Clínia de Periodòncia i Cirurgia d'Implants. Dra. Jorgina Estany

Periodontics

Periodontal disease is an infection caused by the accumulation of bacteria on the surfaces around the teeth that leads to the destruction of the tissues supporting the teeth.  

The symptoms are  bleeding gums, loose teeth, a bad taste in the mouth or bad breath, sensitivity to cold, longer and more exposed teeth, black spaces between  teeth and, on occasion, pain and discharge.

The  treatment we offer our patients consists of disinfection of the gums, elimination of bacteria by root scaling, oral hygiene control and, if necessary, surgery.    

CAUSES OF DISEASE
Dental plaque is the accumulation of various types of bacteria, glycoproteins and other substances that originate in saliva. During the day, plaque forms around the teeth and, if  not brushed properly, they start to calcify. In a few days dental calculus or tartar forms, which may continue to gather more and more plaque and thus increase in thickness.

The bacteria present in the dental plaque then start to attack the gums. The gums swell up, become red and sensitive, and bleed during brushing. This signals the appearance of gingivitis, a disease that does not usually cause pain.   

PERIODONTAL DISEASE
Periodontal disease is an infection caused by an accumulation of dental bacteria which leads to the destruction of the tissues supporting the teeth. 

Over time, inflamed gums separate from the teeth and their swelling spreads deeper, producing what are known as  periodontal pockets. Toothbrush bristles and the toothpaste carried on them cannot enter these pockets, allowing bacteria to multiply.   The infection eventually reaches the bone. The bone will continue to absorb the infection, and as a result of the weakening of the areas supporting them the teeth will become more and more exposed at their roots. This entire process constitutes what we call periodontal disease, also known as pyorrhoea, and which eventually leads to loss of teeth if not treated in time.   

Its most frequent symptoms are  bleeding of the gums, loose teeth, a bad taste in the mouth or bad breath, senstivity to cold, longer and more exposed teeth, and black spaces between teeth. It may also occasionally cause pain and discharge. 

Various different factors may speed up the development of periodontal disease. Among the most noteworthy of these are: filling the mouth too full when chewing, grinding of the teeth when sleeping, hereditary tendencies (shown by previous cases in the family), hormone imbalances (due to diabetes, pregnancy, osteoporosis, etc.), infectious or immune diseases that lower the defences, medicines (linked to heart or blood-pressure problems, transplants, etc.), and also (it must be remembered, too) unhealthy habits (consumption of cigarettes and/or drugs) and stress.    

THE TREATMENT OF PERIODONTAL DISEASE
At your first appointment, the periodontist (i.e., dentist specializing in the gums) will carry out a detailed examination involving probing and tooth-by-tooth X-rays.   The aim of this examination is to establish the extent to which periodontal disease is present and to provide reference data for its subsequent monitoring.  As a dental practice specializing in this field, we use the electronic Florida Probe, a digital radiology and microbiological examination. 

Initial treatment consists of  reducing the inflammation and infection of the gums through scaling so as to eliminate the bacteria and the calculus accumulated on the surface of the teeth and below the gum line.    This procedure is carried out at the practice by a dentist or by a specialized assistant (a dental hygienist). It may require anaesthesia and take several sessions, and must be accompanied by very careful brushing of the teeth at home.    

At a more advanced stage of the disease, it is possible that, even after the appropriate scaling sessions, deep periodontal pockets or deformities of the gum may still be present.   These must then be eliminated by surgery so as to avoid re-infection and the further spreading of periodontal disease.   There are also other forms of treatment that may be necessary, depending on the nature of the periodontal problem encountered: bone regeneration techniques, crown lengthening, grafts in cases of localized gum recession and even the placing of implants to replace badly damaged or missing teeth.

In all cases, once the advancement of the disease has been halted, the patient must attend regular subsequently appointments.   This regular prophylaxis (every 3, 4 or 6 months), together with good dental hygiene, is essential for maintaining the results achieved after treatment and for enjoying the advantages of a healthy mouth for a long time to come.

