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Periodontology – Gingival Diseases


What is periodontal disease?

Periodontal diseases are inflammatory diseases that affect the gums and other tissues supporting the teeth. Periodontal diseases are responsible for 70% of tooth loss in adults. These diseases can be treated easily and successfully when diagnosed at an early stage. Prevention or treatment of gum diseases are paralleled with other benefits, such as preservation of natural teeth, easier chewing and better digestion. Periodontal diseases start with gingivitis, which is the early stage of periodontal disease. During this period, the gums bleed, are red and grow in volume. Discomfort may be minor during the early period. If left untreated, the disease may progress to periodontitis and cause irreversible damage to the gums and the alveolar bone supporting the teeth.

Periodontitis is a more advanced stage of periodontal diseases. Damage to the alveolar bone incurs as well as to the other tissues supporting the teeth. A periodontal pocket forms between the tooth and the gums. The presence of a periodontal pocket facilitates the setting of infection and disease progression. As the disease progresses, the teeth become loose and may even end up in extraction.


What are the symptoms of gum disease?

There are many signs of gum disease;

– Bleeding gums during tooth brushing

– Red, swollen and sensitive gums

– Gums are easily detachable from teeth, gingival gums

– Inflammatory discharge between teeth and gums

– Loose teeth or increasing distance between teeth (the formation of spaces between teeth or increase of existing intervals)

-Changes in the relationship between upper and lower teeth during biting

– Constant bad breath.

However, periodontal disease can reach advanced stages without any symptoms. Therefore, it is very important to visit the dentist on a regular basis.


What is the cause of gum disease?

The most important cause of gum disease is the “bacterial dental plaque,, a sticky and colorless film that accumulates on the teeth. Removing dental plaque by daily brushing and dental floss are essential for a healthy mouth. If the plaque is not effectively removed from the teeth, it becomes a permeable structure with an irregular surface, known as calculus or tartar. Harmful products released by bacteria on the plaque cause irritation of the gums. Because of these products, the fibers that connect the gums firmly to the teeth are destroyed, the gums move away from the teeth and a periodontal pocket forms. This facilitates the progression of bacteria and their products into deeper tissues. The pocket deepens as the disease progresses, the bacteria goes deeper and the destruction of the alveolar bone supporting the teeth begins. If the disease is left untreated, the teeth will eventually loosen and may even require extraction.



Periodontal diseases are diseases that can be prevented and controlled to a great extent. Treatment depends on good oral hygiene, correct and early diagnosis and correct treatment approaches. Therefore, both the patient and the physician must actively participate in the treatment.


Phase 1 of the treatment

The most important step in periodontal treatment is the elimination of infection and the patient learning how to maintain oral health by cleaning gums, teeth and interdental cleaning effectively and regularly. The infection can be eliminated by the dentist removing the microbial dental plaque, dental calculus and the root surface of the dental calculus that cause the disease and the patient maintaining this condition. This process is called “initial treatment,, it is an indispensable stage in the treatment of any type of periodontal disease and is carried out in 3-4 sessions depending on the condition of the case. During initial treatment, removal of local factors that facilitate bacterial attachment such as the replacement of poor and overflowing fillings, filling decayed teeth, alignment with gingival edge and correcting improper prosthesis, root canal treatments and extraction of teeth beyond salvage should be carried out. Furthermore, in the presence of a systemic disease, medical consultations are carried out at this stage. At this stage it is also necessary to plan for possible prostheses.

Phase 2 of the treatment

If the periodontologist detects a condition that cannot be completely cured with the initial periodontal treatment, he will recommend periodontal surgical procedures. The decision is influenced by the depth of pockets after the initial periodontal treatment, gingival growth and recession, the presence and shape of bone loss and amount of gingiva.  Not all periodontal diseases and defects can be treated with the same surgical procedures. The determinant factors in treatment selection are patient and tissue characteristics and the course and prevalence of the current periodontal disease.

The main purpose of surgical periodontal treatment is to eliminate pocket depths, to try to simulate the original bone-gum and tooth relationship thus creating an environment that is easy for the patient and the dentist to clean. Therefore, it is also called ‘corrective treatment’.

Stage 3 of the treatment

Subject to the condition of the case, patients are taken into the control program at regular intervals in order to preserve periodontal health obtained after non-surgical and surgical treatments and to prevent a recurrence of the disease. Patients who have not been included in maintenance therapy after a successful periodontal treatment and who cannot provide their own oral care will suffer recurring tissue destruction and symptoms will manifest in a short time. (pocket depth increases, bone loss and tooth loss occurs). Depending on the case, the patient should be followed by the periodontist at 3-6 month intervals.