be able to show you how to clean your teeth effectively to help prevent plaque building up in the future.
If you have severe gum disease, you’ll usually need to have further medical and dental treatment and, in some cases, surgery may need to be carried out. This will usually be performed by a specialist in gum problems (periodontics).
Non-Surgical Therapy
- Scaling and Root Planing: Manually removing the plaque and tarter from the root surfaces of your teeth below the gum line.
- Antibiotics: Because bacteria cause periodontitis antibiotics may be prescribed as pills or as an Antibiotic fiber. The fibers are used in conjunction with scaling and root planing. They are placed directly into the pockets and are removed within 7-10 days later. Antibacterial mouth rinses may also be recommended to help plaque control.
- Bite correction: An imbalanced bite may accelerate bone destruction. Your teeth may be adjusted for proper and better function. A Bite-guard (removable retainer fitting over teeth) may be required to protect teeth surfaces and relax tense muscles.
- Splinting: This technique attaches weak teeth together, combining them into a stronger single unit, making them more stable and offering more comfortable chewing.
Surgical Therapy
- Flap Surgery: Our periodontist separates the gum from the teeth creating a “flap” and accesses the infected pocket. It aims to reduce pocket depth and increase the ability to maintain the remnant pockets clean.
- Gingivectomy: This procedure is performed when excess amounts of gum growth around the teeth have occurred. This results in false pocket formation and the inability to keep them clean.
- Osseous (bone) surgery: This procedure is done to smooth shallow craters and defects in the bone due to mild or moderate bone loss. Guided Tissue Regeneration: This procedure is done in combination with a surgical flap operation where gum growth into a defect is barriered off to allow slower growing bone, cementum and ligament cells to populate a bony defect.
- Bone Grafts: Tiny fragments of the patient’s bone, synthetic bone or bone obtained from a bone bank are used to fill a bony defect around the teeth. These grafts act as a scaffold on or around which patients own bone is conducted or induced to grow.
- Soft Tissue Graft: In cases of gum recession a graft is usually taken from the palate and transplanted onto the receding area to reinforce the thin gum and to inhibit further gum recession.
Flap and Bone Surgery
When gum is inflamed severely (periodontitis), alveolar bone will be absorbed, and defected. Periodontal ligaments which connect between the alveolar bone and the teeth will disappear. Sever bone lose will cause tooth moving and missing. Flap and bone surgery is order to contour the bone, deeply clean the tooth to reduce the inflammation, and promote bone re-growing and connections firm.
Detailed Procedures
- Presurgical bone defect. Gum inflamed and reddish.
- Flap incision to make gum retracted, and the bone shows out.
- The bone is contoured, and remain tartar is removed.
- Gum is sutured back.
- After periodontal surgery, the bone defect disappears, and gum becomes healthy pink color.
Scaling Root Planing
Scaling and root planing is a deep cleaning below the gum line used to treat gum disease.
Why Do I Need It ?
Gum disease is caused by a sticky film of bacteria called plaque. Plaque is always forming on your teeth, but if they aren’t cleaned well, the bacteria in plaque can cause your gums to become inflamed. When this happens, your gums will pull away from your teeth and form spaces called pockets. Plaque then gets trapped in these pockets and cannot be removed with regular brushing. If untreated, gum disease could lead to bone and tooth loss.
If gum disease is caught early and hasn’t damaged the structures below the gum line, a professional cleaning should do. If the pockets between your gums and teeth are too deep, however, scaling and root planing may be needed.
Gingivectomy
Gingivectomy is a dental procedure in which a dentist or oral surgeon cuts away part of the gums in the mouth (the gingiva).
By removing the pocket wall, gingivectomy provides visibility and accessibility for complete calculus removal and thorough smoothing of the roots, creating a favorable environment for gingival healing and restoration of a physiologic gingival contour.
GINGIVOPLASTY
GINGIVOPLASTY is the surgical reshaping of gum tissue around the teeth. It is often is done simply to make gums look better.
Curettage
In cases of long standing gum infection, the tissues inside the gums absorb bacterial toxins and become diseased. In these cases, following anaesthesia, the diseased gums are scraped away from the inside, thus restoring the health of the gums.
HOME CARE
Good dental care at home is essential to help keep gum disease from becoming more serious or recurring.
