PERIODONTICS

Periodontal Disease also commonly referred to, as Gum Disease is frequently the cause for tooth loss in adults. This disease is closely associated with Heart Disease, Diabetes and Pre-term low birth weight infants when present in pregnant women.

 

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. 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.

 

What causes Gum Disease?

Gum Disease is caused by toxins secreted by bacteria in "plaque" that accumulate over time along the gum line. This plaque is a mixture of food, saliva, and bacteria.

 

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.

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

 

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 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.

 

Periodontal Treatment involves:

1. Non surgical therapy

  • Scaling and root planning
  • Antibiotic treatment
  • Bite correction
  • Splinting

 

2. Surgical therapy

  • Flap and Bone Surgery
  • Gingivectomy
  • Bone Grafting
  • Soft Tissue Grafting

 

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 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 in performed in order to contour the bone, deeply clean the tooth to reduce the inflammation, and promote bone re-growing and connections firm.

    In Flap Surgery 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.

    Bone Surgery 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 submerged to allow slower growing bone, cementum and ligament cells to populate a bony defect.

  • Gingivectomy: This procedure is performed when excess amounts of gum growth around the teeth have occurred. This result in false pocket formation and the inability to keep them clean.
  • Bone Grafting: 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 patient's own bone is conducted or induced to grow.

    For a dental implant to be successful the patient must have sufficient bone in the jaw to place the implant into. Usually the quality and quantity of bone in the jaw is reflective of how the bone healed after the tooth was removed, and not an underlying medical condition. Many times a dentist will need to increase the amount of bone in a patient's jaw. Recent developments in bone grafting techniques have made implant treatment possible in cases that would have been impossible just a few years ago. Bone graft material comes from four general sources; your own available bone, freeze dried human bone from a tissue bank, processed bone elements from animals, and, finally, a mineral bone substitute.

 

Bone Grafting Procedure

The actual bone grafting procedure is much more straightforward than you might think. Bone grafting will only take place after your dentist has assessed the quality and quantity of the bone in your jaw and found that there is not enough to continue with a dental implant. Next your dentist will discuss the different types of bone graft with you and decide which will be the most suitable for you.

 

Once this has been decided the bone graft can be performed. For this the dentist will cut the gum at the site of the bone graft and create flap of skin. When the jaw bone is exposed the dentist will place the bone to be grafted onto the site and cover it with a protective membrane. This membrane is used to protect the bone from any microbiota (germs) found in the mouth and ensure that the area is perfectly clean to encourage the healing process. Finally the flap of gum is replaced and stitched carefully back into place. Healing time for a bone graft can vary from patient to patient but on average it is around 4 months. Patients are also given a course of antibiotics to take in the days following their bone graft. Antibiotic mouthwashes are also prescribed to preserve the health of the gum covering the bone graft.

 

Dentists can check on the success of the bone graft by performing x-rays to determine the height and width of the new bone. Once this has been confirmed as satisfactory and the site of the bone graft is totally healed, the next stage of the dental implant process can begin.

 

We have great techniques available to us to replace missing bone. We can increase the height of bone and the width of bone. We can fill in anatomical voids in bone thereby creating new bone and we can fill in all sorts of defects that develop when teeth are lost. We can even use grafting techniques to prevent the loss of bone in circumstances where bone would normally be lost like the extraction of a tooth.

 

  • Soft Tissue Grafting: 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.
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