Periodontics (Gums, Teeth Mobility, Bad Breath)
What is Periodontics? Who is a Periodontist?
Periodontics is the specialty of dentistry that studies the supporting structures of teeth, diseases, and conditions that affect them. The supporting tissues are known as the periodontium, which includes the gingiva (gums), alveolar bone, cementum, and the periodontal ligament.
A periodontist is a fully qualified dentist who has undergone additional University postgraduate training enabling him/her to register as a Specialist in the field. Their level of expertise allows them to provide a higher level of care in treatment of gum diseases, placement and maintenance of dental implants, and associated surgical procedures. Periodontists are also trained in performing cosmetic periodontal procedures.
What is Periodontal (Gum) Disease?
Periodontal disease is an infection of the tissues that hold your teeth in place (gingiva, alveolar bone, cementum, and the periodontal ligament)
What causes Gum Disease?
The mouth is full of bacteria. These bacteria, along with mucus, food remains and other particles, constantly form a sticky, colorless biofilm on teeth surface called plaque. Adequate tooth brushing and flossing help in getting rid of plaque. If not removed, plaque hardens and forms calculus (tartar) that cannot be eliminated by brushing.
Prolonged exposure of the gum to plaque/calculus is harmful since bacteria in plaque causes inflammation of the gums (gingivitis).”In gingivitis, the gums become reddish and swollen with easy bleeding. It is the mildest form of gum disease and is reversible with professional cleaning and good oral home care.
Untreated gingivitis advances to periodontitis. Toxins produced by the bacteria in plaque irritate the gums and stimulate a chronic inflammatory response. The body in essence turns on itself. The tissues that support teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Eventually, teeth become loose and fall off/may have to be removed.
How do I know if I have gum disease?
However, warning signs of gum disease include the following:
- Red, swollen or tender gums
- Bleeding while brushing, flossing, or eating hard food
- Receding gum, causing the teeth to look longer than before
- Loose or separating teeth
- Pus between your gums and teeth
- Sores in your mouth
- Persistent bad breath
- A change in the way your teeth fit together when you bite
- A change in the fit of partial dentures
Who is at risk of developing gum disease?
Prevalence and severity of periodontal disease increase with age. Over 70% of adults aged 65 and above have one form of periodontal disease or another. This is related to the length of time an individual has been exposed to bacterial plaque and other risk factors.
Tobacco use is linked with many illnesses such as cancer, lung disease and heart disease, as well as numerous other health problems. Tobacco users also are at increased risk for periodontal disease and lower chances of successful periodontal treatment.
People with diabetes are at higher risk for developing periodontal disease. Periodontal disease on the other hand complicates the control of blood sugar levels in diabetics
Drugs such as anticonvulsants (phenytoin), calcium channel blocking antihypertensives (Nifedipine, Amlodipine), Immunosuppressants (Cyclosporin) induces gingival overgrowth. Others such as narcotic analgesics, antihistamines, sedatives significantly decrease saliva flow. It is important to inform your dentist/periodontist about your medical history.
Some people are more prone to developing severe form of gum disease than others despite aggressive oral care habits
Hormonal fluctuations alters the status of periodontal health. Such changes may occur during puberty, menstrual cycle, pregnancy, menopause or oral contraceptives use or hormone replacement therapy
During pregnancy, the probability of developing gum disease increases. Gum disease may in turn impact on the foetus and the pregnancy outcome. It’s vital to prevent the disease to avoid pregnancy complications (regular dental visits before and during pregnancy)
Altered local or systemic immune response contributes to the pathogenesis of periodontal diseases. It also predisposes to less common types of severe gingival & periodontal destruction.
Include osteoporosis, stress, rheumatoid arthritis and poor nutrition
How is gum disease diagnosed?
Diagnosis of gum disease begins with a comprehensive dental and medical history by the dentist/periodontist. This is followed by extra oral and intra oral clinical examination. Intra oral examination involves assessing teeth, gums, tongue, bone structure and associated structures (things to look for – plaque, calculus, gum swelling/tenderness, mobility, bleeding, recession, pockets, bad breath, ulcers, discharge, change in occlusion).
Depending on the severity/complexity of the case, an x-ray/scan may be ordered to among other things assess the bone level and determine prognosis.
How is gum disease treated?
Treatment of gum disease is tailor-made for each individual with the sole aim of controlling the infection. For any treatment to succeed, the patient must keep good oral hygiene and adopt a behavior change (e.g. quitting smoking)
Largely, treatment is done via non-surgical means (scaling/root planing, medications, tray delivery systems, occlusal adjustments, periodontal splints among others)
Non-surgical periodontal treatment does have its limitations. When it does not achieve periodontal health, surgery may be indicated to restore periodontal health.
Teeth with hopeless prognosis may be extracted and replaced with dental implants after healing
Scaling and Root Planing
Scaling and root planing is a careful cleaning of the root surfaces to remove plaque and calculus [tartar] from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins. Scaling and root planing is sometimes followed by adjunctive therapy such as local delivery antimicrobials, tray delivery systems, systemic antibiotics, and host modulation, as needed on a case-by-case basis.
A tray delivery system consists of a custom-fit tray made from impressions of the patient’s mouth. Patients use the tray at home to deliver medications that have been prescribed by their dentist
The outcome is usually good with ongoing maintenance therapy to sustain health
Deep pockets around the tooth (more than 5mm) do not resolve by scaling/root planing alone. Such cases require open flap debridement to remove deep seated tartar and reduce pocket depths for ease of cleaning by the patient
During this procedure, the periodontist makes an incision and reflects gum tissue (flap). This is followed by removal of tarter, dead tissue and disease-causing bacteria before securing the tissue into place. In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. This allows the gum tissue to better reattach to healthy bone.
Via a technique known as guided tissue regeneration (guided bone regeneration), a natural or synthetic bone graft is placed in the area of bone loss. A small piece of mesh-like material (barrier membrane) is then used to cover the bone graft separating it from the gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow.
Growth factors – proteins that can help your body naturally regrow bone – may also be used.
In cases where gum tissue has been lost, your dentist or periodontist may suggest a soft tissue graft, in which synthetic material or tissue taken from another area of your mouth is used to cover exposed tooth roots
Gum Recession (Exposed roots/Long teeth)
Sometimes gum recession causes the tooth root to become exposed, which makes your teeth look long and can make you look older than you are. This recession can happen as a result of a variety of causes, including periodontal diseases.
Gum graft surgery and other root coverage procedures are designed to cover exposed roots, to reduce further gum recession and to protect vulnerable roots from decay.
Gummy smile /Uneven gum line
Do you feel your teeth look too short and your smile is too gummy? Does your gum cover too much of some teeth? If so, dental crown lengthening might be the solution for you. During this procedure, excess gum tissue is removed to expose more of the crown of the tooth. Then your gumline is sculpted to give your new smile just the right look.
What causes bad breath?
Bad breath (halitosis) is a general term used to define unpleasant odour emanating from the breath of an individual.
Estimated to be the 3rd most common reason for seeking dental treatment after tooth decay and periodontal disease (1 in every 4 people affected).
90% of all cases are caused by oral conditions (bacterial breakdown of food remains into sulfur compounds). 10% extra oral causes
Majority of patients consider bad breath serious enough to cause embarrassment and affect interpersonal social communication
Causes : Tobacco products, Food (e.g garlic), dry mouth, poor oral hygiene, fasting, some drugs, diseases (e.g some cancers, liver failure, gastroesophageal reflux), nose and throat consitions
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