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What is periodontics?

Periodontics is the dental specialty of gums disease study (gingivitis and periodontitis).

Gingivitis is an infectious disease manifested by bleeding gums. It is reversible, and 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 an infectious origin, which results in loss of the bone that supports the teeth and, consequently, in the long or medium term, losing teeth if the treatment is not performed on time.

Symptoms

  • Gums bleeding (when brushing, eating, or even spontaneously).
  • Bad breath (halitosis).
  • Bad taste in the mouth.
  • Dental sensitivity (especially with cold things).
  • Inflamed gums.
  • Loose teeth.
  • Gums Retraction: exposure the roots or long teeth.

Gum problems DO NOT HURT in most cases, patient can be aware if one of these symptoms appears.

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

Periodontic treatments

Periodontal Decontamination

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

It consists of performing several sessions of scaling and root planning to decontaminate the root of the tooth. But the first and fundamental thing is to carry out X-rays and a detailed study of each tooth that informs us of the degree of inflammation, recession, mobility, and other important data to be able to know in what stage of the disease the patient is and based on this, establish certain guidelines for action and an individualized forecast. Likewise, it is of great importance to instruct the patient in brushing techniques, since without a change in habits the treatment we do will not have the same effectiveness.

Periodontal disease is caused by an imbalance between the bacteria that coexist in our mouth and our defenses. Either they increase the bacteria or 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 antibiotics and which specific.

After this 1st phase, a periodontal evaluation will have to be carried out again to be able to assess the response to treatment and the need or not to perform surgery.

We can also carry out genetic analysis to assess the predisposition to suffer from the disease. This will help us to foresee possible complications, and to make certain decisions for the future, as well as to take preventive steps for the relatives of the patient with periodontal disease.

Periodontal Decontamination

It is the first phase of periodontal treatment. It is focused on eradicating the main cause of gum problems: BACTERIA. Using 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 antibiotics and which specific.

It is the only phase that not all patients need. If residual bags remain after scraping, they must be removed so that they are not colonized by bacteria again. Likewise, regeneration of the lost tissues will be carried out when it is possible through the use of membranes or matrix derived from the enamel, and recessions will be covered by gum grafts in the teeth that need it.

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.

They are normally performed with the patient’s own gingiva, as this is how a higher success rate is obtained and fewer postoperative problems, but in some cases, we can use matrices or membranes of collagen of animal or cadaveric origin.

There are different techniques depending on the extension of the area to be intervened and depending on the characteristics of the defect. The trend is to eliminate large incisions or discharges to reduce scars and to carry out tunneling or apical micro-access surgeries, thus introducing the graft in a minimally invasive manner through a small hole.

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 (tobacco compromises the vascularization of the wound), that their oral hygiene is exquisite and that the teeth do not have excessive mobility, in which case they must be splinted first.

This phase is FUNDAMENTAL in the treatment of gums, if it is not complied with, the success of the treatment cannot be assured. Maintenance is carried out by hygienists supervised by the periodontist. The supra and subgingival plaque and calculus are removed with the use of ultrasound and mini-curettes to delve into the gum. The areas that retain plaque and the areas of possible relapses are detected. How often maintenance should be performed depends on the type of periodontal disease, age, whether or not you are a smoker and the skill of the patient with brushing.

In addition, if the patient has a dental implant in his mouth, these check-ups will have to be more frequent to prevent problems of mucositis or peri-implantitis.

We have incorporated a new apparatus into our clinics that allow us to carry out a new work system developed by the EMS brand, a leader in oral hygiene. This work protocol allows us to be more efficient and less invasive with the periodontal tissues of our patients. We always start with a plaque control to detect the areas with the greatest accumulation of plaque where the patient does not access well with brushing, and thus we can also learn which are the weakest areas to improve their brushing technique. Then we use an ERITITROL spray, which is a fine particle powder that does not damage enamel or ceramic or resin prostheses, and that removes dental biofilm in a more gentle way. If there are thicker calculus deposits, we will use ultrasound (which we will use with hot water to minimize sensitivity) or curettes, and we will end up leaving the entire surface well polished.

We carry out this work protocol in the maintenance phase, or sometimes in the anti-inflammatory phase as a complement to the scaling and root planning sessions.

In addition, at these maintenance appointments, the soft tissues will be checked, if there are new cavities, and implant control x-rays will be performed when necessary.

It is very important that the patient has good dental hygiene and is aware of the use of dental tape and/or interdental brushes, since if we can not have recurrences and continue to lose bone due to poor removal of bacterial plaque.

Periodontal disease cases before and after

See more cases

FAQs Periodontitis / Gingivitis

How is gingivitis detected?

Usually, we detect gingivitis when our gums are irritated, visibly reddened, and if we bleed frequently when brushing, flossing or even eating. When it is getting serious, the gums bleed even alone. Normally is accompanied by bad breath and gum retraction.

How does gingivitis differ from periodontitis?

The main difference is that gingivitis is reversible, heals, and does not lead to bone loss. But if the treatment is not carried out on time, periodontitis can develop, which, although we can cure or stop it, already leaves sequelae, producing a loss of the bone that supports the teeth, which translates into recession of the gums or gaps between teeth with a feeling of longer teeth. For this reason, it is very important to go to a specialist periodontics center when we notice bleeding gums, sensitivity, bad breath or we are smokers, since an early diagnosis will save us from suffering the consequences of periodontal disease.

If I take care of dental hygiene, why do I have gingivitis?

Gingivitis is not always because of 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.

Is gingivitis contagious?

It is not usual, 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.

Can Periodontitis be cured?

Periodontitis DOES CURE, but unfortunately, it leaves sequelae in our mouth such as the recession of the gums or gaps between the teeth. For this reason, it is important to stop this loss of bone, so that these gaps are not getting bigger and bigger and the roots of the teeth are not more and more exposed. Of course, every patient who suffers from gum problems has to be aware that they need a MAINTENANCE for life, both at home, taking good care of their oral hygiene, and in their periodic visits with their hygienist and periodontist who will be attentive to possible relapses or changes in your gums.

How do I prevent gingivitis?

The main way to prevent it is to have 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 remove plaque deposits in areas of difficult access. The frequency of these visits will depend on the individual predisposition to suffer gum problems, the ease of forming stones and the presence of other systemic factors that may affect our oral health such as tobacco, diabetes, pregnancy, heart problems or thyroid among others.

What is the connection between periodontitis and tobacco?

There is a clear relationship between tobacco and periodontitis. Tobacco causes a decrease in the natural defenses of the mouth, since it produces vasoconstriction, and this causes bacteria to penetrate the gums more easily and there are fewer bacteria to defend themselves. It also favors the growth of more aggressive bacteria in the gums, so in many cases we have to accompany the mechanical treatment of chemical treatment with specific antibiotics.

Another negative factor of tobacco is that by producing vasoconstriction, the patient does not perceive the bleeding of the gums and therefore does not give an alert to visit a specialist. For this reason, we always recommend that smoking patients attend their oral examinations at least twice a year.

Which are the periodontitis symptoms?

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. Although sometimes none of this is felt and the only thing the patient perceives is a greater gap between the teeth.