Periodontology

Periodontology (Gum Diseases and Treatment)

Gum diseases are chronic, bacterial infections that occur in the periodontal tissues surrounding your teeth. They do not cause pain unless they reach very advanced stages. Gum diseases are serious infections and can progress for many years without any significant symptoms in the mouth, and if left untreated, even healthy teeth without caries can wobble due to loss of supporting tissue. Gum diseases can affect one or more teeth together or separately.

Causes of Gum Diseases

The main factor in the formation of gum diseases is bacterial plaque. For a healthy mouth, bacterial plaque must be removed from the environment with oral care procedures. If the plaque is not removed from the teeth, the calcium salts in the saliva adhere to the teeth through the plaque, leading to the formation of tartar. If there is no bacterial plaque on the teeth, calcium salts cannot adhere to the teeth, that is, tartar cannot form.

By-products of the bacteria in the plaque affect the periodontal ligament that connects the tooth to the bone, causing the destruction of the ligaments. The gingiva moves away from the tooth and a periodontal pocket is formed. Due to the periodontal pocket, bacteria easily penetrate deeper tissues and over time, the bone surrounding the tooth begins to be destroyed.


In the formation of bacterial plaque,

• Inadequate and incorrect tooth brushing.
• Not using auxiliary hygiene materials such as dental floss or mouthwash
• The lack of regular dental calculus control plays a major role.

Other factors that cause gingival diseases are:

• Genetic Factors: It has been determined that genetic tendency is effective in certain forms of gum diseases. In such cases, the disease progresses very rapidly and causes tooth loss at an early age. For this reason, it is beneficial for people with a family history of tooth loss at an early age to be under the control of a gum disease specialist from adolescence.
• Systemic Diseases: Gum health is adversely affected in diseases that affect the body’s immune system such as leukemia and AIDS, and in diabetes.
• Drug use: It has been determined that some drugs have negative effects on the gums.
• Pregnancy: Gums are affected by hormonal changes that occur during this period.
• Stress
• Malnutrition
• Smoking

Symptoms of Gum Disease

• Bad breath
• Shaking teeth
• Recession in the gums
• Tingling when drinking cold beverage
• Teeth not closing as before
• Bleeding while brushing gums
• Newly formed spaces between teeth
• Continuous sores in your mouth
• Recent swelling and redness of the gums

The early period of gum disease is “gingivitis”. Gingivitis is the clinical picture in which only the gum is affected from the surrounding tissues of the tooth. Inflammation of the gums by the bacteria in the plaque layer is the beginning of the disease.
Record; It is a sticky and colorless film layer that constantly forms on the teeth. During this period, redness, bleeding and swelling are observed in the gums. Usually, there is no pain during this period.

In gingivitis,
• There is bleeding on the gums while brushing.
• Gums are red and swollen.
• The contours of the gums are distorted and the surface is shiny.
• There is no pain.
It usually occurs with inadequate oral care, and quick recovery is achieved with professional dental scaling or regular oral care at home. If left untreated, the disease progresses to the stage of periodontitis. Periodontitis is the inflammatory process that starts in the gingiva as a result of the effect of bacteria, causing destruction of the gingival fibrils and alveolar bone that support the tooth. There is a physiological gingival groove of 1-2 mm where the healthy gingiva meets the tooth. In periodontitis, this groove deepens over time as a result of the attack of bacteria and turns into a periodontal pocket.

In periodontitis,

• There is bleeding in the gums when brushing or spontaneously.
• Gums are red and swollen.
• The contours of the gums are distorted and the surface is shiny.
• There is bad odor and taste in the mouth.
• As the gingival disease progresses, gingival recessions occur. As a result of gingival recession, sensitivity to hot and cold may occur, as the sensitive root surface of the teeth is exposed.

Gum Diseases Treatment

The most important goal in gingival treatment is to reduce and slow down the inflammatory reaction. In the first stage of treatment, it is aimed to remove calculus, bacterial plaque and pockets that cause inflammation. Hand tools and ultrasonic devices (cavitron) working with sound waves are used to remove dental stones and bacterial plaques. As with other diseases, it is very important to start treatment early. Periodontal destruction can be slowed down or stopped with treatments with hand tools and ultrasonic devices.
* If gum disease is in the gingivitis stage, tartar cleaning and professional oral care are sufficient. If the disease has progressed to the stage of periodontitis, that is, pocket formation and bone destruction have begun, tartar cleaning and curettage (smoothing of the root surface) treatment is required. Curettage treatment is performed by a gingival specialist (periodontologist) in 2-4 sessions. Curettage requires skill, delicate touch and experience. At the end of this process; root surface becomes a polished and slippery surface. Thus, the adhesion of calculus and bacteria to the surface is prevented. During the healing phase, a reconnection between the gingiva and bone is expected. The recovery period is 4-6 weeks.
* In advanced periodontitis cases, surgical operation (flap) may be required after curettage. In this operation, the gums are lifted up to the bone surface, root surfaces and inflamed tissue residues are cleaned, and when necessary and appropriate, biomaterials such as bone grafts and membranes are applied in order to regenerate bone around the teeth, and the gums are brought to the appropriate position and sutured. Stitches are removed after 7-10 days. The recovery period after flap operations is 6-8 weeks.
* In addition to the mechanical treatments applied by the physician, mouthwashes and systemic antibiotics may be required.
* Since the diagnosis is made, oral care of the individual is also very important in addition to all these treatments. If the patient does not cooperate, the success rate of the treatment methods decreases.
* Periodontitis Follow-up is very important because patients with slough are in the risk group and there is a possibility of recurrence of the disease. The patient is regularly called for controls.
* Bad, old fillings and prostheses that cause the onset and progression of gingivitis in the mouth should be replaced.