Periodontics is a natural part of dentistry, which engages in the supporting structures of the tooth (periodontium), its prevention and care in case of illness. Periodontium and its health are mainly influenced by the quality of dental hygiene. Poor teeth cleaning causes plaque, bacteria and tartar to adhere to the tooth surface. This results in congestion, inflammation and gum disease and periodontitis occurs. It manifests itself by the bleeding of gums, pain, gum recession, loosening of the teeth, etc. Treatment of periodontal disease is always long-term, its base is in perfect hygiene and appropriate medical therapy after consultation with a doctor while concentrating on preserving the gums and keeping the patient’s teeth in a functioning condition for as long as possible.
What does Periodontics solve?
Periodontics deals with the supporting apparatus of the tooth, its treatment and prevention of diseases that affect it. To provide a better idea – the tooth is placed in a socket in the jawbone but it is not fused with it, it is connected to it via a complex system of connective tissue fibers, which act as a shock absorber. It absorbs all shocks and pressures during chewing and biting, thus protecting the tooth and bone against damage. The system also includes a cervical seal – a gingival margin surrounding the root (lower part) of the tooth.
A disease of the tooth supporting apparatus is called periodontitis. It is a chronic disease in which involves bacteria reproducing in the plaque that builds up on teeth with poor hygiene. Plaque is a bacteria breeding ground where they can multiply indefinitely and which extends into spaces between the gums and tooth in the area of cervical seal. Gradually, the plaque can spread to the supporting apparatus of the tooth and the bone socket, which can cause damage to the supporting apparatus, wiggling of the tooth, its loosening or its loss. If periodontitis is left untreated, the gingival margin retreats from the root of the tooth and the root becomes exposed. This causes increased tooth sensitivity, esthetic problem especially in the anterior segment of teeth and other complications.
Who is the periodontological treatment suitable for?
Patient's dentist refers patient to a specialized periodontics department. This regards patients experiencing the following symptoms: bleeding gums, painful and swollen gums, tartar, bad breath, gums retreat, exposure of roots, looseness of teeth, changes in the position of teeth, etc.
The cause of periodontal disease (periodontitis) is poor hygiene (plaque, tartar, bacteria), smoking, grinding of teeth, inappropriate prosthetics, systemic diseases and use of certain medications, stress, hereditary dispositions, orthodontic anomalies, etc.
What happens prior to the periodontological treatment?
Periodontological treatment is always preceded by dental examination, assessment of the condition of the gums and microbiological diagnostics (sampling), which can reveal periodontal pathogens and determine the severity of periodontal infections.
Based on the results of examination and assessment of periodontal status, the doctor will recommend appropriate treatment.
How does the periodontological treatment proceed?
The periodontological treatment is a preventive procedure, medical treatment and surgery designed to improve condition of the supporting apparatus, eliminate potential problems and perform maintenance of teeth.
Periodontology also includes variety of surgical procedures that solve, reduce or eliminate some of diseases that affect the tooth-supporting apparatus, such as frenulektomy - removal of frenum, gingivoplasty – reshaping of loose gum tissue at the exposed root of the tooth, vestibuloplasty - surgical covering of exposed roots by a graft.
The goal of treatment is to keep the gums in the best condition, prevent deterioration of the disease and keep the patient's teeth in working order as long as possible. Treatment consists of several parts: hygienic care, conservative periodontal treatment and surgical periodontal treatment.
Hygienic phase is the foundation of the entire treatment - addresses the removal of coatings and tartar, it includes dental treatment and examination of existing teeth or removal of teeth that can be no longer maintained in the oral cavity.
Conservative periodontal treatment is a treatment of the tooth and gums; however, no surgical procedure is used. Treatment of all teeth is performed during two visits, usually two days in a row and with the use of local anesthesia. At present, treatment can be used accompanied by laser treatment. This treatment also treats soft tissues, it is more gum-friendly, it improves healing, effectively removes the infection and minimizes the need for subsequent surgical treatment.
Surgical periodontal treatment – This treatment is used only for patients when the conservative periodontal treatment does not suffice. The bone tissue which is damaged by inflammation is surgically modified, the anatomy of periodontal tissues is restored, and various periodontal defects and damage to tissues of the tooth-supporting apparatus are solved.
Periodontal treatment is always followed by a period of regeneration and healing of the treated tissue. In case of normal treatment, this lasts up to 10 weeks. Then, check-up examination follows to evaluate the treatment outcomes and on its basis, the doctor will decide about further procedures. Patients, whose treatment results are satisfactory, continue maintenance therapy. Patients, whose periodontium is not sufficiently healed and conservative treatment did not yield the expected results, are recommended surgery or other procedures.
The basis of the follow-up care is perfect oral hygiene. It is also important to follow your doctor's advice.
Other procedures can follow the treatment, which restore functional and aesthetic appearance of the teeth - for example, fabrication of suitable restorations, orthodontic treatment, etc.
Other types of treatment
Frenectomy is a surgical procedure in which the mucosal fold, the so-called frenum, is completely removed. The procedure prevents damage to the surrounding tissue and the toot-supporting apparatus in cases where the frenum is short and causes excessive pressure on the surrounding tissue. In addition, it often causes impaired pronunciation and various speech disorders.
The surgery treats upper and lower frenum of the lip or frenum under the tongue, when the mucosal fold is completely removed or cut (frenotomy). Surgical treatment is performed under local anesthesia, pain appears post surgery along with swelling and bruising. The modern methods include laser treatment – the procedure is painless and fast (5-10 minutes), and healing is much shorter. Given that in most cases, this surgery is performed on children, the speed and careful approach of the surgery is a big advantage.
Vestibuloplasty is a surgical procedure during which a soft vestibule is removed in order to avoid excessive tension on the periodontium and the gums because this can cause root exposure and enamel erosion.
On one side, the gums surround the roots of the teeth, and on the other side, the mucosa becomes the cheek. The place of crossing, where the gums form some kind of depression (vestibule), may be too shallow and constantly pull the gum, which can lead to gum recession and other problems. In order to alleviate the tension on the gums, it is necessary to surgically move the pit downwards (deepen it), so the tension can be reduced or completely removed.
The surgery procedure is performed under local anesthesia not only in the front section of the vestibule but also in the lateral areas. The procedure is mostly performed in adults at younger age or adolescents, when the surgery is prevention against further deterioration of the condition and gum recession.
Gingivoplasty is a surgical procedure, which corrects loose gum by the root of the tooth, eventually covering the exposed roots of teeth with mucosa graft from the upper root of the mouth.
The gum never grows back, so if the roots are exposed, the condition can only be solved by a surgical covering of the roots by a graft. The procedure can be performed under local anesthesia in several different ways – the doctor selects the most appropriate procedure for a given patient. After a week, the doctor checks the condition of the gums and removes/pulls out the stitches; the total healing time is about 3 weeks, but the root of the mouth from where the lining has been cut for the graft usually heals longer.
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