Periodontology (Gum) Treatments

Periodontology is a branch of dentistry that deals with gingival diseases and their treatments. The term “periodontal” means the surrounding area of the tooth. Gingiva means gums. The terms used for inflammation of the gum tissue are “gingivitis” and “periodontitis”.

Gingivitis

Gingivitis is the early stage of gum disease. The gums become red and swollen with edema and bleeding occurs. There is no bone resorption on the alveolar bone which supports the tooth. Gingivitis is usually encountered when there is inadequate oral hygiene. By exercising proper dental care and treatments, gums are restored to their original form.

The most prominent symptom is spontaneous bleeding as a result of a trigger (brushing, biting, etc.) or by itself. Because smoking deteriorates the oral vascular structure, it may conceal the most important symptom by blocking the bleeding of the gums; therefore, causing the disease to progress into more advanced stages in a patient outside of regular check-ups. The factors that increase the severity of the disease are diabetes, smoking, genetic disposition, systemic diseases, stress, malnutrition, hormonal changes, pregnancy, HIV infections, and the use of certain medications.

What is Periodontitis?

Untreated gingivitis may progress to periodontitis. Over time, the toxins of the bacteria that exist on the accumulated bacterial plaque on teeth irritate the gums and these toxins cause a chronic inflammatory response. Destruction begins on the supporting bone and tissues around the tooth. The gingiva is separated from the tooth and a periodontal pocket is formed. As the disease progresses, the pocket gets deeper, and an increase is observed in bone and gum tissue destruction. If there isn't an intervention to this process, the bone destruction will lead to a necessity for tooth extraction.

The Symptoms of Gingival Diseases

Gingival diseases often progress without presenting any symptoms, and the symptoms won't appear until later stages of the disease. However, the warning symptoms of gingival disease are as follows:

Blushing, swelling, sensitivity, and pain in the gingiva

Gingival bleeding when brushing, flossing, or chewing something rough

Gingival recession, teeth having a longer appearance than usual

Tooth loss or diastema formation

Pus discharge from the gingiva

Mouth sores that appear in the mouth

Permanent bad breath

Compatibility issues with existing partial dentures

Prevention of Gingival Diseases

Also known as gingival diseases, periodontal diseases are caused by bacterial plaque accumulating between teeth and the gingiva.

When the gingival disease isn't treated, the inflammation impairs the structure of the bone and the gingiva and causes gingival recession and tooth loss. In addition, as demonstrated by research, it leads to tooth loss. In other respects, research has also shown that gum disease is associated with many diseases including diabetes and heart disease. The patients are lucky in terms of the fact that gingival disease is a preventable and treatable disease.

Preventive habits listed below should be exercised daily and regularly.

a) Brushing: Toothbrushing facilitates the elimination of bacterial plaque and food particles between the tooth and the gingiva. It is important to keep in mind that the tongue also needs to be brushed.

b) Flossing: Daily flossing facilitates the elimination of food particles and plaque between the teeth. Because toothbrushes cannot enter the tooth and gum line, these areas need to be cleaned with dental floss.

c) Mouthwash: Mechanical cleaning in dental care with brushing and flossing is essential. Mouthwash is supplementary for plaque removal.

d) Knowing the risk factors: Smoking, diabetes, and genetic factors increase the risk of periodontal disease. Dental visit frequencies are adjusted considering these factors.

e) Going to the dentist: Regular dental check-ups every 6 months are necessary for maintaining the continuity of oral and dental health.

Gingival Diseases and Systemic Diseases

As a result of research, periodontal diseases are shown to be associated with many other diseases. The inflammation caused due to periodontal disease amplifies the manifestation of other diseases in the body. The treatment of inflammation aids with periodontal disease treatment as well as the treatment of other chronic inflammatory issues.

a) Diabetes and Gingival Diseases: In diabetic patients, the chance of periodontal disease is high. The periodontal diseases in diabetic patients are observed with blood sugar and diabetic complications. The connection between diabetes and periodontal diseases is bilateral. Severe periodontal disease increases blood sugar; consequently, causing diabetic complications related to this condition. Diabetics have a higher chance of periodontal disease than other people.

b) Heart Disease and Periodontal Disease: The connection between these diseases is demonstrated in various research. While the cause-effect relationship is not fully proven yet, it has been established that the inflammation caused by periodontal disease increases the risk of heart disease. Periodontal disease may worsen pre-existing heart conditions. In the conducted research, it has been determined that Acute Cerebrovascular ischemia patients have oral infections and there is an association between periodontal disease and strokes. However, more research is needed.

c) Osteoporosis: It has been shown in various scientific research that jawbone loss and osteoporosis have a connection. Osteoporosis may cause tooth loss by causing loss of jawbone density.

d) Respiratory Disease: It has been discovered that oral bacteria can enter the lungs by breathing and nest there, consequently causing diseases such as pneumonia.

e) Alzheimer's: One of the pathological bacteria isolated in gum diseases has also been found in amyloid plaques. Accordingly, the relationship between gum infections and Alzheimer's is a current research topic.

Gum Disease Treatments

The first step in gingivitis and periodontitis treatment is tartar scaling and maintaining oral hygiene. Oral hygiene involves utilizing the correct brushing technique and timing; dental floss and interdental brushes for interdental space cleaning.

Due to the severity of the disease and many other factors, there are surgical and non-surgical periodontal treatment methods. The purposes of periodontal treatments are eliminating periodontal pockets and maintaining gingival health.