- Brush your teeth twice a day with a soft brush
- clean between your teeth daily
- eat a balanced diet
- avoid using tobacco
- See your dentist every 6months to 1year.
Laser and Gum Therapy
What are various applications of LASERS in dentistry?
LASERS have numerous applications in dentistry. Few of them are:
- Caries Prevention
- Sterilization of canals during RCT
- Treatment of gum diseases with LANAP
- Teeth whitening
- Would Healing
- Removal Of Hyperplastic Tissue
- Uncovering Impacted Tooth
- Dental Implant Exposure
- Gingival Re Contouring
- Crown Lengthening
- Fiber band excision in OSMF
What are the types of dental LASER treatments available?
Laser procedures are divided into hard tissue and soft tissue procedures. Hard tissue procedures involving the tooth structure whereas soft tissue procedures for periodontal treatment.
Will the LASER hurt?
Since 1990 LASERS are being used extensively in dentistry. LASERS are very comfortable when compared to the conventional dental drill/Surgical blade. It is a painless procedure and there is very minimal need of Local anesthesia. In patients who are uncomfortable with dental drill/surgical blade, LASER treatment is the best option which reduces anxiety in those patients. Bleeding and swelling are also very minimal. Treatment with LASERS is safe and effective. A wide range of dental procedures can be done with LASER and are often used along with other instruments. It is a FDA approved procedure.
How long will I need to stay home after the LASER gum surgery?
LASER gum surgery is painless and there will be no significant impact on the patients. Patients can return to work from very next day. Patients can manage with any discomfort just with the simple pain medication given.
Is LASER gum surgery safe for patients with serious medical conditions?
In patients with serious medical conditions like diabetes and heart disease also, LASER gum surgery is the treatment of choice. Patients who are on medication and cannot be treated by conventional procedures can be treated by LASER. Bleeding is minimal and bacterial infection is much minimized in LASER treatment procedures. The clotting and sterilizing properties of LASER are good.
What is the difference between a Dental LASER surgery VS traditional gum surgery?
Key differences between traditional gum surgery and LASER gum surgery are
| Dental Lasers | Conventional Surgery | |
| Pain | Very minimal | Need NSAIDs |
| Bleeding | Very minimal | Present |
| Inflammation | Very minimal | Present |
| Healing | Excellent | Good |
| Gum Recession | Very minimal | Present over long term |
| Long term results | Excellent tissue regeneration | Relatively less |
| Other medications | No need to stop medications | Sometimes requires to stop other medications |
| Cutting and stitching | Not required | Needs cutting and stitching |
Is LASER gum surgery more expensive than traditional gum surgery?
LASER gum surgery is definitely more expensive than the traditional treatment because of cost of the equipment incurred. However the benefits of LASER therapy outweigh the cost as there are many advantages such as minimal pain, minimal bleeding and minimal inflammation and quick healing. Higher rate of patient satisfaction is seen in LASER gum treatment. It is safest possible gum treatment in some patients.
How long does LASER gum therapy take?
LASER gum therapy is performed in one long session of 2-3 hours in many cases, to treat the periodontal disease. It can also be done in two sessions, with one week apart each taking about 1-1/2hours.
The action of LASER is quick, bacteria or tissues can be removed in few minutes. Depending on the severity of gum disease and size and number of areas treated, gum therapy requires single or several visits.
How does a dental LASER work?
LASER produces a very narrow, intense beam of light. LASER work by delivering energy in the form of highly concentrated beam of light and heat. It works as infrared light is easily absorbed by water and gum tissues contain more water content. It acts as a cutting instrument & it also acts as vaporizer by causing a reaction when kept in contact with the tissue.
What are the benefits of dental LASERS?
Benefits of LASERS
- More comfortable (less invasive)
- Virtually painless
- Less need of anesthesia
- Treatment done more precisely and accurately
- Reduces trauma(No cutting and stitching needed)
- Fewer complications(The symptoms are very minimal)
- Fast recovery (Healing is quick.)
- Reduce the amount of bacteria
- Minimal bleeding and swelling
- Versatility( used for wide range of both hard and soft tissue procedures)
- Less use of drill
- Reduce post operative pain and therebyreduce the need for pain medication
- Water LASER does not generate any heat, vibration or pressure
- Fewer dental visits
What are the causes of Gum Disease?
