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What is Periodontal Disease/ Gum Disease?
Periodontal disease, also known as periodontitis or simply gum disease, is a chronic condition that afflicts a great many people, most of whom are unaware of it. The disease involves inflammation of the periodontium, the tissue that holds the teeth, which consists of the alveolar bone itself, the periodontal ligament between the bone and the teeth, the cementum covering the root, and the gums. There are several factors responsible for causing the inflammation, and some are genetically inherited, but a key factor in every case is the mass of bacteria that build up in plaque and tartar (calcified plaque, also known as calculus). Smoking is also a major risk factor for the disease.
What are the symptoms of periodontitis?
Red, swollen gums which bleed when you brush your teeth
Displaced teeth (widened space between molars)
Loose and mobile teeth
Receding gums, making the teeth look bigger
Exposed roots resulting from receding gums, formation of cavities in the root, and sensitivity at the neck of the tooth
Heavy tartar deposit
Occasional sensitivity and dull pain in the gums
What are periodontal pockets?
People with these symptoms often think the problem is only with their gums (--see receding gums). But periodontitis is in fact a disease of all of the tissue supporting the teeth, including the bone. Under attack from the inflammation caused by the bacteria on the teeth, the tissue gradually atrophies (deteriorates). Atrophy of the bone reduces the stability of the teeth, which loosen, get displaced, and ultimately fall out. The lining of the bone – the gums – passively recedes as the bone atrophies, and does so more slowly. Just like the skin of somebody who has lost a lot of weight, the gums do not contract with the other tissue, but like wrinkled skin, hang loose as “surplus gum” which forms pockets next to the tooth. A pocket is a gap between the inflamed, loosened gum and the surface of the tooth, and always contains plaque and tartar. Since it is impossible to remove plaque from underneath the gum with a toothbrush, the bacteria there further exacerbate the inflammation and deepens the pocket in a vicious circle. The continual inflammation causes the bone to weaken so much that the teeth are displaced from their proper position, gaps open up between them, they become loose, and ultimately there is nothing to hold them and they fall out.
It is also important to know that severely atrophied bone is unable to support the implants needed as a base for fixed or stable tooth restorations, and a bone transplant operation may be required.
With proper treatment, the disease can be halted. We can stop bone loss and eliminate inflammation, but the process will not go into reverse, and the bone will not build back up to its original level. After this has been done, maximum patient motivation is needed to maintain the periodontium in its healthy state and prevent further bone loss. This demands very thorough oral hygiene. It is only worth entering into full-scale periodontal treatment if you understand the importance of oral hygiene and learn how to do it properly. Keeping your teeth healthy after the treatment is crucially dependent on cleaning teeth properly at home and, if appropriate, giving up smoking.
What is the treatment for periodontal disease?
The first stage in periodontal treatment is to measure the periodontal pockets. The dentist measures the depth of the pockets at six points around each tooth using a special blunt-ended probe with a millimetre scale.The dentist also looks for other indications of inflammation – gum bleeding and the amount of the plaque around the teeth. This procedure is completely painless, and is really no more than a thorough inspection. After the pockets have been measured, a computer image of the bone and the gum is produced, making the condition clear to both the dentist and the patient. The computer also tells us the amount of plaque and gum bleeding as percentages. These data indicate the severity of the disease and how it should be treated.
Every periodontal treatment involves professional oral hygiene treatment. Calculus is removed from the gums with an ultrasonic scaler, from between the teeth with a manual scaler, and from the teeth by polishing. It is important to have this performed at least once a year, and not only if you have gum disease.
If you receive treatment for periodontal disease, it is vital to know the right technique for cleaning your teeth above gum level, and to use it regularly. For that reason, an essential stage in treatment is an education and motivation session. There, the dentist or hygienist asks you to brush your teeth in the usual – and most cases, inadequate – way, and applies a dye to reveal the plaque left behind on places where tooth brushing did not reach. Then we help you learn a better technique. Learning to of dental floss or an interdental brush is also very important, because these clean the places where gum inflammation most often starts – the spaces between the teeth.
