Periodontitis is the inflammation of supporting structure of the tooth. In simple terminology, the foundation of the tooth gets affected.
In Periodontitis, the microorganisms over the plaque, their toxins infect the gums, surrounding periodontal ligament that connects the tooth with the bone and induce supporting bone loss. This over a period of time can loosen the teeth.
Periodontitis is progressive disease without much pain. Hence it often goes unnoticed. Early diagnosis and intervention is crucial for better results.
What are the causes of Periodontitis?
Poor oral hygiene with calculus deposits.
Untreated gingivitis.
Hormonal disturbances like puberty, pregnancy etc.
Systemic conditions like diabetes, or congenital disorders.
Habits like smoking.
Side effects of certain anti-hypertensives or anti-epileptic drugs can cause gum inflammation & gradually predispose it to Periodontitis.
Continued inflammation of the gums or gingivitis can result in the gums pulling away from the teeth, allowing for formation of "pockets" filled with bacterial plaque, calculus (tartar), food debris and pus. This painless infection results in damage to the bone (socket) supporting the teeth.
Moderate eriodontitis
Further spread of the gum infection results in further loss of bone support. Loose, shifting teeth and more obvious recession of the gum can be seen.
Advanced gum disease is one of the leading causes of tooth loss in adults. Painful gum abscesses can occur as the deeper infection gets trapped under the gum, resulting in a buildup of painful pressure. Severe mobility of teeth is observed leading to teeth loss.
What is the treatment of periodontitis?
Treatments for Periodontitis are non surgical & surgical procedures.
Root planing involves smoothening the root surfaces of teeth with thin curettes. This allows gum tissues to firmly reattach to roots that are clean and smooth thus preventing tooth loss and sensitivity problems.
The procedure makes it more difficult for plaque to accumulate along the root surfaces. Because this procedure goes deeper than a regular cleaning, the mouth is anaesthetized. The cleaning may take two visits to complete.
Debriding the root surface is a critical element in establishing periodontal health.
Periodontal flap surgery is the treatment procedure to clear the deposits around roots of teeth and to remove necrotic tissue lining of the pocket that prevents healing of gums and periodontium.
Flap surgery is recommended in cases where the pocket depth around teeth has reached a level that makes cleansing difficult. It is usually associated with areas of bone loss that needs to be surgically corrected.
What is the procedure of flap surgery?
Flap surgery is done under local anesthesia. Prior to the procedure, full mouth radiographs (X-Rays) called OPGs are advised to determine the amount of bone loss around the teeth.
After administration of local anesthesia, small incisions are made in the gum, so that it can be lifted back to expose the tooth and bone. The entire area is thoroughly cleaned, all tartar and infected granulation tissue is removed and the bone is examined.
Due to the periodontal disease, bone could be diseased and often needs to be re contoured for the gum to heal properly.
Then the diseased tissue lining of gum is removed and the surface of damaged bone is smoothed out.
Based on the amount and type of bone loss, bone grafting is accomplished. There are a variety of bone graft materials both natural and synthetic and are chosen based on the case.
At the end of the surgery, the gum is sutured (sewed) back to its place.
Finally a gum pack or a periodontal pack is placed over the stitches to avoid trauma or disturbance to the surgical site.
How many visits are needed for flap surgery?
Flap surgery is usually done in an outpatient setting.
Mouth is divided into four quadrants and in each visit, surgery is accomplished in either one quadrant or two quadrants that is, half of the mouth, based on the complexity of the case and patient comfort. So on an average flap surgery is usually completed in 2-4 appointments.
What are the post-operative instructions following flap surgery?
Mouth is divided into four quadrants and in each visit flap surgery is accomplished in either one quadrant or two quadrants that is half of the mouth based on the complexity of the case and patient comfort.
Medicines are advised to relieve post operative pain and swelling. They should be consumed as per the doctor's instructions.
Cold packs may be beneficial to avoid swelling.
Small amounts of soft food should be consumed.
Fluid intake should be increased.
Smoking should be avoided as it will disturb the healing procedure.
Should visit the dentist after a week for a follow-up.
What are grafts and why are they used?
Grafts are materials used to replace or restore missing bone or gum tissue.
They can be of two varieties:
Hard tissue grafts or bone grafts.
Soft tissue grafts.
What are bone grafts?
A bone graft is used to recreate bone and support the soft tissues lost due to gum disease. It's also called regenerative surgery.
Bone grafting materials commonly used include bits of a patient's own bone, cadaver bone, cow bone and synthetic glasses. The patient's own bone is the best graft material.
Barriers are used to prevent the gums from growing into the bony defect. They are made from human skin, cow skin or synthetic materials.
What are Soft tissue grafts or Root coverage procedures? Why are they used?
Soft tissue grafts can be used to cover roots or develop gum tissue where absent due to excessive gingival recession.
A thin piece of tissue is grafted from the roof of the mouth, or gently moved over from adjacent areas, to provide a stable band of attached gingiva around the tooth.
The gingival graft may be placed in such a way as to cover the exposed portion of the root.
During this procedure, the periodontist takes gum tissue from patient's palate or another donor source to cover the exposed root. This can be done for one tooth or several teeth to even patient's gum line and reduce sensitivity.
A soft tissue graft can reduce further recession and bone loss. In some cases, it can cover exposed roots to protect them from decay.
Soft tissue grafts and other root coverage procedures are a predictable way to cover unsightly, sensitive or exposed root surfaces, to prevent future gum recession and restore healthy gum tissue. This will reduce further bone loss and recession, make the tooth less sensitive, protect the root from root cavities, and look more natural when you smile.
What is gingivoplasty?
Gingivoplasty is a procedure in which gums are surgically reshaped and re-contoured for cosmetic, physiological, or functional purposes.
Gingivoplasty is usually done in combination with gingivectomy under local anesthesia. The term comes from gingiva meaning gums and the word ending -plasty meaning to reshape. Many patients have a gummy smile which is caused by excessive and overgrown gum tissue. Excess gum tissue can usually be removed to reveal a beautiful smile underneath.
After a gingivectomy procedure, the gingivoplasty procedure thins the remaining gums tissue so the tissue looks natural and pleasing.
What is gingivectomy?
Gingivectomy is the surgical procedure done under local anesthesia to remove and reshape loose, diseased gum tissue to get rid of pockets between teeth and gums. The indications for gingivectomy are:
Elimination of suprabony pockets regardless of their depth, if the pocket wall is fibrous and firm.
Elimination of gingival enlargements
Removal of suprabony periodontal abscesses
A pack which covers the surgical site is usually applied to protect the site from any injury.
What is crown lengthening?
Crown lengthening is a simple surgical procedure which adjusts the position of the gum around the affected tooth, thereby providing a more solid tooth on which to anchor the restoration of choice.
A functional crown lengthening will helps the patient regain a beautiful smile and allows them to eat and speak with comfort and confidence.
Crown lengthening is available to prepare a tooth for restorative dentistry or to cosmetically enhance the smile.
This procedure is also recommended to make a restorative or cosmetic dental procedure possible.