Periodontal surgery

We perform the following surgical operations:

  • Surgery for debridement and elimination of residual periodontal pockets.
  • Periodontal plastic surgery to correct gum defects: grafts to increase gum size and to cover exposed roots (free gingival autografts, alloderm® grafts, etc.), correction of asymmetries and "gummy" smiles, melanin colouration, etc. 
  • Correction of bone defects through bone regeneration techniques (bone grafts, membranes, Emdogain®, etc.) or through osteotomy and osteoplasty.
  • Preventive surgery (also including crown lengthening and correction of asymmetries and "gummy" smiles, etc.) 
  • Atraumatic extraction with ridge preservation so as to avoid atrophy and be able to insert implants immediately or at a future time.
  • Extraction of embedded teeth and wisdom teeth.
  • Surgery for inserting implants, ridge enlargement, sinus enlargement, immediate implants, etc. 

Whenever technically possible, we use microsurgery and/or minimally invasive surgery in order to improve aesthetic appearance as much as possible and reduce postoperative pain.  In addition, any of these techniques can also be applied under sedation. 

RELATIONSHIP BETWEEN PERIODONTAL DISEASE AND OTHER ILLNESSES
The health of the mouth has an influence on the health of the whole body. Gum infections in particular, in addition to causing potential tooth loss, also affect the rest of the organism.

For example, the bacteria that produce gum infections may from a distance also cause infections inother organs such as the heart. In this case, the bacteria, together with inflammatory products, lead of the formation of plaques of arteriosclerosis that obstruct the arteries and thus increase the risk of either coronary ischaemia and a heart attack or cerebral ischaemia and stroke (apoplexy). Risk factors that are common to both heart conditions and periodontal disease include addiction to tobacco, diabetes, stress, etc.   

With regard to diabetes, people who suffer from this disease have a greater likelihood of developing a gum infection and, sometimes, this infection may make it more difficult to control blood glucose levels. This is why it is important for diabetics to have regular dental examinations.

Gums are very sensitive to hormonal changes. Thus during pregnancy women also have a greater tendency to suffer from bleeding gums, due to the increase in progesterone and oestrogen, which increases their blood flow and aggravates the inflammation that produces bacterial plaque.   

From the first trimester onwards it is very common for the gums to take on a reddened appearance and, at times, to bleed after brushing; this is known as pregnancy gingivitis.  This reddening of the gums is due to the fact that the pH of the saliva is now more acidic, which means that the saliva loses part of its anti-bacterial effects. During the second and third trimesters gingivitis with inflammation and even spontaneous bleeding frequently occurs. If this gingivitis is not controlled, it may develop into a periodontitis and destroy the bone and tissues that support the teeth.

Furthermore, during the last trimester of pregnancy, the high levels of prostaglandins encountered may lead to premature childbirth. Various studies have shown that pregnant women who suffer from this condition have up to a 5.2% higher risk of experiencing premature childbirth or giving birth to an underweight baby than healthy women.   Another disorder of the mouth that may appear in pregnant women is the so-called pyogenic granuloma, also known as pregnancy tumour. This usually begins between the fourth and sixth month of pregnancy and is a gum tumour in the form of a mushroom that bleeds very easily but is not at all serious, and in nearly all cases disappears after childbirth. Its treatment essentially consists of having the gums disinfected by the relevant specialist. 

Last, but by no means least, it should be noted that cigarette smoking makes periodontal disease more serious, since smokers develop a more aggressive variety of this type of disease, and also respond less easily to treatment.  Moreover, in the case of habitual smokers, dental implants merge into the bone less easily. 

 

 

  • Sonda electrònica Florida®
  • Gingivitis
  • Periodontitis inicial
  • Periodontitis moderada
  • Periodontitis
Clínica Estany © 2017