* Non-Surgical Periodontal Treatment (Subgingival Curettage)

In this treatment method, the bacterial plaque and tartar in the pocket and root surface are cleaned, bacterial toxins are eliminated and the root surface is smoothened out. This procedure is performed under local anesthesia. Sometimes, local antibiotics, systemic antibiotics, host modulation, and dental lasers can be used as a supplement for this procedure.

* Surgical Periodontal Treatments

For the elimination of the periodontal pocket, the gingiva is lifted with surgery, all the inflammatory tissue is cleaned, and the tartar and bacterial leftovers located in the pocket on the root surface are removed. If necessary, the damaged bone surface is remedied and regenerative procedures may be performed according to the severity of bone destruction.

* Regenerative methods

These are surgical periodontal treatment methods. The gingiva is surgically lifted, and the root surface and the surrounding inflammatory tissues are cleaned. Bone grafts and membranes or tissue-stimulating proteins are utilized.

Surgical and non-surgical treatment methods are of utmost importance in the reduction of periodontal pockets and bacteria elimination for stopping the progression of periodontal disease. Pocket elimination will not be solely enough for establishing gingival health. To keep the disease from recurring, it is essential to carry on maintaining oral hygiene daily and attending periodontal dental check-ups.

Gingival Recession and Treatment Methods

Gingival recession due to periodontal diseases is caused by the existing inflammation, leading to the loss of connective tissue attachment in the gingiva and bone destruction. It is the most common cause in cases of gingival recession.

In some cases, the gingiva is healthy but there is a gingival recession. This condition is more related to incorrect brushing techniques, habits such as tooth grinding, occlusal rest or edge incompatibilities on prostheses, teeth crowding or misalignments, smoking, and increasing age.

In addition to the causes of gingival recession, the gingiva being thin or thick is another factor that defines the severity of the recession.

Because the treatment of periodontal diseases has been discussed in another title, gingival recession treatment methods will be discussed in this section. The first stage in gingival recession treatment is establishing the cause. According to the severity of the recession, conservative methods, elimination of causes, and surgical treatment of the open root surface are performed. These mucogingival surgical methods involve either grafting gum tissue from the neighboring area, grafting from the patient's hard tissue, or using artificial grafts and similar materials for treatment.

Gingival Enlargement

Gingival enlargement may develop due to the inflammation caused by bacteria as well as hormones (pregnancy or puberty), medications (nifedipine, cyclosporine A, and phenytoin drug family), tumoral (benign or malignant), and some systemic illnesses. The treatment of enlarged gingival tissue involves the removal of enlarged tissue and correcting the gingiva to healthy margins as well as eliminating the factors.

Periodontal Plastic Surgery

Periodontal plastic surgery is the procedure performed in smile design and other prosthetic restorations. Correction of the excessively exposed gum line, the reverse smile line, treatment of gum recession, crown length extension, extensive muscle attachment removal, reshaping of the gingival papilla, and boosting the edentulous space are among this group of surgical procedures.

The “Gummy Smile” procedure, which is one of the periodontal plastic surgical methods and crown lengthening procedures can be solely based on gingival scaling as well as performed supplementally along with bone surgery.

Peri-implant Diseases

Peri-implant diseases are inflammatory conditions that affect the soft and hard tissues on the surrounding area of the dental implant. Just like a natural tooth, bacteria nests beneath the gingiva on the implant, irritating the gingival tissue over time and causing inflammation and tissue damage. If it is not diagnosed early, bone destruction occurs, and the implant gets damaged or even lost.

Peri-implant illnesses are classified into two categories.

a) Peri-implant Mucositis: This condition is limited to the soft tissue around the dental implant. No bone destruction is observed at this stage. It is usually the precursor for peri-implantitis. If this early stage is promptly and successfully treated, recovery is possible and healthy tissue around the implant starts to form again.

b) Peri-implantitis: This condition is observed when the inflammation around the soft tissue harms the implant-supporting bone. Peri-implantitis usually requires surgical treatment.

The symptoms of peri-implant diseases are similar to the symptoms of gum disease. These are:

- Blushing on gums

- Bleeding when brushing.

As with natural teeth, implants also need to be brushed and flossed and regular dental check-ups are required.

In addition to inflammation, other risk factors that cause peri-implant diseases to develop are the past presence of periodontal disease, lack of oral hygiene, smoking, and uncontrolled diabetes.

Laser Applications in Dentistry

Laser was discovered in the USA in 1960. The abbreviation (LASER) derives from "Light Amplification by Stimulated Emission of Radiation". However, the word is used in Turkish as "Lazer". After approximately 20 years of its discovery, the technology made its way to the world of medicine and started being used in dentistry later. Initially, it was used in the treatment options involving soft tissues. Surgical procedures are simplified thanks to the application of laser technology in dentistry. Since there is minimal damage to the tissue, laser technology is becoming widespread in various stages of surgical procedures. The most important advantages of the technology are bleeding-free operations on soft tissue, fast healing rate, and sterilization in the area of operation thanks to laser technology. Having no vibration on hard tissue and no need for anesthesia when performing minimal procedures, it has become a solid alternative for any patient who has dentophobia. Laser procedures for soft and hard tissue are applied with different power levels and frequencies. Each procedure has different conditions. After selecting the type of procedure, the wavelength exclusive to that particular procedure is only applied to the tissue that is going to be operated on. Today, there are laser types with different wavelengths such as Nd YAG laser, Diode laser, Erbium laser, CO2 laser, and KTP laser. Each laser differentiates from one another in terms of tissues they can have an impact upon. When operating the Laser devices, it is mandatory to take the necessary protective precautions. The dentist, the assistant, and the patient all must wear protective glasses, especially during the procedure.