Dr. Maneesh Rai, Dentist, Bhopal

Subtitle

Gums

GUM (GINGIVAL) DISEASE

 

WHAT IS GUM DISEASE & ARE YOU AT RISK?

Did you know that more than 75% of all adults in India have gum disease?

-Many people have gum disease and are not even aware they have this problem.

Did you know that gum disease is the #1 reason adults lose their teeth

-Gum disease is a "silent" disease-until your teeth become loose and fall out--many people do not know they have it and how seriously they do.

Did you know that HIV (the virus that causes AIDS) can be passed by kissing between two people who have advanced gum disease?

-A recent report indicated that a young woman in a relationship with a man who had HIV, caught AIDS from kissing him. Both people had moderate to advanced periodontal disease and it is believed that she caught the AIDS because of a direct blood transfer between their diseased gums.

 

 


 

SIGNS & SYMPTOMS OF GUM DISEASE

Do your gums bleed when you brush, floss or use a toothpick?

Are your gums red, swollen and painful?

Do you have pus coming from between your gums and teeth if you push on your gums?

Are your gums pulling away from your teeth?

Has there been a change in the way your teeth come together when you bite or chew on food?

Do your teeth look longer because of receding gums?

Are your teeth loose?

Do you have bad breath?

If you wear a partial denture does it still fit the same?

If any of these statements are true then you may have a problem with your gums.You should visit your dentist and get an evaluation and schedule an appointment. You may need more than just a routine cleaning for your teeth to get your gums healthy again.

A thorough evaluation of your gums and your overall dental health includes a comprehensive examination, a complete set of x-rays, and periodontal probing.If there is bone loss and deep pocketing you may need non-surgical periodontal or surgical periodontal care.


 

THE VARIOUS STAGES OF GUM DISEASE

 

 

These are healthy teeth, gums and bone. The instrument is a periodontal probe and in healthy gum it should only go 1-3mm (marks) into the gum. Regular checkups with professional cleanings will help keep you in good gum health.

 

 

 

These are teeth, gums and bone that have gingivitis-the early stage of gum disease. Notice the gum is red and puffy, and there is plaque and tartar building up around the gum. There is no bone loss, yet. The probe measures 3-5 mm into the space between the teeth and gum. Gingivitis can be reversed with proper treatment.

 

 

 

This is Periodontitis, the plaque and calculus spreads down the root infecting the bone and the ligament holding the tooth into the jaw. This causes the gums and bone to recede away from the tooth. The space between the tooth and the gum measures more than 5 mm and traps food and more plaque under the gum. With proper treatment you can prevent further damage.

 

 

 

This is advanced gum disease. The infection has destroyed most of the bone around the tooth. The plaque and tartar has covered the tooth well below the gum and on the roots. The gums recede even further, the teeth become loose and can shift causing your bite to change. The pocket between the tooth and the gum is more than 8 mm. You are at great risk of losing your teeth.

 

GUM-HEALTH MAINTENANCE
 

Maintaining good oral health is the key to keeping your teeth for a lifetime. This includes regular visits to the dental office for cleanings, x-rays and check ups. Cleaning (Scaling & polishing) as detailed below, can be as infrequent as every six months, or as often as every three or four months, depending upon the health of your gums, and how quickly you develop tartar and stains on your teeth. Remember that 75% of all adults have periodontal disease.

Home brushing and flossing are the building blocks to a lifetime of healthy teeth and gums. Flossing removes food that might remain between your teeth after you brush. If the food is not removed it can start decay, and if the food gets trapped in your gum it can cause gingivitis, or make your existing gum disease worse. You should brush 2-3 times a day, preferably after every meal and before you go to sleep.

 

SCALING & ROOT PLANING (NON SURGICAL TREATMENT)

Scaling and Root Planing is usually the first dental treatment a patient receives for periodontal disease. Scaling and root planing attempts to remove all of the unwanted irritants under a patient's gums in an attempt to eliminate inflammation and infection.

