Periodontics

Periodontics

Are your gums getting the respect they deserve?

They will… now that you have entrusted your gum care in our safe hands!

What is periodontal disease / gum disease?

The word periodontal literally means around the tooth. Periodontal diseases also known as gum diseases are some of the most common infections in the world next to respiratory infections! One major problem is that periodontal disease is usually painless, with few obvious symptoms in its early stages. If left untreated, periodontal disease can eventually result in tooth loss. In fact, periodontal diseases are now the leading cause of tooth loss in adults. Despite the number of people infected with this disease, most believe they don’t have them.

Despite all these facts, periodontal diseases are also some of the most preventable diseases, you need to understand what causes them, practice good oral health habits and seek regular professional case.

What causes gum disease?

The main cause of these gum disease is bacterial plaque, a sticky, colorless film that constantly forms on your teeth. If plaque is not removed on a daily basis it can turn into a hard substance called calculus (tartar). When plaque and calculus are not removed, the bacteria in plaque produce toxins (or poisons) that can destroy the supporting tissues and bone around the teeth . As the diseases progress, the gums around the tooth becomes loose and separates away from the tooth resulting in deep areas called pockets. As these pockets deepen, more gum tissue and bone are destroyed and the teeth eventually become loose. If periodontal diseases are not treated, the teeth may need to be removed.

What are the warning signs of gum disease?

A general dentist or periodontist during regular examinations can easily detect periodontal disease.

A periodontal charting will be performed for all teeth. An instrument called the periodontal probe, with ruled millimeter makings is used to measure the depth of the.space between the teeth and gums. Ideally, normal measurement ranges between 1 and 3mm. Depths greater than this may signify the presence of periodontal pockets and associated gum disease. X rays will also be taken to see the extent of bone damage that has occurred.

Is there a cure?

The good news is that periodontal disease is preventable and treatable if diagnosed at the right time .We at AD&IC provide you with professional care in our office and instructions on proper home care. Our periodontist would welcome the opportunity to carefully evaluate your individual situation and discuss treatment options.

The goal of periodontal treatment is to control any infection that exists and to halt progression of the disease. Depending on how advanced an individual case is, treatment may involve any of the following:

• Non Surgical treatment
• Surgical treatment

Non Surgical treatment

Surgical treatment

Non Surgical treatment

• Dental Cleaning by a dentist or dental hygienist (prophylaxis / scaling) All the deposits which are harmful for your teeth are removed with the help of curettes and ultrasonic devices.
• Deep Cleaning (Scaling and root planing) With the help of curettes and ultrasonic devices, all the deposits which are harmful for your teeth are removed and your roots are cleaned to speed up the healing process. With the help of curettes and ultrasonic devices, all the deposits which are harmful for your teeth are removed and your roots are cleaned to speed up the healing process.

• Bite (Occlusal) Adjustment: an improper bite may increase bone destruction attached to such offending teeth. We may either choose to adjust your bite so that your teeth meet properly and function better, or construct a custom bite guard or splint a removable device that fits over upper or lower teeth to protect teeth surfaces and relax tense jaw muscles.
• Medications are used to help kill germs that cause Periodontitis or suppress the destruction of the tooth’s attachment to the bone. Antibiotic gels, fibers or chips are applied directly to the infected pocket. Antibiotics may be placed in the pocket or given orally depending on the case.
• Use of x-rays and charting of the pockets to see how deep the pockets are. Maintain regular check-ups
• with your dentist (once a month up to once every 3 months or as requested by your dentist) to re-evaluate the stage of the gum disease.

Surgical Treatment

Periodontal surgery is necessary when the tissue around your teeth is unhealthy and cannot be repaired with non-surgical treatment. Various surgical treatments done at FMS are:

• Curettage
• Flap surgery
• Gingivectomy
• Frenectomy
• Flapsurgery with BONE GRAFTS
• Guided tissue regeneration(GTR)
• Gum Contouring

Is there any possibility of regaining the bone that is lost due to periodontal disease?

With advanced materials and techniques like bone grafts and guided tissue regeneration, it is possible to restore lost bone to some extent. Our periodontist would first assess the case and give you various treatment options depending on the situation.

What are the various advances in surgery?

