Perio

PERIODONTOLOGY

Gingivitis

This is the most common form of periodontal disease. It affects almost everyone at some time during their lives.

Gingivitis is inflammation of the gum caused by plaque. The micro-organisms and toxins found in plaque stimulates our bodies immune and inflammatory responses making the gums appear red and swollen. Inflamed gums will bleed when stimulated e.g. brushing or flossing.. This is often seen as blood when rinsing after brushing.

Treatment

As gingivitis is an inflammatory response caused by plaque, its treatment involves the removal of the bacteria which are present in plaque and tartar which irritates the gums.

It is vital to have your gums checked by your dentist to confirm the presence of any gingivitis and not a more serious cause of bleeding. Once a consultation is completed and a positive diagnosis made, treatment consists of professional cleaning and debridement of the plaque and tartar that has collected. This is often completed by our hygienist. You will also be given instructions on how best to maintain your teeth to prevent re-occurrence of the problem. If oral hygiene is of a consistent good standard further gingivitis will be prevented.

Periodontal Disease

This term refers to a range of diseases with health and stability of the gum at one end and bone destruction and infection of the periodontal tissues at the other.

We now know that periodontal disease has genetic patterns and an increased risk in patients who smoke or have certain medical conditions e.g. diabetes.

What causes periodontal disease?

Like gingivitis the micro-organisms and toxins found in plaque accumulate at the gum line and stimulate our immune and inflammatory response. This activation of the immune response in periodontal disease leads to irreversible damage to the bone around our teeth and the attachment of how our teeth are attached to the supporting bone.

Signs & Symptoms

In many cases, especially in the early stages, there are no signs or symptoms of periodontal disease. The disease process can follow a very variable pathway. In some cases it can be widespread and in others localised, often it affects both sides of the jaw.

The process follows an irregular pathway and often patients are completely unaware until the final stages of the disease process. Regular visits with your dentist will pick up the early changes. By probing your gums with a special gum probe, your dentist can find areas of periodontal disease before you may be aware of any problems.

In the late stages of periodontal disease, teeth can become loose, drift (causing spaces or crossing over of teeth) and gum recession can be seen.

Treatment

Our treatment of periodontal disease starts with the diagnosis and assessment of risk factors, such as smoking habits, general health and family associated risks.

We would then modify or control risk factors that are possible. Stopping smoking is important and liaising with your GP if medical risk factors exist e.g. diabetes.

Dental treatment consists of measuring the distance between the gum support and the bone support and the remaining teeth (pockets). We would also assess the response of the gums to the pocket measurements e.g. bleeding or pus present when probing

Normally the affected teeth are scaled and debrided under local anaesthetic, this is usually one side of the mouth (upper and lower) per visit. These 2 visits are completed in close succession and sometimes are completed with antibioticsand gum probing measurements are repeated 8 to 12 weeks later.  Excellent oral hygiene is required to prevent new plaque and tartar build ups returning, and you will be shown how to best to maintain your mouth.

If the scores have improved or stabilised, follow up usually consists of further reviews and routine scale and polish appointments with the hygienist, normally on a 3-4 monthly cycle. If the scores have deteriorated or not improved then other treatment options are usually required. This can involve surgical debridement, splinting mobile teeth, bony regeneration, and furcation opening to aid cleaning.

Other periodontal treatments can also be considered for the correction of bony defects (e.g. GTR), gum recession (e.g. coronally advanced flaps, connective tissue grafts) or correcting tooth lengths due to tooth wear (e.g. crown lengthening).

Horbury Dental Blog