What is periodontal disease?
Periodontal diseases are inflammatory diseases affecting the gums and other tissues supporting the teeth. Periodontal diseases are responsible for 70% of tooth loss in adults. When these diseases are diagnosed early, they can be treated easily and successfully. Prevention or treatment of periodontal disease brings other benefits such as the preservation of natural teeth, better chewing and better digestion. Periodontal disease begins with gingivitis, which is the early stage of periodontal disease. During this period, the gums are bleeding, red and enlarged in volume. It may not cause much discomfort in the early period. If left untreated, the disease can progress to periodontitis and cause irreversible damage to the alveolar bone supporting the gums and teeth.
Periodontitis is a more advanced stage of periodontal disease. The alveolar bone is damaged along with other tissues supporting the teeth. A “periodontal pocket” forms between the teeth and gums. The presence of a periodontal pocket facilitates the localization of the infection and the progression of the disease. As the disease progresses, the teeth begin to wobble and may even need to be extracted.
What are the symptoms of gum disease?
There are many symptoms of gum disease;
-Bleeding gums during tooth brushing
-Red, swollen and sensitive gums
-Gums that can be easily separated from the teeth and move away
-Inflammatory discharge between teeth and gums
-Teeth that are wobbling or gradually moving further apart (gaps between teeth or increased gaps between teeth)
-Changing the relationship between the upper and lower teeth during biting
-Persistent bad breath.
However, periodontal disease can also reach advanced stages without any symptoms. It is therefore extremely important to visit the dentist at regular intervals.
What causes gum disease?
The most important cause of gum disease is the sticky and colorless film layer accumulated on the teeth called “bacterial dental plaque”. Removing dental plaque through daily brushing and flossing is a basic requirement for a healthy mouth. If plaque is not effectively removed from the teeth, it turns into an irregular surface and permeable structure known as tartar. Harmful products released by the bacteria in plaque cause irritation of the gums. Because of these products, the fibers that bind the gingiva tightly to the tooth are destroyed, the gingiva moves away from the tooth and a periodontal pocket is formed. This facilitates the progression of bacteria and their products into deeper tissues. As the disease progresses, the pocket deepens, the bacteria penetrate deeper into the bone and destruction of the alveolar bone that supports the tooth begins. If the disease is left untreated, the teeth will eventually become loose and may even need to be extracted.
GUM DISEASES AND TREATMENT METHODS
Periodontal diseases are largely preventable and controllable. Treatment depends on good oral hygiene, accurate and early diagnosis and the right treatment approaches. Therefore, both the patient and the physician should actively participate in the treatment.
Phase 1 of treatment
The most important stage in periodontal treatment is the elimination of the infection and the patient’s learning to maintain oral health by practicing effective and regular gum, tooth and interdental cleaning. Elimination of the infection is possible when the microbial dental plaque, calculus and the root surface to which the calculus is attached are cleaned by the physician and the patient maintains this condition. This process is called “initial treatment”, it is an indispensable stage in the treatment of all types of periodontal disease and is performed in 3-4 sessions depending on the case. During the initial treatment, local factors that facilitate bacterial adhesion, such as replacement of bad and overflowing fillings, filling of decayed teeth, correction of prostheses with improper fit and shape with the gingival margin, removal of local factors that facilitate bacterial adhesion, root canal treatments and extraction of hopeless teeth, if any, should be performed. Medical consultations in the presence of a systemic disease are also carried out at this stage. Planning for possible dentures is also necessary at this stage.
Phase 2 of treatment
If the periodontologist detects a condition that cannot be fully treated with the initial periodontal treatment phase, periodontal surgical procedures will be recommended. Data such as pocket depths remaining after initial periodontal treatment, gingival growth and recession, the presence and shape of bone resorption, and the amount of gingiva will affect the decision to be taken. Not all periodontal diseases and defects can be treated with the same surgical procedures. The determining factors in the choice of treatment are the characteristics of the patient and the tissue and the course and extent of the existing periodontal disease.
The main purpose of surgical periodontal treatment is to eliminate pocket depths, to try to make the bone-gum and tooth relationship similar to the original, thus creating an environment that is easy for the patient and the physician to clean. For this reason, it is also called “corrective treatment”.
Phase 3 of treatment
Depending on the condition of the case, patients are taken into a follow-up program at regular intervals in order to maintain the periodontal health achieved after non-surgical and surgical treatments and to prevent recurrence of the disease. After a successful periodontal treatment, in patients who do not receive maintenance treatment and do not provide their own oral care, tissue destruction starts again in a short time and symptoms of the disease appear. (pocket depth increases, bone loss and tooth loss occur) The patient should be followed up by a periodontist at intervals of 3-6 months depending on the case.