Where there is an active, bleeding pocket 4 mm deep or bigger, the tartar must be removed from underneath the gum. Because the ultrasonic scaler cannot reach into these concealed places, the dentist uses a specially-shaped manual instrument called a curette. Curettage is done under local anaesthetic so as to be painless and not to cause sensitivity. The procedure involves cleaning the surface of the root by removing both the tartar and the inflamed side of the pocket. This creates the conditions allowing the gum to reattach to the tooth surface. The day after curettage, we treat the pockets with a “soft” laser and rinsing to remove bacteria. This takes about 15 minutes. Your teeth may become sensitive to cold and tooth brushing in the next few days, and this can be treated in the surgery by painting on a fluoride gel, but will eventually fade away naturally.
The bacteria in a periodontal pocket is a potential centre of infection that can take effect on the condition of other parts of the body, so that this treatment is important for more than oral health alone. The harmful bacteria that proliferate in periodontal disease upset the balance of the normal flora throughout the mouth. As the pockets deepen, these harmful bacteria become more and more numerous, especially as the patient is unable to clean them. Getting rid of these bacteria and restoring the normal flora is one of the aims of treatment. Curettage is accompanied by treatment with anti-bacterial gel to reduce the bacteria count in the pockets. Then you will use an antiseptic mouthwash at home for the next two weeks to stop plaque re-forming. In some cases, we supplement the treatment with systemic antibiotic treatment to rid your whole body of harmful bacteria, so as to increase the chances of healing and allow your body to recover.
As the healing progresses, the gum to draws back and reattaches tightly to the neck of the tooth. It regains its smooth, pink appearance and does not bleed when probed. It is a very visible improvement! The exposed area of the root may start to look better as the gum moves upwards, but even more important than the aesthetics is that the inflammation stops and no longer acts as a centre of infection.
Loose or displaced teeth get stronger and more stable. The condition is regarded as properly healed when the depth to which the gum is detached from the atrophied bone is no more than 3 mm, and the gum does not bleed when probed. At this depth, the surface is still accessible to home oral hygiene practices, so that by taking proper care, you can keep your gums free of inflammation and you will not require any more curettage treatment. You will find that tooth brushing no longer makes your gums bleed, your breath smells better and your mouth feels cleaner.
The course of treatment required depends on the individual, and is decided after the first measurement of the periodontal pockets. The price of the treatment will depend on whether curettage is needed on a few teeth, a quadrant or the whole jawbone. Six weeks after the first curettage, we measure the pockets again, by which time they will have reduced to the maximum extent. If they are still deeper than the ideal 3 mm, we will have to repeat the curettage and the measurement. After reaching the healed and inactive state, about six months pass before the tissue completely stabilises and matures. During this period, we will check the process every month or so.
If the disease does not recur, periodontal maintenance treatment can begin. This is required to make the new condition permanent and to prevent the process of deterioration starting up again. Maintenance treatment includes a customised course of periodic professional oral hygiene treatment (scaling and polishing) at intervals of 3–6 months, and regular monitoring by measurement of periodontal pockets. Any inflammation detected in a pocket can be remedied with curettage before it becomes severe. With the help of our dentists, you can look forward to healthy gums indefinitely, but it is important to bear in mind that aftercare following periodontal disease lasts a lifetime. We must also repeat that smoking is one of the greatest risk factors for the disease. As long as you keep the habit, your chance of healing is minimal.
Since my return to the UK I have received so many compliments on my new smile, it has given me new confidence. Thank you to all the team at Firstdent I will be back to see you soon"!
John from London
Dear Firstdent Team!
We both had a great time in Budapest and the dental work itself was simply first class, you carried out all of the work that we agreed in a most professional manner, using the highest quality materials, at a time to suit our holiday arrangements and all carried in your most modern luxurious surroundings.
Nobody could ask for anything more, I really do appreciate this level of service and I would not hesitate to recommend Firstdent to anybody.
Kind regards, Gordon