What is Gum Disease? (also known as Gingivitis and Periodontitis)
Plaque accumulates in the areas where the teeth meet the gums, causing inflammation. The earliest signs are bleeding while brushing and redness. However, no pain is felt. The next stage is swelling of the gum. This is called Gingivitis. Gradually the gum becomes detached from the enamel exposing the root and causing a pocket, which fills with plaque. Eventually the pocket becomes deeper until inflammation reaches the bone, which is then slowly destroyed. The bone can be destroyed to such an extent that the tooth becomes loose and may even fall out. This is called Periodontitis.
Some patients are more susceptible to periodontal disease than others and factors including general health, diabetes, smoking and stress, all have an influence in determining the nature and extent of periodontal disease.
Treatments of Gum Disease
Your dentist will carry out an assessment at your check up of your gum condition. For many patients, treatment provided by the dental hygienist is sufficient to maintain healthy gums with direction from the dentist.
The teeth and root surfaces of the teeth can be professionally cleaned with scaling instruments by the hygienist. However, in addition to this, good home care and oral hygiene by the patient is essential to allow the gums to heal. Advice and demonstration of exactly how best to clean teeth and dental implants, especially in difficult to reach areas, is an important part of the hygienist treatment.
When the gum problems are moderate, our advanced treatment is often best carried out by a Periodontist (a dentist specially trained in the treatment of gum disease). This treatment may be for the whole mouth or limited to individual teeth.
Specialist Periodontal Treatments
Patients can benefit from seeing a specialist dentist called a Periodontist who treats more advanced gum disease or specific gum problems. The Periodontist has had advanced training in using microsurgical techniques for gum treatment that is more intensive and may be beyond the scope of a dental hygienist or general dentist due to the technical difficulties involved. Specialist equipment such as dental lasers and micro surgical tools used by the periodontist can help achieve the optimum results. As with all periodontal treatment the patient’s home care is a vitally important part of ensuring its successful completion.
The Periodontist will be able give patients detailed analysis and advice on the treatment options which are available and the lifestyle factors which can aggravate periodontal problems. In addition long term treatment planning is often invaluable for patients with more developed gum problems.
Periodontal surgery and Regenerative Treatments
Historically, periodontal surgery used to be part of the gum disease treatment, especially in severe cases. Nowadays, our approach to periodontal disease is much more conservative, rarely requiring surgery. Usually a course of non-surgical thorough root debridement followed by a tailored maintenance programme is usually enough to keep your gums healthy and guarantee a good long-term prognosis of your teeth, as long as patients maintain a high standard of oral hygiene. However, there are situations where periodontal surgery is required such as gum recession or deep periodontal defects.
Gum recession is mainly caused by gum disease and vigorous tooth brushing. Other factors such as tooth malposition, high frenum pull or lack of attached gum can predispose to gum recession. The root surface exposure can cause hypersensitivity to hot and cold drinks or even to toothbrushing. Also the root surface is more prone to decay or wear, as it’s softer than the enamel of your teeth. At the same time your tooth/teeth can look longer giving an unpleasant look/aesthetics. The goals of a root coverage procedure are to recover the loss of soft tissues and prevent further loss in order to guarantee a good long-term prognosis of your tooth/teeth. Most of the surgical techniques involve the use of a gum graft (connective tissue graft ) to cover the root surface. The gold standard is harvesting a graft, usually from the roof of your mouth, to cover the exposed root. This procedure is very predictable and usually the discomfort is minimal. There are also some biomaterial products, such as Mucograft and Alloderm, which can be used as an alternative/substitute.
We have found the use of lasers extremely beneficial for the treatment of gum diseases for our patients. They offer unique and additional benefits to conventional treatment alone. The result for our patients are quicker healing times with the minimum of discomfort.
The laser also acts using a unique combination of energy and water to provide more precise decontamination and removal of diseased periodontal tissues. It sterilises as it removes diseased tissue and provides a clot that inhibits reinfection. In experienced hands, it provides a more precise and gentle approach and can encourage bone regeneration.
The case below shows extremely inflamed and diseased overgrown gum tissues. The patient was suffering with virtually spontaneous bleeding of the gums. The traditional treatment would often involve reshaping the gums with surgery involving stitches afterwards.
A variety of techniques can be used depending on the clinical situation and this can be achieved using conventional or laser assisted techniques.
This is a disease around an implant which may result in bleeding gums, swollen gums, infection and pus around an implant, however in many cases the patient is unaware of the problem as the disease progresses without pain. The supporting bone around an implant may be lost and in a worst case scenario the implant could be lost as a result of excessive bone loss around the implant.
The cause of disease around an implant is usually related to a lack of adequate cleaning resulting in bacterial contamination of the implant surface. The results is infection in the tissues surrounding the implant causing the loss of bone beneath. The disease can be progressive, but is also treatable if dealt with positively and early enough.
We have much experience and expertise in the treatment of diseases around implants and can prevent the loss of an implant in the majority of instances. This has allowed us to develop preventative strategies when we can regularly monitor and maintain the implants our patients have.
When disease has developed, the approach to treatment can vary from mild to more advanced cases, but usually involves a modification of the day to day brushing or cleaning around the implant/ gum interface. The area around the implant would need decontaminating either by physical or chemical means which involves scaling procedures and irrigation or washing around the implant with disinfectant solutions or gels.
Xray showing Peri implantitis and advanced bone loss around implants after lack of cleaning
In more advanced cases, the implant surface would need decontamination by removing the contaminated surface layer of the implant, producing a more healthy environment and thereby allowing the gum tissue to heal around the decontaminated surface.
The waterlase MD laser is a useful adjunctive tool which we have found especially helpful in accessing difficult to get to areas around implants and due to its unique properties can be used to provide a more effective treatment regime and often minimises the need for a conventional surgical access technique and so the use of stitches is not always necessary. It is an excellent tool for removing the inflamed tissue around the implant which promotes the bone loss. It can also be used to help decontaminate the surface of an implant. It results in quicker healing times and less discomfort associated with the healing phase.
Waterlase being used to treat periimplantitiis
If you have any questions or need further information, please contact us
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