Various advances in surgery include regenerative techniques where the tissues that are lost due to disease are regenerated to a certain extent. Various methods of regeneration include: Bone graft materials which are natural or synthetic substitutes to bone and a technique called Guided tissue regeneration which allows only the cells which are required for healing to reach the surgical site.

Is extraction the only treatment for mobile (loose) teeth?

Treatment for a mobile tooth depends on the severity of mobility. In teeth were the mobility is mild it can be tied together to the adjacent healthy teeth by using a wire and a tooth colored material. This procedure is called splinting. Extraction is the only option for teeth with severe mobility

How can you prevent periodontal diseases from returning?

Nothing will help you maintain the results of professional treatment better than proper home care (daily removal of plaque by proper brushing, flossing and other cleaning methods) recommended for you.

We believe in teamwork to help prevent your periodontal disease from returning. Once the disease has been arrested, a regular maintenance (cleaning) schedule will be set up for you. This will allow us to continuously assess your periodontal health. During these visits, your mouth is closely examined, new calculus and plaque are removed and your teeth are polished.

Is there a treatment for teeth which appear long and the gums seem to be pulling away?

When gum tissue recedes due to periodontal disease, it pulls away from the teeth making the teeth appear longer. Cosmetic procedures can restore some coverage and dramatically improve a person’s smile. Soft tissue grafts and other root coverage procedures cover exposed roots and restore healthy gum tissue. This will reduce further bone loss and recession, make the tooth less sensitive, protect the root from root cavities, and look more natural when you smile.

What is the treatment for gummy smile?

Teeth may appear “short” due to the relationship between their teeth and gums. This creates a “gummy” smile. A procedure called “gum contouring” is often used to remove excess gum tissue and expose more of the crown of the tooth. In fact, your gum line can be carefully sculpted to create just the right proportion between gum tissue and tooth surface — and the result is a better looking smile.

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Dental Tips

• Brush your teeth twice a day
• Use dental floss for interdental cleaning
• Rinse your mouth with water or take a few sips of water after eating sweets and sticky foods like pastries, chocolates, ice-creams etc
• Eat a well balanced diet, with fresh fruits, vegetables, eggs, milk and milk products
• Visit your dentist every 6 months for a routine dental check-up and for scaling (cleaning of teeth) once a year

Myths & Facts

Myth – 1

When the gums bleed, it is better not to brush the teeth.

Fact

Bleeding of gums is a sign that they are unhealthy. This usually is a result of plaque and food particles accumulating around the teeth. Until this collection is removed, the gums continue to bleed. This is an indication that the individual needs to visit a dentist for opinion and treatment. Brushing the teeth with a soft toothbrush by the proper technique removes the plaque and helps the gums recover. Initial bleeding seen during brushing gradually reduces over a period of time.

Myth – 2

Charcoal, tobacco, etc, in powder form is better than toothpaste in cleaning teeth.

Fact

The objective of cleaning the teeth is to remove the plaque and food particles on and around the teeth by the bristles of a toothbrush with the help of a toothpaste or powder. A standard paste or powder contains proper sized particles, which are not harmful to the teeth. However, other powders are coarse and can erode the outer layer of the teeth and permanently damage them. Hence, only standard toothpaste or powder should be used with a toothbrush. Toothpaste is better than powder as it can easily be dispensed on the brush and it may contain fluorides, anti-tartar chemicals, etc. The foaming action of the toothpaste also helps to freshen the mouth. Tobacco should not be used. Users enjoy the euphoric effect of nicotine present in tobacco rather than cleaning of the teeth and slowly become addicted to it. Hence, it should never be used.

Myth – 3

Dental treatment should be avoided during pregnancy.

Fact

While there is no truth in the above statement, dental X-rays are to be avoided during the first three months of pregnancy. Many a times dental treatment is provided even during late pregnancy. Routine dental procedures can be carried out without any fear. However, major surgical procedures may require medical opinion before treatment. If anything, periodontal treatment (gum treatment) during pregnancy reduces the occurrence of pregnancy complications. Several studies over the last two decades have found an increased incidence of pregnancy complications in patients with poor oral hygiene. So next time you or someone you know is pregnant, don’t forget to refer her to a dentist for routine check up and scaling.

Myth – 4

Cleaning the teeth with finger & powder is better than with toothbrush.

