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Periodontology (Gum) Treatments

Periodontology is a dental specialty which handles gum diseases and treatment. The word "periodontal" means the surrounding area of the teeth, whereas gingiva means gum. The words used for defining the inflammation of gum tissue are "gingivitis" and "periodontitis".

What is Gingivitis?

Gingivitis is the early onset condition of gum disease. The gum tissue becomes red, swollen, oedematous and bleeding occurs. There is no bone loss on the alveolar bone which supports the teeth, yet. The most important symptom is bleeding which occurs via a trigger (brushing, biting etc.) or by itself. Because of the fact that smoking deteriorates the oral vascular structure and increases the amount of keratinisation of gum tissue, it can prevent the bleeding which conceals the most important symptom, consequently causing the patient's condition to deteriorate further, if they are not being monitored by a dental professional regularly.

What is Periodontitis?

Periodontitis is the advanced stage of gum disease. Red, swollen, oedematous and bleeding gum tissue's condition continues and bone loss is now being observed in the jawbone which supports the teeth. This inflammatory condition of the gum tissue can be observed in young, adult or the elderly alike. This inflammatory condition of the gum tissue can be observed in young, adult or the elderly alike. Not only it can be regional, but it can also affect the entire oral cavity. The disease can be more aggressive in the young age group, whereas it can be more chronic in the elderly. However, this situation can differ from person to person and present variety. Bone loss in periodontitis occurs within certain time periods such as intense stress and sadness, diabetes, smoking and alcohol consumption, teeth clenching, anatomic factors, decline in body resistance or pregnancy, which could all be considered as factors causing bone loss.

What Are The Consequences of Periodontitis?

You can lose your teeth in the long term because of gum disease. Some patients can experience swelling and bleeding on the gum tissue. Periodontal abscesses can form and in worse cases, drainage seeps from the periodontal pocket, causing bad taste and odor. Following one of such symptoms, the condition becomes chronic and complaints may temporarily subside. However, if left untreated, migration and luxation begin to occur due to excessive bone loss. Despite having a generally slow progress rate, periodontal diseases can also manifest in aggressive forms. Loose teeth due to bone loss which is severe enough to diminish chewing function is dependant on the severity of the condition. As the condition progresses, the treatment becomes more and more difficult.

The Symptoms of Gingitivis and Treatment

The main cause of gingivitis is the formation of bacterial plaque in the neighbor area of the gum tissue. Depending upon the lack of oral hygiene, bacteria begins to deposit on teeth as forms of plaque. Multiplying by mitotic division approximately every 20 minutes, bacteria can start inflammating the gum tissue, and causing bleeding in about 2 to 4 days. When allowed to continue accumulating, in approximately 21 days, bacteria becomes increasingly developed and hazardous enough to even cause bone loss by morphing into more harmful types. Tartar is formed by minerals that deposit on bacterial plaque. The source for these minerals come from food, saliva and periodontal pocket fluids. The accumulation of bacterial plaque will be prevented by maintaining a good oral hygiene, thus enabling the prevention of both gingivitis and tartar formation. As the bacterial plaque stays in the mouth longer, it will grip the teeth even tighter and become tartar. The patient must seek a dental professional's help in such conditions. The most important thing to uphold is to keep a healthy structure on gum tissue before going forward with prosthetic applications.

Gingivitis is often caused by poor oral hygiene. The disease is reversible when first line treatment is applied which includes scaling, polishing and oral hygiene motivation and with proper oral health care. When left untreated, gingivitis can develop into periodontitis. Over time, plaque progresses under the gum, irritating the gum tissue with bacteria and toxins, which causes the chronic infection and the bone loss on the bone supporting the teeth, thus separating the gums from the teeth and forming gaps between gums and the teeth called periodontal pocket. As the disease progresses, the periodontal pocket deepens and recession occurs due to further bone loss. In the advanced stages of the disease, the teeth luxate and lose their function. The luxating teeth may have to be extracted even though they are not decaying. In the case of periodontitis, subgingival curettage is applied in addition to scaling and polishing. In the very advanced stages, periodontal surgery is performed. It is essential that the patient fully commits to maintaining their oral hygiene, thus removing the bacterial plaque, in every type of gum treatment. Otherwise, the success rate of the treatment gets lower.

Gingival Recession Causes and Treatment Methods

Bacterial plaque is considered as the main cause of gingival recession. Recession occurs due to gingival disease caused by bacterial plaque. The additional factors of gingival recession are muscle stiffness, the position of teeth and the root, irregular restorations, occlusal trauma, type of the gum tissue, smoking, aging and especially traumatic brushing. The treatment of gingival recession includes reshaping of the area of loss by either shifting the gums from surrounding regions or by taking soft tissue graft (mucogingival surgical tehniques) from the patient's palate.

