The periodontium is the tissue surrounding the tooth: the surrounding alveolar bone, gums and ligaments which hold the tooth in the bone cavity, and the alveolus. The tooth is not firmly fixed in the cavity, it is not ‘clamped’ in there. It ‘hangs’ in the alveolus, where it is fixated by the periodontal ligaments, which act as shock absorbers to soften the chewing forces. There is a gum riffle between the tooth and gum that deepens if it is collecting plaque, stones form in there and, in the course of developing inflammation, it eventually becomes a pathological gum or even a bone pocket. This is an inflammatory condition called periodontal disease.
Periodontal diseases can be caused by:
- Insufficient oral hygiene, dental plaque, and teeth stones which have formed over time.
- Possible genetic predisposition,
- Stress, depression, smoking, and the resulting deterioration in oral hygiene.
What are the possible signs of periodontal disease?
- Gum redness, swelling, bleeding (when cleaning your teeth or by itself).
- Gum withdrawal, tooth root exposure, ‘elongated’ teeth.
- Teeth being able to move, a change in their position (i.e. teeth inclining to the front).
- Increased gaps between the teeth.
- Puss collected in gums.
- Increased gum sensitivity to hot, cold or acidic food.
- Bad breath.
PROPER PERSONAL ORAL HYGIENE AND REGULAR PROFESSIONAL ORAL CARE ARE THE BEST WAYS TO PREVENT GUM DISEASE.
Figure from Oral B ‘A patient’s guide to good oral health’.
Untreated gum inflammation (gingivitis) progresses to become periodontal disease (when inflammation of tissue around the tooth takes place), causing the bone to start melting. Periodontal pockets develop soon after and teeth become loose or even fall out. Periodontitis may be local (covering 2-3 teeth in different areas of the tooth arch) or spreading (covering all teeth).
The solution is timely treatment in 2-3 stages:
The first stage (non-surgical, conservative) is the treatment of periodontitis, which involves the deep cleansing of periodontal pockets. Ultrasonic, hand-held instruments are used to remove the deposits, located deep below the gums, root surfaces are evened out, and deep gum pockets are disinfected. This phase is always carried out whenever deep periodontal pockets are present and is started at least a couple of weeks after a professional oral hygiene visit.
After non-surgical, conservative treatment is concluded, it is possible that teeth will develop increased sensitivity to cold or hot temperatures. It is important to know that this is due to the healing of the gums (the gums contract with the decrease in swelling and bleeding) and this reaction is usually temporary and most frequently disappears within a few weeks of treatment. Currently, it is recommended to use a desensitising toothpaste and mouthwash. If the patient does not start treatment, the disease progresses, more and more bone tissue is lost, and teeth fall out without any support or need to be removed due to constant infection in the oral cavity.
The second stage is the surgical treatment of periodontitis in cases of advanced, neglected, severe forms of periodontitis. Its necessity and volume are evaluated after the first stage of periodontal treatment, after at least two months. If deep periodontal pockets remain, a periodontal flap operation is required. This operation is the removal of inflammatory tissue and teeth stones, formed deep under the gums, by pulling back the gums, returning them and stitching them in place. The procedure is carried out under local anesthesia and the seams are removed after 7-10 days. Teeth sensitivity (usually temporary) may be experienced, just like after the first stage of treatment.
If the patient is motivated and adheres to proper individual oral hygiene, the tissues heal much faster.
The third stage is supportive treatment when regular professional oral hygiene is performed. It is an especially important part of the treatment, determining if the treatment results achieved during the first two stages will be preserved, and is needed to prevent the renewal of the disease.
How often should a patient come for supportive treatment?
This depends upon the severity of the disease and the patient’s oral hygiene skills – this is individual and prescribed by the doctor (every 2-6 months).
All of these three stages of dental treatment help stabilise the rest of the bone, reduce or eliminate tooth mobility and progression of the disease.
This is the withdrawal of the gum edge, when the tooth root surface becomes exposed; inter-tooth surface opening is also possible. It is a fairly common condition that develops gradually, and can go unnoticed by the patient. The emergence of gum recessions is possible due to a variety of reasons, often acting together. Causes may be inflammatory and non-inflammatory.
The main causes of non-inflammatory origin are irregular, intense, traumatic teeth cleaning (in which case often the tooth surface will also be damaged), irregular tooth position in the tooth arc (i.e. the tooth is elongated, tilted, etc.), excessive tooth load due to irregular bite positioning, orthodontic treatment of teeth, an incorrectly fitted lip leash, a gum trauma (such as an earring in your lip) and smoking.
The causes of inflammatory origin are gum withdrawal due to periodontal disease, dental plaque or stones.
Withdrawal of gums may cause increased teeth sensitivity, and caries may develop at the exposed root of the tooth.
Treatment. If gum recession cases are isolated, their extent is limited, and it does not cause the patient discomfort, no specific treatment is required. However, it is advisable to consult a doctor-periodonotologist regarding its possible causes and prevention of further progression.
If gum recession is advanced, gum causes are evaluated and, under appropriate conditions, soft tissue plastic surgery is performed in which more connected gum tissue is formed and the tooth root surface is covered. The gums should be free of inflammation prior to the surgery so, if it is necessary, periodontal treatment is applied beforehand.
This procedure is executed to remove a part of the gum. This may be required when:
- The gum has swollen due to inflammation (periodontitis).
- The gum has expanded due to the use of certain drugs or rare diseases.
- There is a need to correct the shape of the gum and the size /shape of the teeth at the same time before prosthesis or aesthetic sealing.
- There is a clinical extension of the tooth crown.
This procedure is usually easy to tolerate and does not cause a lot of discomfort. Healing can be observed after 7-14 days.
TOOTH CROWN EXTENSION
This is performed prior to tooth prosthetics when the tooth height above the gum is insufficient. This may be caused by severe caries or the breaking/chipping of the tooth under the gums.
This procedure, like gingivectomy, is usually easily tolerated. Healing can be observed after 7-14 days.
You can familiarise yourself with the services provided by other KOA odontology clinics here.