Bacterial Plaque is the main cause of Gum Disease. A sticky, colorless film of Bacteria that constantly forms on your teeth is called Plaque or bacterial Plaque.Many Bacteria which are present in this Plaque are harmless, but some Bacteria are harmful and are the cause for Gum Disease. If Plaque is not removed it hardens, which is called Calculus (tartar). Brushing and flossing cannot remove Calculus. The supporting tissues and bone around the teeth are destroyed by the Bacteria in the Plaque. The Gums around the tooth become swollen and moves away from tooth forming pockets. As Disease progresses, more Gum and bone tissue is destroyed and teeth become loose, which eventually exfoliate.
What are the stages of Gum Disease?
The stages of Gum Diseases are:
- Gingivitis (most well known and mild form of Gum Disease)
- Most common and earliest form of Periodontal Disease.
- Gingiva is inflamed.
- Inflammation is caused by Bacterial Plaque accumulation in the absence of effective daily oral hygiene.
- Change of color from tissues normal pink to various shades of red.
- Early or Mild Periodontitis (more advanced stage of Gingivitis).
- Clinically appears the same as Gingivitis.
- Redness, bleeding on probing, and gum swelling are seen.
- Bone loss is seen.
- Pocket depth increases approximately from 4-6 mm.
- Moderate Periodontitis
- Inflammation and infection extend deeper into the tissues.
- 20-50% bone loss from around the tooth root.
- Pocket depths may increase from 4-8 mm.
- Bleeding, swelling, redness are present.
- Advanced Periodontitis
- Bone loss is severe representing a loss of 50-85% of bone support from the tooth root.
- Teeth become very loose.
- Uncomfortable during functional movements.
- Pocket depths range from 7-12 mm.
- Bleeding, swelling, redness are seen.
- Gingivitis if not treated progresses to Periodontitis which is the severe form of Gingivitis
How will I know whether I have Gum Disease?
Bleeding of Gums is the sign for Gum Disease. As there is no pain in Gingivitis or Periodontitis, you will not be aware of Disease
Symptoms of Gum Disease:
- Bleeding Gums while brushing. “Healthy Gums do not bleed”
- Swollen, red, tender Gums
- Loose Gums that move away from tooth
- Continuous Bad breath or bad taste in the mouth
- Teeth becoming loose
- Pus around teeth and Gums
How can Gum Disease be treated?
Treatments for Gum Diseases: Gum Diseases can be treated in two ways:
- A) Non-surgical treatments for Gum Diseases
- Professional dental cleaning
- Scaling and root planning
- B) Surgical treatments for Gum Diseases
- Flap surgery/pocket reduction surgery
- Bone grafts
- Soft tissue grafts
- Guided tissue regeneration (GTR)
- Bone surgery
Can Gum Disease affect my general health?
Health of your mouth certainly affects the health of your whole body. There is a strong association between Gum Disease and heart disease, diabetes and stroke. Bacteria from Gums enter blood stream and settle in the coronary arteries thus causing heart diseases.
“Without Periodontal health, you can’t have good general health”
Respiratory Infections
- Pneumonia can be caused by inhaling bacteria from the mouth and throat
- Bacteria from dental plaque can be inhaled into the lungs
Severe Osteopenia
- Gum disease and related tooth loss is seen in Osteopenia
- In postmenopausal women, severity leads to tooth loss
Preterm or low birth weight babies
- Giving birth to preterm baby is seen in women with advanced gum disease
- Fetus is exposed to infection as oral microbes cross the placental barrier
Stroke
- Increased risk of stroke is seen in Periodontitis
Heart disease
- Increased risk of fatal heart attack is seen in Periodontitis
- Cardiovascular disease is diagnosed more likely
- Clotting problems in Cardiovascular system is due to the bacteria from mouth
Uncontrolled Diabetes
- Diabetic control is disrupted in chronic periodontal disease
- Pocket environment is altered in diabetes and bacterial overgrowth is seen
- Risk of tooth loss is increased by 2 times in smokers with diabetes
- Periodontal disease is 3 times more likely to develop in type 2 diabetics
What can I do to prevent Gum Disease?
