What is Periodontics?
PERIODONTICS is the specialty of dentistry that deals with the study of gum diseases (gingivitis and periodontitis).
GINGIVITIS is an infectious disease manifested by bleeding gums. It is reversible and does not cause bone loss. It can be mild, moderate or severe depending on the degree of inflammation.
PERIODONTITIS or ‘pyorrhea’ is a chronic disease also of infectious origin, which causes the loss of the bone that supports the teeth and, consequently in the long or medium term, the loss of teeth if not treated in 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)
Periodontic treatments
Anti-inflamatory phase
Also called “periodontal decontamination”, it is the first phase of periodontal treatment. It is focused on eradicating the main cause of gum problems: BACTERIA. This requires mechanical treatment (scaling and root planing), and in some cases also chemical (antibiotics).
It consists of several sessions of scaling and root planing to decontaminate the root of the tooth. But the first and fundamental thing is to take X-rays and a detailed study of each tooth with an electronic probe (Florida Probe) that informs us of the degree of inflammation, recession, mobility and other important data in order to know what stage of the disease the patient is at and, based on this, establish certain guidelines for action and an individualized prognosis. Likewise, it is of great importance to instruct the patient in brushing techniques and interdental hygiene, since without a change of habits the treatment we do will not have the same effectiveness.
Periodontal decontamination
Periodontal disease is caused by an imbalance between the bacteria that live in our mouth and our defenses. Either the bacteria increase or the defenses decrease. This imbalance favors the growth of pathogenic species that are more aggressive to our gums, and that do not disappear just by scraping.
Therefore, to ensure that the treatment is effective, we take a sample with paper tips that are introduced into the gum (not a painful procedure). This is sent to the laboratory to determine the presence and proportion of periodontal pathogens. Depending on the result we see if we have to take an antobiotic and which specific one.
Periodontal evaluation
Once this 1st phase is finished, a periodontal evaluation should be carried out again with the florid probe in order to evaluate the response to treatment and the need or not to perform surgery.
We can also carry out a 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 attitudes in an early manner in the relatives of the patient affected by periodontal disease.
Surgical phase
This is the only phase that not all patients need. If residual pockets remain after scaling, they should be removed so that they are not re-colonized by bacteria. Likewise, regeneration of lost tissues will be performed when this is possible through the use of membranes or enamel-derived matrix, and recessions will be covered by means of gum grafts in the teeth that need it.
Gum grafts
Grafts can be performed on teeth, on implants or in areas where teeth are missing to recover the volume lost after an extraction.
They can be performed for different purposes:
- Covering of exposed dental roots (can occur due to aggressive brushing, dental malposition, piercings…).
- Enlargement of inserted gingiva (in areas with traction of braces or short vestibule bottom).
- Thickening 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 essential that the patient does not smoke, since tobacco compromises the vascularization of the graft.
They are usually performed with the patient’s own gum, since this is how a higher success rate and fewer postoperative problems are obtained, but in some cases we can resort to matrices or collagen membranes of animal or cadaveric origin.
There are different techniques depending on the extension of the area to intervene and depending on the characteristics of the defect. The tendency is to eliminate incisions or large discharges to reduce scarring and to carry out tunneling or apical micro-access surgeries, whereby the graft is introduced through a small hole in a minimally invasive manner.
Periodontal regeneration
In some cases we can regenerate lost bone. Basically, we can regenerate in cases where there are vertical intraosseous defects. Depending on the morphology of the defect we can resort to proteins derived from the enamel matrix, or to regeneration with collagen membranes.
For regeneration it is essential that the patient does not smoke (tobacco compromises the vascularization of the wound), that oral hygiene is exquisite and that the teeth are not excessively mobile, in which case they should be splinted beforehand.
Maintenance phase
This phase is FUNDAMENTAL in the treatment of gums, if it is not fulfilled the success of the treatment cannot be assured. Maintenance is carried out by the hygienists supervised by the periodontist. Plaque and calculus are removed supra and subgingivally with the use of ultrasound and mini curettes to go deeper into the gum. Areas that retain plaque and areas of possible relapse are detected. The frequency of maintenance depends on the type of periodontal disease, age, whether the patient is a smoker or not, and the patient’s brushing skills. In addition, if the patient has a dental implant in his mouth, these revisions will have to be more frequent to prevent mucositis or peri-implantitis problems.
