Periodontics is the treatment and maintenance of gums affected by gum disease. Gum disease, or more correctly, 'periodontal' disease, causes loss of the healthy attachment of the tooth to the gum and jaw bone.
If gum disease is allowed to progress, a 'pocket' develops between the tooth and the gum, and bone around the tooth is lost. You may notice that your gums bleed when brushed or are slightly swollen, but sometimes there are no obvious signs, making it all the more important to have regular dental reviews and hygienist sessions.
Teeth compromised by the presence of deep pockets and the loss of the supporting bone, become loose and may move or drift, causing collapse of the 'bite', and unsightly spacing. Gum disease is the most important cause of adult tooth loss. The best treatment is prevention, but when gum disease becomes established, Periodontal Treatment is designed to re-establish a healthy attachment of the tooth to the jaw bone.
There are many different types of gum disease or more correctly, periodontal diseases; all are caused by dental plaque and can usually be prevented. Dental plaque consists of bacteria and bacterial by-products. It forms on everybody's teeth and accumulates in places that are hard to reach, such as between the teeth, next to a rough restoration or under a bridge.
Individuals may have widely differing genetic susceptibilities to gum disease, and susceptibility may also be altered by systemic disease (such as diabetes) or lifestyle factors (e.g. smoking).
If plaque is allowed to accumulate undisturbed it undergoes a change in character and begins to produce toxins that irritate the gums. Everybody's resistance to these toxins and irritants is different; some people can accumulate vast quantities of plaque, yet have very little trouble with their gums.
Others will show early signs of gum disease when only tiny amounts of plaque are present. For example, pregnant women are very sensitive to plaque; smokers are more likely to have gum problems and there may even be a correlation between gum disease and stress. No matter how sensitive the individual is to plaque, a dramatic improvement in any form of gum disease will result from very careful and thorough cleaning.
Often this may simply involve visits with our hygienist and instruction in the use of cleaning aids, such as interdental brushes and dental floss. It is not at all uncommon to see a very rapid improvement in gum health in just one or two weeks following an improvement in these habits.
The first sign of gum disease is often bleeding gums - "gingivitis". If this is not dealt with it can develop into "periodontitis" where the attachment of the tooth to the gum and bone is weakened. "Pockets" form; these are regions where although the gum is closely apposed to the tooth it is not actually connected to it anymore. Plaque can then lodge in the pockets, causing the disease to progress quickly, as simple cleaning will not clear the plaque. If the pockets deepen, teeth may become loose and abscesses may form.
We often see new patients who have first become aware of their gum problem when a tooth becomes mobile or they experience pain from an acute abscess. The precise treatment of a gum problem depends very much on location, severity and the type of infection.
The most important first stage of any treatment is cleaning, that is removal of all the plaque around the neck of the teeth. This is sometimes enough to eliminate the gum disease, however where pockets have formed you need help from a member of the dental team to remove plaque and tartar (mineralised plaque) from the depths of the pocket.
Such treatment involves root planning, which is removal of tartar, and cleaning of the tooth surface below the gum line. This is usually carried out by our hygienists, but where pockets are deep, or the tooth furcation (area between the roots) is involved, treatment may involve gum surgery.
Where large amounts of bone have been destroyed by gum disease, regenerative techniques can sometimes be used to rebuild the supporting bone, cover root surfaces with new tissue where the gum has receded, or reattach failing gums to teeth affected by deep pockets.
The adverse effects of smoking on health are today well documented. Cigarette smoking is considered the single most important preventable environmental factor contributing to illness, disability and death. The mouth acts as a primary target for tobacco smoke, as well as being affected by tobacco products in the blood stream.
Smoking affects wound healing and tissue turnover: not surprisingly this means that people who smoke age faster with deterioration of their skin, hair, bones, and gums. Interestingly, by way of example, older people who smoke are three times more likely to fracture their hip as a result of the affect of smoking on bone density.
Unfortunately, not so many people are aware of the hugely significant effect that smoking has on the teeth and gums.
People who smoke have fewer teeth, more gum disease and more complicated patterns of healing. This is particularly troublesome after surgery. Smoking will reduce the success rate of gum surgery and implant surgery, and will for some people cause failure of implants.
We are always happy to assist our patients with advise on smoking cessation.
To arrange an appointment call us on 01843 860625.
Maintaining excellent oral hygiene and forming the right habits from an early age will almost entirely prevent gum disease and tooth decay. However, it is never too late to start and regular hygienist appointments and the right approach to maintenance will dramatically reduce dental problems.
Restored teeth or implants need at least as much, if not more, hygiene maintenance than teeth, and so it is important that a proper regimen is planned and adhered to once treatment is complete.
A patient who has had gum disease may always be vulnerable to gum disease, and needs to be that much more careful with their oral hygiene.
A patient who has had tooth decay in the past will continue to experience problems with decay unless they change their diet - in particular, sugar frequency. Dental restorations do not protect teeth from decay – they only replace what has been lost.
Patients who have had complex treatment also need regular examinations, so that any problems may be picked up early, and dealt with promptly.
If you think you have or know you have gum disease call us on 01843-860625 to arrange an appointment.
The three most common causes of concern to patients who have had surgery or extractions are discomfort, bleeding, and swelling:
Most extractions and gum surgery can be carried out with very little discomfort; usually any that develops will respond rapidly to Paracetomol or Neurofen. It is important not to use tablets containing Asprin such as Anadin or Veganin for pain relief, as it can cause the wound to bleed. A mouthwash of hot salty water is often soothing, (hold a mouthful of the salt water over the area but do not rinse vigorously in order not to dislodge the blood clot). If severe pain develops please telephone us. 'Dry Socket' is a fairly painful, but surprisingly harmless condition, which can occur following difficult and sometimes even straightforward extractions.
Like any other wound, those in the mouth will bleed if disturbed. A small amount of blood in the mouth often looks like much more than it actually is because it is mixed with saliva. If the wound bleeds heavily then place a cloth pad, which has been soaked in hot water over the area, and apply biting pressure for an undisturbed period of at least ten minutes. After this the wound may continue to ooze. If heavy bleeding continues please contact us.
Swelling is common after extensive surgery. This sometimes happens after implant surgery, apicetomy, and the removal of wisdom teeth. Every patient reacts differently, but usually most of the swelling will resolve after a few days. Swelling of this kind is not usually associated with postoperative infection.
Of course, one can eat and drink after surgery, but choose soft foods that do not cause discomfort, and wait until the anaesthesia has worn off to ensure you do not bite or burn your lip without realizing it. Patients who have had implant surgery should avoid eating crunchy or tough foods for the three week.
One of the best ways to speed up healing of the tissues is to keep them very clean. For the first twelve hours after surgery do not brush the immediate area, but do clean the rest of your mouth as usual. After this time it is most important that even the area that is directly adjacent to the surgical sight is kept clean; brush carefully around the tooth or implant - plaque is soft and is easily removed.
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