Idea About Dental Gum Disease

PERIODONTITIS

Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body, in essence, turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.

There are many forms of periodontitis. The most common ones include the following.

• Aggressive periodontitis occurs in patients who are otherwise clinically healthy. Common features include rapid attachment loss and bone destruction and familial aggregation.
• Chronic periodontitis results in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss. This is the most frequently occurring form of periodontitis and is characterized by pocket formation and/or recession of the gingiva. It is prevalent in adults but can occur at any age. Progression of attachment loss usually occurs slowly, but periods of rapid progression can occur.
• Periodontitis as a manifestation of systemic diseases often begins at a young age. Systemic conditions such as heart disease, respiratory disease, and diabetes are associated with this form of periodontitis.
• The necrotizing periodontal disease is an infection characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions such as HIV infection, malnutrition and immunosuppression.

Treatments for Gum Disease

There are a variety of treatments for gum disease depending on the stage of disease, how you may have responded to earlier treatments, and your overall health.

Treatments range from nonsurgical therapies that control bacterial growth to surgery to restore supportive tissues.

Non-surgical Treatments for Gum Disease

Treatments for gum disease that don't involve surgery include:

• Professional dental cleaning. During a typical checkup, your dentist or dental hygienist will remove the plaque and tartar (plaque that builds up and hardens on the tooth surface and can only be removed with professional cleaning) from above and below the gum line of all teeth. If you have some signs of gum disease, your dentist may recommend professional dental cleaning more than twice-a-year. Dental cleanings are not a treatment for active gum disease. They are, though, an important preventive measure that can help you stave off its development.
• Scaling and root planing. This is a deep-cleaning, nonsurgical procedure, done under a local anaesthetic, whereby plaque and tartar from above and below the gum line are scraped away (scaling) and rough spots on the tooth root are made smooth (planing). Smoothing the rough spots removes bacteria and provides a clean surface for the gums to reattach to the teeth. Scaling and root planning is done if your dentist or periodontist determines that you have plaque and calculus (hardened plaque, also called tartar) under the gums that need to be removed.

Surgical Treatments for Gum Disease

Some treatments for gum disease are surgical. Some examples are:

• Flap surgery/pocket reduction surgery. During this procedure, the gums are lifted back and the tarter is removed. In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. The gums are then placed so that the tissue fits snugly around the tooth. This method reduces the size of the space between the gum and tooth, thereby decreasing the areas where harmful bacteria can grow and decreasing the chance of serious health problems associated with periodontal disease.
• Bone Grafts. This procedure involves using fragments of your own bone, synthetic bone, or donated bone to replace bone destroyed by gum disease. The grafts serve as a platform for the regrowth of bone, which restores stability to teeth. New technology, called tissue engineering, encourages your own body to regenerate bone and tissue at an accelerated rate.
• Soft tissue grafts. This procedure reinforces thin gums or fills in places where gums have receded. Grafted tissue, most often taken from the roof of the mouth, is stitched in place, adding tissue to the affected area.
• Guided tissue regeneration. Performed when the bone supporting your teeth has been destroyed, this procedure stimulates bone and gum tissue growth. Done in combination with flap surgery, a small piece of mesh-like fabric is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow to better support the teeth.
• Bone surgery. Smoothes shallow craters in the bone due to moderate and advanced bone loss. Following flap surgery, the bone around the tooth is reshaped to decrease the craters. This makes it harder for bacteria to collect and grow.
  

In some patients, the nonsurgical procedure of scaling and root planning is all that is needed to treat gum diseases. Surgery is needed when the tissue around the teeth is unhealthy and cannot be repaired with nonsurgical options.

• Drugs Used to Treat Gum Disease Antibiotic treatments can be used either in combination with surgery and other therapies or alone, to reduce or temporarily eliminate the bacteria associated with gum disease or suppress the destruction of the tooth's attachment to the bone.
• Chlorhexidine (marketed as the prescription-only brands Peridex, PerioChip, PerioGard, and by numerous other over-the-counter trade names) is an antimicrobial used to control plaque and gingivitis in the mouth or in periodontal pockets. The medication is available as a mouth rinse or as a gelatin-filled chip that is placed in pockets after root planning and releases the medication slowly over about 7 days. Other antibiotics, including doxycycline, tetracycline, and minocycline may also be used to treat gum disease, as determined by your dentist.

In addition, a nonprescription toothpaste that contains fluoride and an antibiotic to reduce plaque and gingivitis, called triclosan, is often recommended.

Are Special Preparations Needed Before Treatment for Gum Disease?

Your dentist or periodontist is able to perform most procedures in his or her office. The time needed to perform the procedure, your degree of discomfort and time needed to heal will vary from patient to patient depending on the type and extent of the procedure and your overall health. Local anaesthesia to numb the treatment area may be given before some treatments. If necessary, a medication may be given to help you relax.

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