We have incorporated a new appliance to our clinics that allows us to perform a new working system developed by the brand EMS, 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 of greatest plaque accumulation where the patient does not access well with brushing, and so we can also learn which are the weakest areas to improve their brushing technique. We then use a spray of ERITITROL, which is a fine particle powder that does not damage the enamel or ceramic or resin dentures, and removes dental biofilm more gently. If there are thicker deposits of calculus we will use ultrasound (which we will use with hot water to minimize sensitivity) or curettes, and we will finish leaving the entire surface well polished.
Frequently Asked Questions about Periodontitis and Gingivitis
How is gingivitis detected?
Normally, we will detect that we have gingivitis when our gums are irritated, visibly reddened or bleed when brushing, flossing or even eating. When it is a more serious case, the gums may bleed spontaneously. This bleeding is often accompanied by bad breath or a bad taste in the mouth and sensitivity.
What is the difference between gingivitis and periodontitis?
The main difference is that gingivitis is reversible, can be cured and does not lead to bone loss. But if treatment is not carried out in time, periodontitis can develop, which, although it can be cured or slowed down, leaves after-effects, producing a loss of the bone that supports the teeth, which translates into gum recession or gaps between the teeth with the sensation of longer teeth.
Therefore, it is very important to go to a center specialized in periodontics 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 my dental hygiene, why do I have gingivitis?
Gingivitis is not always caused by poor oral hygiene. It can also occur in people suffering from diseases such as diabetes, hypertension, or immunosuppression circumstances. On the other hand, women sometimes suffer from gingivitis during pregnancy as a consequence of hormonal changes. In addition, sometimes it happens that we brush 3 times a day but we do not do it correctly, or we do not use dental floss, and that can lead to gingivitis.
Is it contagious?
It is not usual to be contagious, however, there is always a risk that bacteria can be transmitted through saliva, especially in stable couples. It has been seen that continuous contact with a patient with gum problems can cause us to suffer from it as well.
How do I prevent gingivitis?
The main way to prevent it is to have a constant oral hygiene. Ideally, brush your teeth after every meal and floss at least once a day to make sure there is no food or bacteria between your teeth. It is good to know that electric toothbrushes have been proven to remove more plaque than manual toothbrushes, which is a great help to keep our gums healthy.
On the professional side, it is recommended to visit the dentist 1 to 2 times a year to remove plaque deposits in hard-to-reach areas. The frequency of these visits will depend on the individual predisposition to suffer from gum problems, the ease of forming calculus and the presence of other systemic factors that may affect our oral health such as smoking, diabetes, pregnancy, heart or thyroid problems among others.
Can periodontitis be cured?
Periodontitis IS CUREABLE, but unfortunately it leaves after-effects in our mouth such as gum recession or gaps between the teeth. Therefore, it is important to stop this bone loss, so that these gaps do not get bigger and bigger and the roots of the teeth are not more and more exposed. However, every patient who suffers from gum problems must be aware that he/she needs MAINTENANCE for life, both at home, taking good care of his/her oral hygiene, and in his/her regular visits to the hygienist and periodontist who will be attentive to possible relapses or changes in his/her gums.
Is there a relationship between tobacco and periodontitis?
There is a clear relationship between tobacco and periodontitis. Tobacco causes a decrease in the natural defenses of the mouth, as 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 bacteria that are more aggressive for the gums, so in many cases we have to accompany the mechanical treatment with chemical treatment with specific antibiotics.
Another negative factor of tobacco is that by producing vasoconstriction, the patient does not perceive bleeding gums and therefore does not alert him to go to the specialist. For this reason, we always recommend that patients who smoke should have their oral check-ups at least twice a year.
What is the symptomatology of periodontitis?
The symptomatology is very similar to gingivitis. The main symptom of periodontitis is bleeding and inflammation of the gums, bad breath and increased sensitivity and even movement of the teeth. Although sometimes none of this is felt and the only thing the patient perceives is a larger gap between the teeth.
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