Fact

The use of a tooth brush with bristles to clean plaque and food particles from almost all the surfaces of the teeth. The finger may not reach all the areas as well as a brush does. Hence, it is recommended to use a toothbrush with paste to clean the teeth and freshen the mouth. Finger can only be used to massage the gums after brushing is complete.

Myth – 5

Dental procedures are always painful.

Fact

Most dental procedures are carried out under local anesthesia, which makes the procedures totally painless. In addition the modern day high-speed drills cause less vibrations and are more comfortable for the patients.

Myth – 6

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 – 7

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.

Scaling & Root Planning

The main cause of these diseases is bacterial plaque, a sticky, colorless film that constantly forms on your teeth. If plaque is not removed on a daily basis it can turn into a hard substance called calculus (tartar). When plaque and calculus are not removed the bacteria in plaque produce toxins (or poisons) that can destroy the supporting tissues and bone around the teeth. As the diseases progress, the gum around the tooth becomes loose and separates away from the tooth resulting in deep areas called pockets. As these pockets deepen, more gum tissue and bone are destroyed and the teeth eventually become loose. If periodontal diseases are not treated, the teeth may need to be removed.

Dental Cleaning by a dentist or dental hygienist (prophylaxis / scaling)

All the deposits which are harmful for your teeth are removed with the help of curettes and ultrasonic devices. There are 2 methods of scaling

Manual Scaling

Here certain fine instruments called hand scalers are used to remove the harmful deposits from your teeth

Ultrasonic Scaling

Here a specialized instrument called an ultrasonic scaler is used which oscillates at vibrations of almost 25,000 to 40,000 Hertz with a water spray Various tips are available depending on the areas to be scaled.

Deep Cleaning (Scaling and root planing)

With the help of curettes and ultrasonic devices, all the deposits which are harmful for your teeth are removed and your roots are cleaned to speed up the healing process.

Is it true that getting scaling done loosens the teeth and increases sensitivity?

While there is no truth in that the teeth become loose after professional cleaning of teeth with minimal deposits over the teeth, one may see mobility or loosening of teeth where there are plenty of deposits.

In such cases, there is bone loss and the space which was earlier occupied by bone is now occupied by harmful deposits and the teeth appear to be firm. But after cleaning due to removal of deposits the support is lost and the teeth appeared to have become loose.

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.

Gingivectomy

Gingivectomy is the surgical removal of excess gingival tissues which are seen normally in gum enlargments.

Gingivoplaty

It is the surgical recontouring of gums.

Initial incision marking the excess tissues

Removal of diseased gingival tissue

A periodontal dressing in place

Before surgery

After surgery

Another Case

Initial incision marking the excess tissues

Gum Disease

The main cause of these diseases is bacterial plaque, a sticky, colorless film that constantly forms on your teeth. If plaque is not removed on a daily basis it can turn into a hard substance called calculus (tartar). When plaque and calculus are not removed the bacteria in plaque produce toxins (or poisons) that can destroy the supporting tissues and bone around the teeth .As the diseases progress, the gum around the tooth becomes loose and separates away from the tooth resulting in deep areas called pockets. As these pockets deepen, more gum tissue and bone are destroyed and the teeth eventually become loose. If periodontal diseases are not treated, the teeth may need to be removed.

Healthy gums and bone

Gingivitis

Gums appear light pink and are sharply defined. Bone completely surrounds the roots of the teeth. Teeth are firmly fixed into the bone.

Is the infection of gum tissue and is the initial stage of the disease.Gums become red, swollen and bleed easily. Underlying bone is not affected.

Periodontitis

Shows various stages of periodontal disease i.e. mild, moderate and severe depending on the amount of destruction of gum and bone around the teeth resulting in deep pockets.

Flap Surgery, gum surgery

Your teeth are at risk because of periodontal disease. It began with the buildup of plaque and tartar on your teeth, which may have resulted from insufficient brushing and flossing. Over time, the plaque and tartar have caused loss of the supporting tissue around some of your teeth.

When plaque builds up on a tooth, bacteria in the plaque attack the bone around the tooth as well as the fibers, which connect the tooth to the bone. As the fibers and bone are destroyed, a pocket or space forms between the gum and the tooth- an ideal site for more plaque to build up. Without proper hygiene, the process may continue, sometimes without symptoms, until the tooth is endangered.

Why do you need periodontal (osseous) gum surgery?

