Gingivitis / Periodontitis

periodontitis gingivitis

1) CONCEPTS:

PERIODONTICS is a dentist speciality of gums disease study (gingivitis and periodontitis).

GINGIVITIS is an infectious disease manifested by bleeding gums. It is reversible, does not lead to bone loss. It can be mild, moderate or severe depending on the inflammation degree.

PERIODONTITIS or “pyorrhea” is a chronic disease with infectious origin, which results in bone lost that supports the teeth and, consequently, in long or medium term, missing teeth if the treatment is not performed on time.

2) SYMPTOMS:

  • Gum problems DO NOT HURT in most cases, patient can be aware if one of these symptoms appear
  • Gums Bleeding (when brushing, eating or even spontaneously).
  • Bad breath (halitosis).
  • Bad taste in the mouth.
  • Dental sensitivity (especially with cold things).
  • Inflamed gums.
  • Dental mobility.
  • Gums Retraction: exposure the roots or long teeth.

Sometimes, these symptoms are camouflaged by tobacco, which causes vasoconstriction and hide inflammation signs. Therefore, if you smoke, we advise you to do a periodontal study to rule out any gum problem before is too late.

 3) ETIOLOGICAL FACTORS:

The main etiologic factor is bacterial plaque. Plaque buildup, usually due to improper brushing, causes gingivitis or gums inflammation . If keeps this in time, or the patient has genetic predisposition to develop a periodontitis, bone loss begins. In addition there are a number of general and local conditions that facilitate its appearance or aggravate its course:

  • General Factors: Diabetes, pregnancy, tobacco, poor dental hygiene, stress, malnutrition, some medications (antihypertensive, immunosuppressive, hydantoin).
  • Local Factors: Poorly adjusted prostheses and fillings, dental crowding, deep grooves or anatomical defects.

Periodontal disease has a CURE. The adequate treatment stops bone loss, but in addition it is necessary a LIFE MAINTENANCE , both at home (with the recommended hygiene methods) and at the clinic (to access areas where the patient does not get to prevent relapses).

FAQ PERIODONTITIS /GINGIVITIS

Usually we detect  gingivitis when our gums are irritated, visibly reddened, and if we bleed frequently when brushing, flossing or even eating. When is getting a serious, the gums bleed even alone. Normally is accompanied by bad breath and gum retraction.
When a gingivitis is not treated, it becomes periodontitis, which leads to loss of the bone that supports the teeth. Periodontitis requires a more rigorous and long term treatment.
Gingivitis is not always suffered from poor oral hygiene. It can also occur in people with diseases such as diabetes, hypertension, or immunosuppression circumstances. On the other hand, sometimes women during pregnancy can also suffer it as a result of hormonal changes. In addition, we might brush 3 times a day but we do not do it correctly, or we do not floss, and that can lead to gingivitis.
It is not usually, however, there is always a risk that the bacteria can be transmitted through saliva, especially in stable couples. It has been shown that continued contact with a patient with gum problems can cause us to suffer it as well.
The main way to prevent it is to have a constant oral hygiene. Ideally, brush your teeth after each meal and floss once a day to ensure that no food remains between your teeth. It is good to know that electric brushes are shown to remove more plaque than manual ones, which is a great help in keeping our gums healthy.

As for the professional section, it is recommended to visit the dentist between 1 and 2 times a year, to assess the general condition of the mouth.

It is an irreversible disease, this means that the bone lost is difficult to recover; But if it is treated in time, it can be controlled, extending the life of the teeth and avoiding its extraction in the most serious cases.
There is a clear relationship between tobacco and periodontitis. Tobacco causes a decrease in the natural defences of the mouth and this causes bacteria to penetrate the gums more easily.
Symptomatology is very similar to gingivitis. The main symptom of periodontitis is bleeding and inflammation of the gums, bad breath, sensitivity increased and even dental pieces movement.

Periodontal Treatment

Several sessions of scaling and root planing are realized to decontaminate the root of the tooth. Radiographs and a detailed study of each tooth with an electronic probe (Florida Probe) are performed, which inform us of the degree of inflammation, recession, mobility and other important data to assess the response to treatment and, based on that, establish some guidelines for action and an individualized forecast.

It is essential to instruct the patient in brushing techniques and interdental hygiene.

After scraping, a microbiological analysis is done to determine if there are any more aggressive bacteria that have caused inflammation and bone loss. This will help us to know if we have to use antibiotics or not, and what specific antibiotic is necessary.

After completing this first phase, a new periodontal evaluation will have to be carried out in order to assess the response to the treatment and the need or not to perform surgery.

We can also carry out a genetic analysis to assess the predisposition to suffer the disease. This will serve to anticipate possible complications, and make certain decisions for the future.

Not all patients need it. If residual scraps are left after scraping, they must be removed so that they are not re-colonized by bacteria. Also, regeneration of lost tissues will be performed when it is possible through the use of membranes or matrix derived from the enamel, and recessions will be covered by gingiva grafts on the teeth that need it.
This phase is FUNDAMENTAL in the treatment of gums, if it is not fulfilled can not assure the success of the treatment. Maintenance is carried out by hygienists supervised by the periodontist. Supra and subgingival plaque and calculus are eliminated with the use of ultrasound and mini curettes to deepen the gingiva. Areas that retain plaque and areas of possible relapse are detected. How often maintenance should be performed depends on the type of periodontal disease, age, whether or not the patient is a smoker, and the patient’s ability to brush.

Periodontal Decontamination

Is the first phase of periodontal treatment. It is focused on eradicating the main cause of gum problems: BACTERIA. It is necessary mechanical treatment (scaling and root planing), and in some cases also chemical (antibiotics).

Periodontal disease is caused by an imbalance between the bacteria that coexist in our mouth and our defenses. Either they increase the bacteria or they lower the defenses. This imbalance favors the growth of pathogenic species that are more aggressive to our gingiva, and which do not disappear just by scraping. Therefore, to make sure that the treatment is effective, we make a sample with paper tips that are inserted into the gum (no painful procedure). This is sent to the laboratory to determine the presence and proportion of periodontal pathogens. Depending on the result we see if you have to take antobiotic and which specific.

Gingiva grafts

The grafts can be made on teeth, on implants or in areas that are missing pieces to recover the volume lost after an extraction.

They can be made for different purposes:

  • Coating of exposed dental roots (can occur by aggressive brushing, malposition of teeth, piercings …).
  • Inserted gingiva enlargement (in zones with traction of “frenillos” or bottom of short vestibule).
  • Increased thickness in areas where a tooth is missing to improve hygiene and aesthetics.
  • Increased gum volume on dental implants.

It is a microsurgical technique, very meticulous, but with spectacular results in many cases. For the success of the treatment it is imperative that the patient does not smoke, since the tobacco compromises the vascularization of the graft.

Periodontal Regeneration

In some cases we can regenerate the lost bone, where vertical defects are present. Depending on the morphology of the defect we can use proteins derived from the enamel matrix, or regeneration with collagen membranes.

To regenerate it is essential that the patient does not smoke, and if the teeth have mobility, they must be ferulized before.

It is a microsurgical technique, very meticulous, but with spectacular results in many cases. For the success of the treatment it is imperative that the patient does not smoke, since the tobacco compromises the vascularization of the graft.