Periodontology is the branch of dentistry that examines the structure of the soft (periodontal ligament, gum) and hard tissues (bone, cementum) surrounding the teeth, the diseases that occur in these tissues and the treatment of these diseases.
Teeth are not directly attached to the bone in which they are located, called the alveolar protrusion. Between the teeth and the bone, there is a tissue consisting of fibers, which we call periodontal ligament. The periodontal ligament ensures that the force on the teeth is softened and transmitted to the jawbone. These structures are covered with gums. These tissues around the tooth are called periodontal tissues and constitute the scope of periodontology.
Healthy gums are pale pink, matte and firm in consistency. The gum surrounds the tooth like a collar in the neck area, and ends in a knife-edge shape where it meets the tooth. There is a gap of approximately 1-1.5 mm between the tooth and the gum. This gap is called the gingival groove. Periodontal diseases originate from this gum groove. Healthy gums do not bleed during brushing.
Gums form the infrastructure of our mouth and teeth. Just as a solid foundation is needed for a solid structure; Healthy gums are needed for our teeth or the prosthetic restorations to be made on them to be healthy.
Gums form the infrastructure of our mouth and teeth. Just as a solid foundation is needed for a solid structure; Healthy gums are needed for our teeth or the prosthetic restorations to be made on them to be healthy.
Gum Diseases
Gum diseases are chronic, bacterial infections that occur in the periodontal tissues surrounding your teeth. They begin with bacterial plaque causing inflammation in your gums. They do not cause pain unless they reach very advanced stages. Gum diseases are serious infections that can progress in the mouth for many years without any significant symptoms, and if left untreated, they can cause even healthy, non-decayed teeth to shake and fall out due to loss of support tissue. Gum diseases can affect one or more teeth together or separately.
As the gum disease progresses, a stage called gingivitis is reached. In the gingivitis stage, there is inflammation in the gums, but the inflammation has not yet spread to the bone that supports the tooth.
In gingivitis,
- There is bleeding in the gums while brushing.
- The gums are red and swollen, their contours are distorted and their surface is shiny.
- There is no pain.
If gum disease is not treated at this stage, it progresses to the next stage, periodontitis. In periodontitis, the inflammation spreads from the gum to the periodontal ligament and tooth support bone. The gingival groove between the tooth and the gum deepens due to inflammation and turns into a periodontal pocket. The presence of a periodontal pocket facilitates the progression of gum disease.
In periodontitis,
- There is bleeding in the gums while brushing or spontaneously.
- The gums are red and swollen, their contours are distorted and their surface is shiny.
- There is a bad odor and taste in the mouth.
- As the gum disease progresses, gum recession occurs.
- As the sensitive root surface of the teeth is exposed as a result of gum recession, sensitivity to hot and cold may occur.
Gum disease continues to develop unless treated. The teeth begin to shake and move further away from each other, and the gaps between the teeth gradually increase.
If gum disease is not treated at this stage, you may lose your teeth.
Treatment of Gum Diseases
In the early stages of gum diseases – the gingivitis stage, treatment includes cleaning the tartar and bacterial plaque on the teeth and smoothing the root surface. When tartar and plaque are removed, bacteria that cause gum disease are also removed from the environment. This gum treatment is usually sufficient to eliminate the inflammation and reattach the gum to the tooth. In addition, the patient should be informed by the physician about controlling the bacterial plaque that causes inflammation, that is, ensuring oral hygiene.
If the gum disease has reached the periodontitis stage, the aim of the treatment is to clean the tartar in the periodontal pockets, to ensure the disappearance of the periodontal pocket, to create a smooth root surface to ensure that the gum adheres to the tooth, and to obtain a gum form that is easier to clean. After gum treatment, patients should be checked regularly and the tartar and plaque formed should be removed. However, the main responsibility in periodontal treatment falls on the patient. In order to maintain the health achieved as a result of gum treatment, the person must continue oral care procedures effectively.
What is Dental Stone Cleaning and Root Planing?:
It is the most common and protective method among the treatments for gum diseases. In dental scaling, tartar and tartar, also called plaque, are removed. Plaque is a sticky substance and consists mostly of bacteria. Dental tartar forms when plaque hardens over time. Plaque and tartar adhere to the tooth surface, especially the root surface below the gum line. Root surfaces need to be smoothed as plaque tends to cling to the rough surface. In this process, all dental stones are cleaned and irregularities on the root surface are eliminated.
How to Apply?: Ultrasonic tools and hand tools are used for scaling and root planing. Ultrasonic devices work with air pressure or electricity. It has two components. The first is a relatively blunt metal tip. This tip vibrates at high frequency and removes plaque and tartar from the tooth surface. The second component is the water flushing system, which helps cool the metal tip as it works and removes debris from the tooth. Hand tools have sharp edges, and these edges are pressed against the teeth to remove tartar from the tooth surface. These hand tools are called scalers and curettes. They come in various shapes and sizes for different teeth and different surfaces of the same tooth, and they are not motorized tools.
First of all, large plaque and tartar are removed from the crown and root surface of the tooth with ultrasonic tools. Hand instruments are used to remove all remaining material and smooth the root surfaces. While the dentist is working below the gum line, he cannot see plaque or tartar. However, the roughness of the root surface guides it.
In the early stages of gum disease (gingivitis) or in cases where more advanced gum disease is localized in one part of the mouth (localized periodontitis), scaling and root planing are usually completed in a single appointment. If the patient has periodontitis, one half of the jaw is treated in a single appointment. Therefore, the treatment is completed in four sessions. After treatment, patients are generally asked to come to a follow-up appointment.
What are Gingivectomy and Gingivoplasty?:
Gingivectomy is the surgical removal of gum tissue. Gingivoplasty is the shaping of healthy gum tissues around the teeth.
How is the Application Done?: Gingivectomies and gingivoplasty are usually performed with hand instruments. But it can also be done with electrosurgical instruments, laser and/or rotary instruments. Special instruments with angled edges are used to reach the tooth area.
Local anesthesia is applied to numb the gums. Gingivectomy may take a few minutes or an hour. The length of time depends on the amount of tissue to be removed. Gingivoplasty takes a few minutes.
Soft Tissue Grafts
Gum recession may occur due to gum disease (periodontal disease), physical trauma (brushing too hard or too frequently with a hard-bristled toothbrush), position of the teeth and aging. If gum recession is severe, some of the tooth roots may be exposed. This condition can cause hot and cold sensitivity as well as root rot. It may also cause problems in terms of image.
In soft tissue grafts, more gum tissue is added to these areas to prevent future recessions. With the help of this process, the resulting root surface is covered and sensitivity is stopped. At the same time, the appearance of the tooth is also improved.
What is Gum Flap Surgery?
In gum flap surgery, the gums are separated from the teeth and temporarily separated. This way, the dentist can see the tooth root and bone.
How to Apply?:
The area is first numbed with local anesthesia. The gums are separated from the teeth with the help of a hand tool. Thus, the physician can directly access the roots and the bone tissue that supports the tooth. The infected tissues are then removed from between the teeth and from holes (defects) in the bone. Scaling and root planing procedures are performed. If there are defects in the bone, they can be corrected by reshaping the bones. During this procedure, bone corners can be softened using the Er:YAG laser or rotary instruments. After these procedures, the gums are placed back on the teeth and fixed with stitches.