This surgical procedure is used by the periodontist to smooth / correct defects and irregularities in the bone surrounding the diseased teeth with the ultimate goal of eliminating periodontal pockets

What exactly we do during gum surgery?

Do not let the word “Surgery” scare you except in complex cases.

• Once the area is made numb with local anesthesia, we flap / raise the gum back so that we can visualize the amount and type of bone loss. We can also visualize tartar that may be attached to the roots.
• We then remove the tartar and scoop out the diseased tissue from the bone defects. This infected material / tissue is basically responsible for the progression of your gum diseases. Next, we use hand instruments called Curettes to smoothen your root surfaces.
• Once the bone defects are contoured and your root surfaces are cleaned, the gum is placed back in its original position and stitches are placed.
• Postoperative instructions are then given to teach you how to take care of the area so that as little discomfort will take place as possible.

Gum pocket and defect before surgery.

Gum is retracted for access to the bone and root.

Bone defects are removed.

Gum tissue is sutured back around the tooth.

After healing, the gum is tightly “seald” around the tooth.

What are the precautions after gum surgery?

Post Procedure Instructions

• Bleeding: Some bleeding may occur within the first 24 hours following surgery. This is normal. If this should occur, apply gentle pressure to the area with a piece of sterile cotton or wet gauze.
• Working-Exercise: You can carry out your normal routine activities like going to work etc., but avoid any kind of strenuous exercise.
• Diet: You are recommended to follow a soft and cold diet for a few days. Avoid consumption of hot beverages for at least 2 to 3 days after surgery. Preferably, chew from the other side which is not surgically treated.
• Smoking – Alcohol: Alcohol should be restricted during the first 48 hours following surgery. Please abstain from smoking for at least 2 weeks after surgery as smoking has been shown to slow down the healing process.
• Medication: If any medication has been prescribed for comfort and/or the prevention of infection during the healing process, please follow the directions carefully.
• Ice Packs for Swelling: If there is any swelling, ice packs should be applied to the area during the first four hours after surgery (use 15 minutes on 15 minutes off). Some swelling can be expected during the first 24 hours.
• Saltwater Rinse: Using teaspoon of salt in a glass of warm water, you may rinse the treated area gently. Rinsing several times in the first twelve-hour period will help keep your mouth fresh and odor-free. However, vigorous rinsing should be avoided in the first 24 hours.
• Brushing: Try to avoid brushing over the surgical area for at least 5 to6 days after surgery as it may dislodge or loosen the sutures. Brushing can be started once the sutures are removed. Meanwhile the area can be kept clean by massaging the area with the finger and paste and also with the help of a mouthwash.
• Surgical Dressing: If necessary a periodontal dressing will be placed over the treated area which protects the surgical site and should remain in place for approximately one week. Small pieces may break off but this should be of no concern. However, if the complete dressing should come off within three days, please call to have it replaced. If this should occur after the fourth day, there is no need for concern so long as there is no discomfort. Continue to rinse the area with warm salt water until your next appointment

What are the recent advances in surgery?

Periodontal surgery has evolved with newer techniques and materials advancing the art and science of dentistry.

REGENERATION is a present concept where the tissues that are lost due to periodontal disease are reconstructed to a certain extent using newer and advanced techniques.

Various methods of regeneration used at AD&IC are:

• Bone Grafts
• Guided Tissue Regeneration

Is flap surgery a permanent cure?

As you have learned, you may be prone to periodontal diseases that require constant and careful attention. Like other chronic diseases, such as diabetes, hypertension and asthma, there is no permanent cure. Periodontal surgery helps control disease and prevents further destruction to the gums and bone, thereby minimizing tooth loss. Regular check-ups would ensure tooth loss is further minimized.

A case of Flap surgery

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Bone Grafts

When plaque and calculus are not removed the bacteria in plaque produce toxins (or poisons) that can destroy the supporting tissues and bone around the teeth. As the diseases progress, the gum around the tooth becomes loose and separates away from the tooth resulting in deep areas called pockets. As these pockets deepen, more gum tissue and bone are destroyed forming deep bone defects.ts are bone substitutes (powders/ gels/ sponges) etc., which are placed in the diseased areas to enhance new bone formation with application of regenerated techniques.

Case-I Anterior Teeth

Case-II Posterior Teeth

A case of Bone Graft