Treatment of periodontal disease

ODQ Sheet – Periodontal Disease

What is periodontal disease?

Periodontal diseases and pathological conditions are diseases affecting the supporting tissues of the teeth, namely the bone that supports
the teeth and the gums.

The main periodontal diseases are gingivitis and periodontitis. Gingivitis is an inflammation of the gums around the teeth. It
reversible when treated. However, periodontitis is a severe condition that deteriorates the gums and the bone that supports the teeth.

Periodontal diseases are infections caused by the accumulation of pathogenic bacteria and their toxins in the gum crevice:
a small 1 to 3 mm groove located at the junction of the tooth and gum. These diseases can be aggravated by certain factors, the main ones being
These diseases can be aggravated by certain factors, the main ones being tartar accumulation, smoking, genetic influence, stress, a disease such as diabetes and the use of certain
medications.

The most effective ways to prevent these diseases are through meticulous oral hygiene,
including flossing, not smoking and regular visits to the dentist for frequent cleanings.
dentist for frequent cleanings.

Periodontitis is characterized by a loss of the bone support of the tooth and by the detachment of the gum around the teeth leading to the formation of « periodontal pockets » (Fig. 1). Periodontitis is often asymptomatic. However, the main signs observed by patients are gingival bleeding, swelling, loosening of the teeth, tooth migration and sometimes bad breath (Fig. 2). As the disease worsens, the teeth become loose. Untreated periodontitis can lead to tooth loss.

Screening for periodontal disease is done during recall visits to the dentist by means of an examination called the « PSR ». This simple and quick examination allows the dentist to detect periodontal disease. Depending on the result, your dentist will make appropriate recommendations. When periodontal disease is confirmed, the dentist will proceed with a more complete examination of your periodontium in order to evaluate its gingival characteristics: its shape, color, texture as well as the quantity and quality of the gum tissue. The depth of pockets and loosening is measured. A
X-rays are required to complete the evaluation of the periodontal bone. This global evaluation allows us to make a diagnosis, to identify the etiological factors and, finally, to establish a treatment plan appropriate to the state of your gums that will allow you to improve your oral health.

WHAT ARE THE STEPS IN PERIODONTAL TREATMENT?

Generally, treatments begin with an etiological periodontal health phase. This consists of eliminating the irritating factors – bacterial plaque and tartar – and correcting all the factors that promote their accumulation. Habits that could aggravate the disease must be modified. This treatment, called scaling and root planing, consists of cleaning up the periodontal pockets. It is usually performed under local anesthesia using manual and ultrasonic instruments. In some situations, an additional antibiotic therapy may be recommended. In the days following this treatment, the patient may experience increased sensitivity to chewing and brushing as well as to temperature changes. Following resolution of the gum inflammation, there will be contraction and firming of the gums, which may result in some additional exposure of the roots, giving the appearance of longer teeth. Special attention will be paid to the quality of daily oral hygiene to prevent root cavities, since roots are less resistant to decay than tooth enamel. To treat the increased sensitivity of the teeth to hot or cold thermal stimulation, the dentist may prescribe a toothpaste formulated to reduce sensitivity and may apply a desensitizing agent if necessary. This phase of treatment usually stops the progression of the disease and reduces the inflammation of the gums by reducing the depth of the periodontal pockets. In the following weeks, a re-evaluation of the periodontal condition will be performed in order to measure the improvement obtained. Following the periodontal health phase, some teeth may require periodontal surgery. The purpose of the surgery is to allow the dentist to access the roots affected by deep periodontal pockets and to facilitate a complete debridement. Such an operation will restore the gum and bone to a more natural contour, further reducing the depth of the periodontal pockets and, at the same time, facilitating the hygiene applied by the patient. There are regeneration techniques that can be tried, depending on the case. These procedures use different materials to promote the reformation of bone to partially replace the losses caused by periodontal disease. These techniques require specific clinical application conditions and your dentist can recommend them if they are appropriate for you. Surgical procedures provide significant benefits to the treatment, but involve a healing period. It is also important to know that there is a risk of relapse or worsening of the periodontal disease despite all the treatments performed.

GUM GRAFTS

Tooth « loosening » can be caused by several factors, including overly vigorous brushing or periodontal disease. Teeth that naturally have very thin gums are at greater risk of gum recession. This results in gum and bone loss and consequent exposure of the root of the tooth (Fig. 3). In the presence of loosening, it is very important to identify and correct the causative factors. Subsequently, a gingival graft may be indicated to arrest the recession process and prevent further loss of gingiva and bone. Gingival grafts are used to recreate the band of gingiva that has been lost through gingival recession. In special cases, it may be possible to partially or completely cover the exposed root. This procedure is usually performed with a graft from your palate, which is grafted where a gap has been located.

CROWN LENGTHENING

There are situations where there is excess gum tissue. In fact, a « gummy smile » exposing a lot of gum tissue can be caused by excess gum tissue covering an abnormal amount of the surface of your teeth and giving the appearance of short teeth (Fig. 4). Other situations, such as deep decay, a broken tooth below the gum line, or a lack of tooth structure length to make a restoration such as a crown or bridge can compromise the restoration of the tooth. This situation can be corrected by a procedure called crown lengthening. This surgery adjusts the level of the gum and bone to expose more of the tooth surface and give it a normal-looking length or to allow for a proper restoration (Fig. 5).

THE POSSIBLE RISKS AND COMPLICATIONS OF PERIODONTAL SURGERY:

• of pain
• bruising and/or swelling of the operated area
• of the infection
• postoperative bleeding
• Adverse drug reactions
• temporary loss of sensation in the operated area
• longer looking teeth
• sensitivity of the teeth to hot and cold
• loss of interdental papillae (triangle of gum tissue between the teeth)
• a loss of the graft

HOW TO KEEP YOUR GUMS HEALTHY?

Periodontal disease can recur if the cause comes back. This is why it is very important to adhere to a maintenance program
maintenance program that includes regular visits at intervals recommended by your dentist. It is also important to maintain high standards of oral
oral hygiene standards. Your dentist and hygienist can help you customize a care plan that includes proper brushing technique and use of
brushing technique and daily flossing. By controlling the amount of plaque and tartar adhering to your teeth, you can go a long way to reducing
help reduce the risk of recurrence of the disease.

That being said, it is important that any periodontal treatment required to control periodontal disease be performed by a licensed practitioner, i.e. a dentist.
either a general dentist or a dentist specialized in periodontics.