The Causes of Gingival Hyperplasia and Treatment Methods

Gingival hyperplasia can develop due to inflammation caused by bacteria, as well as hormonal causes, medicinal causes (nifedipine, siklosporin A and fenitoin) or tumoral causes (benign or malignant) and various systemic conditions. The treatment of gingival hyperplasia is the removal of enlarged tissue so that the gums are brought back to their old healthy dimensions as well as the removal of causes.

Flap Surgery (Periodontal Surgery)

When treating conditions with a periodontal pocket depth of 5 mm, in order to reorganise the root surface and facilitate comfortably reaching the inflammated area, periodontal (flap) surgery has to be performed. The most important advantages of the technique are reaching the area of defect with direct vision, cleaning of the granulated tissue and especially the ability of reaching diastema of the molar teeth root. The purpose of these types of operations are the elimination of the periodontal pocket. Periodontal pockets are either shallowed by cutting them down or applying graft and membrane in order to regain lost bone and supporting tissue, thereby shallowing the periodontal pockets.

Flossing

Dental floss cleans the microbial dental plaque and food debris between the teeth. The types of floss are waxed, non-waxed, nentol, flouride, chlorhexidine. Flossing is recommended after brushing. When flossing, the rope has to be wrapped on both middle fingers and guided by two index fingers. If the patient is unable to floss with this method, slingshot-shaped special tools, including rope docked on a holder which is angled properly for the mandibula and maxilla, can be used. During flossing, it is recommended to go underneath the gum tissue and clean the whole surface with the motion of a seesaw and refrain from cutting the gum tissue. It is recommended to floss at least once a day.

Gingivectomy

Gingivectomy is a surgical method where excess gum tissue is removed in order to reshape the gum tissue levels for gummy-smile (gum tissue exposed more than normal when smiling) cases. Swollen and irregular gums are brought back to their ideal dimensions. In addition to traditional methods, today it is possible to utilize laser technique. In conditions where esthetic issues include both the gums and the teeth, a complete smile design can be achieved.

Coronoplasty

In this technique, a process of reduction (occlusal adjustment) is performed so that the premature contacts can be eliminated and occlusion can be adjusted. Due to the fact that these grindings are performed on the enamels and with special drills, there will be no teeth sensitivity. Thanks to the reshaping, it is possible to make circular shaped teeth a little more flat and indented teeth a little more straight.

Mucogingival Surgery

This method is used in the treatment of gingival recession concerning one or more teeth. By reshaping the gingival recession with the gingival tissue taken from the palate or shifted from the neighboring area, the loss of gum tissue and irregularities are eliminated.

Laser applications in Dentistry

Laser is discovered in USA on 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 simplifed thanks to the application of laser technology in dentistry.

Due to the fact that there is minimal damage to the tissue, laser technology is becoming widespread in various stages of the surgical procedures. The most important advantages of the technology are bleeding-free operations on soft tissue, fast healing rate and sterilisation on 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 on the tissue which 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 absolutely wear protective glasses especially during the procedure.

Laser application on Soft Tissue

Soft tissue lasers with special wavelength are mainly used in 3 types of procedures such as biostimulation, regional infection control and oral soft tissue incisions. Lasers are utilized in dealing with the conditions of gum tissue after oral surgeries and reducing the number of microorganisms which cause inflammation on gums. Gingivectomy, gingioplasty and frenectomy procedures can be performed without bleeding, stitching and less anesthesia thanks to laser technology. The technology also allows to proceed with other procedures without waiting thanks to no bleeding. In cases where scaling and root planning of periodontal pockets, in order to change the microbial contents of the periodontal pocket, it is possible to utilize sterilizing effect of the laser technology. Eliminating oral tumoral formations, avoiding stitches and faster healing rate is all possible with utilizing laser technology. During the early stages of aphtous ulcers, laser application will remove patient's pain and prevents the wound from opening, thus eliminating the difficulties when eating and speaking. Additionally, the procedure also diminishes the potential chance of aphtous ulcers or herpes to appear again. It is also reported that stimulating the tissue (biostimulation) with laser can promote and control the healing process.

Laser application on Hard Tissue

Laser technology can be used for cleaning the surface decay on teeth without the need for anesthesia. During surgical procedures involving the jawbone, it is also possible to lift the bone without vibration. Although successful in hard tissue procedures, the disadvantage of laser is the prolonged length of the operation. It can also be used for sterilizing the root canals during root canal therapy. Treatment of the inflamed regions surrounding the area of implants can be handled without any need for antibiotics. In addition to tooth paste and clinic flourine when treating teeth sensitivity, it is alternatively possible to plug the dentine canals with the utilization of laser technology.

Teeth Whitening and Laser Technology

It is possible to activate the whitening agents with later technology to achieve whitening as an alternative to the traditional whitening techniques.