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.
Laser gum treatment,flap
surgery, Laser gum treatment,flap surgery, Laser gum treatment,flap surgery,
Laser gum treatment,flap surgery, Laser gum treatment,flap surgery
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
flap surgery, gum
surgery,flap surgery, gum surgery,flap surgery, gum surgery,flap surgery, gum
surgery,flap surgery, gum surgery
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