 

PROCEDURE

Half of the patient's mouth is numbed,if required  so that the dentist can comfortably remove any hardened food ( calculus ) from below the patient's gums. This is called scaling and it's like removing the scales from a fish. In addition to hand scaling, we use ultrasonic vibrating tools to blast unwanted hardened deposits off of the patient's teeth during this phase of scaling and root planing. Scaling leaves a rough tooth surface so planing is needed next.

A carpenter planes wood so that it's smooth. Essentially we perform the same procedure on a surgical level on the surface of the teeth. This allows the gums to regenerate without irritation. The gum tissue normally shrinks and becomes tight around the teeth after this scaling and root planing because there is no longer anything there to irritate the gums. Scaling and root planing can also reduce or eliminate the bleeding gums.

After scaling and root planing is completed the gum tissue is allowed to heal and the results are later documented by charting the patient's pocket depth. Our aim is to achieve a 1 to 3 millimeter thickness of gum tissue after scaling and root planing.

 

After scaling and root planing

In some patients, scaling and root planing is the most aggressive treatment needed to control their periodontal disease. This is because scaling and root planing can often eliminate the inflammation and infection that promotes the tissue destruction around teeth with periodontal disease. Because scaling and root planing is a non-surgical treatment, patients often feel comfortable with it, however, scaling and root planing is most effective is treating early periodontal disease.

Unfortunately, scaling and root planing is not a cure. Many patients have scaling and root planing done every two years to continually remove irritants that accumulate over this period.

Non surgical periodontal treatment is appropriate in the early and moderate stages of periodontal disease, otherwise known as Periodontitis.

If there is a great deal of bone loss, a situation known as moderate to advanced periodontitis, then surgical periodontal treatment is required.

All patients that undergo periodontal treatment-whether it be non-surgical or surgical periodontal treatment need to have their teeth cleaned and their gums checked on a regular basis. This will be as often as every three to four months. It is vitally important to do this to prevent further periodontal problems.

Periodontal disease is a chronic problem, without ongoing treatment the infection and disease will recur, and each time it does, more bone can be lost, until eventually the teeth become loose and need to be removed.

The goal of non-surgical periodontal treatment is to bring the gums back to good health by shrinking or eliminating the pockets around the teeth that are the site of infection, without having to have gum surgery.

Gum Surgeries

Surgical Therapy

  • Flap Surgery: Our periodontist separates the gum from the teeth creating a "flap" and accesses the infected pocket. It aims to reduce pocket depth and increase the ability to maintain the remnant pockets clean.
  • Gingivectomy: This procedure is performed when excess amounts of gum growth around the teeth have occurred. This results in false pocket formation and the inability to keep them clean.
  • Osseous (bone) surgery: This procedure is done to smooth shallow craters and defects in the bone due to mild or moderate bone loss. Guided Tissue Regeneration: This procedure is done in combination with a surgical flap operation where gum growth into a defect is barriered off to allow slower growing bone, cementum and ligament cells to populate a bony defect.
  • Bone Grafts: Tiny fragments of the patient's bone, synthetic bone or bone obtained from a bone bank are used to fill a bony defect around the teeth. These grafts act as a scaffold on or around which patients own bone is conducted or induced to grow.
  • Soft Tissue Graft: In cases of gum recession a graft is usually taken from the palate and transplanted onto the receding area to reinforce the thin gum and to inhibit further gum recession.

Flap and Bone Surgery

When gum is inflamed severely (periodontitis), alveolar bone will be absorbed, and defected. Periodontal ligaments which connect between the alveolar bone and the teeth will disappear. Sever bone lose will cause tooth moving and missing. Flap and bone surgery is order to contour the bone, deeply clean the tooth to reduce the inflammation, and promote bone re-growing and connections firm.

Detailed Procedures

Presurgical bone defect Flap incision to make gum retracted The bone is contoured Gum is sutured back healthy gum after periodontal surgery
Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5

1. Presurgical bone defect. Gum inflamed and reddish.
2. Flap incision to make gum retracted, and the bone shows out.
3. The bone is contoured, and remain tartar is removed.
4. Gum is sutured back.
5. After periodontal surgery, the bone defect disappears, and gum becomes healthy pink color.

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