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Introduction To Gum Disease
Introduction To Gum Disease
Additionally, the ‘stippling’ that normally exists on the gum tissue of some people
will often disappear and the gums may appear shiny when the gum becomes
swollen and stretched over the inflamed underlying tissue.
The accumulation may also create an unpleasant smell.
When gums are swollen, the epithelial lining of the gingival crevice becomes
ulcerated and the gums will bleed more easily even with gentle brushing, and
especially when flossing.
Causes
The main cause of gingivitis is poor oral hygiene which leads to the
accumulation of bacteria at the gum line; this is known as dental plaque.
This in turn, can lead to destruction of the gingival tissues, which may progress to
destruction of the periodontal attachment apparatus.
The plaque builds up in the small gaps between teeth, in the gingival grooves and
in areas known as ‘plaque traps’: locations that serve to accumulate and maintain
plaque.
Treatment
The aim of treatment for gingivitis is to remove the cause i.e. plaque. Treatment is
aimed at the reduction of oral bacteria, and may take the form of regular trips to the
dentist or dental hygienist together with adequate oral hygiene home care.
Treatment basically involves:
Meticulous Oral Hygiene on a daily basis – thorough brushing and flossing.
Use of mouthwashes
Regular check-ups with the dentist or hygienist.
Periodontitis
The word “periodontitis” comes from peri (meaning “around”), odont (“tooth”)
and -itis (“inflammation”).
Periodontitis is a disease which affects the tissues that surround and support the
teeth.
Periodontitis involves progressive loss of the alveolar bone around the teeth, and if
left untreated, can lead to the loosening and subsequent loss of teeth.
Periodontitis is caused by microorganisms which stick to and grow on the tooth’s
surfaces, along with an overly aggressive immune response against these
microorganisms.
Diagnosis
We diagnose periodontal disease by inspecting the soft gum tissues around the
teeth with a special probe and by examining the patient’s x-ray(s); in diagnosing
the disease, we want to determine the amount of bone loss around the teeth.
Sometimes we will refer patients to a specialist dentist, known as a periodontist,
for treatment of periodontitis.
The severity of disease refers to the amount of periodontal ligament fibres that
have been lost, termed ‘Attachment Loss’.
Classification
The standard classification of severity is as follows:
Mild: 1–2 mm of attachment loss
Moderate: 3–4 mm of attachment loss
Severe: ≥ 5 mm of attachment loss
Patients should be aware that the gum inflammation and bone destruction are
largely painless. Hence, people may wrongly assume that bleeding gums after
toothbrushing is insignificant, although this may be a symptom of progressing
periodontitis in that patient.
Causes
Periodontitis is an inflammation of the periodontium—the tissues that support the
teeth. The periodontium consists of four tissues:
Gingiva, or Gum Tissue
Cementum, or outer layer of the roots of teeth
Alveolar bone, or the bony sockets into which the teeth are anchored
Periodontal Ligaments (PDLs), which are the connective tissue fibers that run
between the cementum and the alveolar bone.
Multiple clinical studies have shown that non-surgical scaling and root planing is
usually successful if the periodontal pockets are shallower than 4–5 mm. It is
necessary for us to perform a re-evaluation 4–6 weeks after the initial scaling and
root planing, to determine if the treatment was successful in reducing pocket
depths and eliminating inflammation. Pocket depths which remain after initial
therapy of greater than 5-6mm with bleeding upon probing are indicate continued
active disease and will very likely show further bone loss over time. This is
especially true in molar tooth sites where areas between the roots have been
exposed.
Surgery
If non-surgical therapy is found to have been unsuccessful in managing signs of
disease activity, periodontal surgery may be needed to stop progressive bone loss
and regenerate lost bone where possible. There are many surgical approaches used
in treatment of advanced periodontitis, including open flap debridement, osseous
surgery, as well as guided tissue regeneration and bone grafting. The goal of
periodontal surgery is access for definitive calculus removal and surgical
management of bony irregularities which have resulted from the disease process to
reduce pockets as much as possible. Long-term studies have shown that in
moderate to advanced periodontitis, surgically treated cases often have less further
breakdown over time and when coupled with a regular post-treatment maintenance
regimen are successful in nearly halting tooth loss in nearly 4 out of 5 patients
Maintenance