GUM TREATMENT (Periodontal Therapy)
What is Gum disease?
Gum disease is the inflammation of the soft tissue(Gum), and supporting structures of the teeth.
The disease is furthermore categorized in three main types, which are:
manifests when your Gum is irritated by the so called plaque, a composition out of food debris, bacteria and their waste products. This plaque builds up and sticks to the tooth surface. It needs to be cleaned and scrubbed of by regular oral hygiene otherwise the plaque leads to redness, bleeding and swelling of the gums. Those symptoms represent the early stage of the disease progression and is at that time still completely reversible. The gums can still heal out and recover when the plaque is removed.
In cases where the oral hygiene continues to be insufficient and the inflammation of the gums( Gingivitis) is allowed to progress, the next phase of inflammation may occur.
This phase is called Periodontitis and is characterized by the response of the body’s to the ongoing irritation from the plaque. The combination of the irritation and inflammatory response of the body affects the bone surrounding and supporting the teeth.
With time bone structure gets lost, leading to deeper gum pockets, which gets harder to clean. As bone recedes, so does as well the gum, leading to visible parts of the roots which makes the teeth appear longer and sometimes sensitive to hot or cold stimulus.
With the lost of supporting bone structure the teeth may eventually become mobile and can ultimately this leads to the loss of the teeth.
Periodontitis is diagnosed by the inspection of the gum tissue surrounding the teeth. The inspection is made with a periodontal probe measuring the pocket depths and by radiographic findings of increased bone loss.
Periodontitis is a non-curable disease. With a good oral hygiene regime incorporated by the dental team and the patient, which includes regular periodontal or so called deep pocket cleaning by the dentist, it can be controlled and even slowed down.
Acute necrotizing ulcerative gingivitis (ANUG) and periodontitis (ANUP)
This constitutes a severe type of gum inflammation, that develops fast and suddenly.
Its treated with a high increase of oral hygiene including brushing and flossing of the teeth as well as rinsing with mouthwash.
Additionally antibiotics can be given to reduce the amount of bacterial contamination.
Some cases may require further medical tests to exclude the possibility of certain systemic diseases.
What’s the treatment for Gum disease?
The goal of a periodontal – or, as it is more commonly known – gum treatment, is to control the infection of both, the soft tissue and the bone supporting and surrounding the teeth. There are a variety of different treatment modalities, depending on the extent of the infection of the gum. All of these procedures have in common, that they need a good compliance on the side of the patient – especially in keeping a high oral hygiene standards before, during and after the treatment. Ceasing or – at least – limiting certain unhealthy habits, that might cause or aggravate the gum disease (apart from poor oral hygiene), such as smoking is another important factor to effectively manage gum disease or periodontitis as it is called in medical terminology.
Deep Cleaning (Debridement)
The dentist treats the disease by a procedure called scale and polishing as well as with root planning. With scaling and polishing, the tartar or plaque above and underneath the gum line gets scraped off. As with root planning you get rid of rough surfaces and obstacles on the tooth root where debris and germs can easily attach to.
Bacteria that contribute to the disease gets eliminated. Those treatments are executed with ultrasonic instruments as well as with mechanical hand instruments and have to be repeated regularly in six to twelve month periods, depending on the severity of the inflammation.
A far progressed inflammatory gum disease, may necessitates surgical interventions, with or without bone grafting.
This kind of surgery might be necessary in cases where aggressive inflammation and extended pockets remain after conservative, non-invasive gum treatments. The dentist creates a flap and by this lifts back the gum, to have a direct vision and to get to deeper areas of the tooth root where debris and rough surfaces may still be present. After a smooth surface and a clean environment have been achieved, the gum is than brought back in position and sutured.
When the healing is already well-progressed, the gums will fit more tightly around the teeth. This is usually reflected in a reduction of the pocket depths and gum swelling, a more pinkish appearance of the gums (as compared to the more reddish inflammatory state) and a lower susceptibility to gum bleeding. Flap surgeries for treating gums, are mostly used for particularly resistant cases with exceptionally deep pocket probing depths. Other cases of gum disease, however, are primarily treated by scaling and root planing without flap surgery.
Controlled clinical studies suggest, that complying patients, who carefully apply the instructions given to them by the dentist, at home, will benefit significantly from this approach. Insurances, more and more adapt to the scientifically proven, preventive value of systematic gum treatments.
Bone and Tissue Grafts:
In combination with flap surgery, procedures to help regenerate any bone or gum tissue lost due to inflammation may be applied. Bone grafting procedures, in which natural or synthetic bone is placed in areas where bone loss has happened, can help to promote new bone growth.
Guided tissue regeneration is a procedure that can be used either with or without bone grafting. A mesh or membrane is placed between the bone and the gum. It keeps the gum tissue from growing into the area where the bone got lost, giving the new bone formation enough space and time in which it can fill the bony gap, now protected by a scaffold and barrier structure, like a membrane or titanium mesh or combinations.
Growth factors – proteins, that can help your body to naturally regrow bone – may also be utilized to kick-start new bone formation. Other cases, with gum recessions present, soft tissue grafting, where connective tissueis taken from a suitable donor site inside your mouth is used to cover exposed tooth roots. This can both prevent, further gum recession at the particular site and cover the root surface, hence making sensitive teeth, less sensitive to cold or hot beverages, for example.
Authored by Dr. Lionel Laatz (Oral Surgeon& Implantologist, German Dental & Dermatology Clinic, Doha, Qatar) and by Dr. Dominique Laatz MSc. MSc. (Oral Surgeon & Implantologist, German Dental & Dermatology Clinic, Doha, Qatar)