Habits to be cultivated as daily routine to prevent Gum Disease
- Brush your teeth (after meals is more helpful)
- Floss your teeth
- Swish using mouthwash
- Consult dentist every 6 months.
How can you prevent Periodontal Diseases from returning?
Withpatients’ vigilance and good oral hygiene practices you can prevent the return of Periodontal diseases. Maintenance therapy is important.
- Proper brushing and flossing
- You need to have your teeth checked periodically every 6 months if any Plaque buildup is there.
- Avoid smoking
- Good Dietary habits
What is the treatment for Gummy smile?
When excessive gingival tissue is covering the anatomical crown of tooth causing Gummy smile, Gingival surgery (Gingivoplasty) is done. The Gingival margin is positioned apically without exposing the root surface. A new surgical technique involves both Gingivalrecontouring and traction and containment surgery of elevator muscle of upper lip and wing of nose (EMULWN)
REASONS TO CORRECT A GUMMY SMILE
- Improve the aesthetics of your smile
- Increase your self confidence
- Eliminate self-consciousness or embarrassment associated with smiling
CAUSES OF GUMMY SMILES
- ABNORMAL ERUPTION OF TEETH
Teeth may be normal length but appear shorter because of excessive Gum tissue - HYPERACTIVE UPPER LIP MUSCLE
This muscle may cause your lip to rise higher than normal, exposing more Gum when you smile - UPPER JAW BONE GROWTH PATTERN
If the upper jaw protrudes excessively, a Gummy smile may result
TREATMENT OPTIONS for Gummy smiles
- Lip repositioning
REDUCES
The excess movement of a hyperactive upper lip muscle
REATTACHES
The lip closer towards the teeth
DOES NOT
Require hospitalization and can be performed under local anesthetic
- Crown lengthening
EXPOSES
More of the tooth through the reshaping of bone and Gum tissue
CAN BE
Done on one or more teeth, or the entire Gum line
NORMALLY
Only require local anesthetic to reshape targeted areas
- Jaw Corrective Surgery / Orthognathic Surgery
INDICATED
When there is abnormal upper jaw growth Pattern
RELAPSES
Very minimal
REQUIRE
General Anesthesia
Does smoking affect my Gums?
- Gum disease get worse in smoking.
- Severe bone loss and more deep Pockets are seen in smokers.
- Gum destruction is 3-6 times more in smokers.
- Smokers have 5 times greater bone loss than nonsmokers.
- Gum bleeding and redness are less in smokers and thereby difficult to know the presence of disease.
What is the role of Laser in treating Gum diseases?
- Periodontal Diseases are best treated by lasers.
- Lasers are used to access and remove inflamed Gum tissue from around the root of the tooth.
- The diseased tissue is vaporized and removed from the mouth by laser.
- Laser is fired until clot is formed, wound is cauterized.
- Lasers in addition to the scaling and root planing have good effect of the procedure.
- When used properly, patients have less bleeding, swelling and discomfort.
- Lasers remove infection from Gums and reshape it.
Benefits
- Bleeding of Gums is eliminated immediately.
- Deep Periodontal Pockets are sealed.
- No cutting of gums, soreness or discomfort.
- Bone and ligament tissue is regenerated.
- High success rate.
Myths Facts
Myth – 1
- Professional cleaning/scaling/removal of tartar loosens the teeth.
- Fact
- In health, teeth are held firmly by the supporting tissues of the periodontium including bone. Bad oral hygiene results in the deposition of tartar /calculus on the tooth surface. These deposits irritate the gums and can cause inflammation and bleeding of the gums. If the tartar is not removed, the gums may recede and the supporting bone around the teeth gets destroyed. The tartar on the teeth thus causes great harm to the supporting tissues of the teeth. However, patients may experience slight mobility of the teeth after tartar is removed as it kind of binds the teeth together. Professional cleaning removes this tartar and arrests further destruction of supporting bone. Removal of tartar deposits only helps to recover the health of supporting structures.
Myth – 2
- Surgery of the gums affects vision.
- Fact
- There is a myth among many people that any surgery in the mouth affects vision. This is a misconception. Vision is not affected in any way by undertaking treatment of the upper teeth including its extraction.