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Periodontal medicine
The treatment of gingivitis and periodontal disease includes a set of procedures aimed at keeping your gums healthy and your oral hygiene performance great. The removal of all soft and hard deposits from the teeth such as biofilm, plaque and tartar, is much more than just a cleaning
Initial therapy
The first phase of comprehensive periodontal therapy is called initial or cause-related therapy. In addition to removing plaque and tartar, it also removes and corrects all plaque-retaining areas on the teeth – inaccurate crowns, poorly made fillings, roots or teeth that are subject to removal.
It is a complete sanitation of the dentition and periodontal tissues. It has the potential to stop the spread of periodontal disease and preserve tissue. Only in this way can a solid foundation for future rehabilitation be achieved.
Dental calculus
Tartar is a hard deposit – an uncleaned dental plaque that mineralizes (hardens) for a long time. Dental calculus is always in contact with the periodontal tissues, it is rough and additionally retains plaque on itself. It can spread below the level of the gums where it sticks to the root cementum, inflaming the tissues at a deeper level.
Surgical therapy
The purpose of this method is to heal the deep periodontal pockets in the bone. When the periodontal pockets around a group of teeth are very deep, the initial therapy is insufficient. The surgical separation of the gum from the bone provides direct access to it so that the bone and root walls are treated, and it is possible to place a bone replacement material or a soft tissue graft.
Gingival recession coverage
The withdrawal of the gum from the tooth is called gingival recession. This is usually a reaction against trauma – aggressive and improper brushing of teeth, grinding and clenching of teeth, oral piercing and more. Surgical coverage is the only way to effectively treat recessions. It usually involves placing grafts (tissue taken from another place in the patient’s mouth) or shifting the position of the gums.
Periodontal splinting
When teeth are slightly loose or mobile as a result of bone loss or trauma, splinting is usually recommended – i.e. attaching them to each other by various means. After splinting the teeth, an opportunity for optimal hygiene, aesthetics and function is achieved. The masticatory pressure that falls on the damaged periodontium of these teeth is reduced and redistributed more efficiently. The attachment can be done through fiberglass fibers, composite or crowns, etc. Splinting can be a temporary measure or a permanent solution according to the specific case.
Periodontal maintainence
Follow-up examinations are extremely important because periodontal diseases need regular monitoring. In order to keep the dentition natural and functional, we need to strike a balance between the scope of the periodontal process and your protective capabilities. This happens through check-ups – during them we will monitor your oral hygiene, the condition of the tissues after treatment, the level of the alveolar bone and many other factors.
The periodontium is a collection of tissues of different structure, united by a common function – to hold the teeth firmly in place and to effectively transmit the pressure created by the masticatory muscles to the bone base (ie the jaw bones), so that we can eat and chew efficiently and functionally. In general, periodontal tissues are 4:
- Gingiva – the only directly visible part of the periodontium. It is a dense layer of soft tissue that surrounds the teeth on all sides and covers the tooth-holding part of the jaws.
- Cementum – a layer of hard mineralized coating that covers the roots of the teeth. Cementum is a hard tooth tissue, but it is softer than tooth enamel (the coating that covers the crowns of teeth).
- Bone – the jaw bones have 2 parts – a tooth support (called an alveolar ridge) and an apical base (body of the jaw). The tooth-holding part of the bone builds the alveoli – these are the nests in which the teeth are placed. In health, the alveolar bone surrounds the teeth on all sides and is completely covered by the marginal gingiva.
- Periodontal ligament – between the wall of the bone socket and the surface of the cementum, there is a narrow space (gap) filled with fluid and collagen fibers. They act as a hydraulic shock absorber when the tooth is pushed into its seat as a result of chewing. This neutralizes and redistributes the masticatory pressure. The collagen fibers in this narrow slit are oriented in certain directions, have a characteristic appearance and bear the collective name periodontal ligament. Their number, density and function depend on the level of the tooth-holding bone around the tooth, as with one end they attach to the bone wall of the tooth socket, and with the other – on the rough surface of the tooth cementum.
Both diseases are basically inflammatory, ie. to some extent meet the criteria for infection. The mechanism of development of these diseases is complex and multifactorial, but it is based on two elements – dental plaque and the reactions of our immunity.
Generally, gingivitis is an inflammation of the gingiva (gums). This condition does not affect the underlying bone and the bone support of the tooth, and is completely curable. Gingivitis is the result of insufficient or ineffective oral hygiene, which allows microorganisms to accumulate on the tooth surfaces, which through their vital activity irritate the gums. Symptoms include redness, bleeding and swollen gums, discoloration and separation of the gums from the teeth. There are many factors that can mask or change the course of this disease, but the main reason is always ineffective oral hygiene.
Periodontal inflammation involves the deeper parts of the tooth-holding tissues. The onset of this disease is the result of complex interactions between uncleaned and “mature” plaque and our own immune mechanisms. The result of these interactions leads to boneloss, inflammation of soft tissues, tooth mobility and even tooth loss, impairment of masticatory function and instability of the whole bite. Once lost, the periodontal bone cannot be regained, i.e. regenerated. However, there are therapeutic options for replacing it with synthetic or natural materials. Unfortunately, periodontal disease has no strong and distinctive symptoms, except in its terminal stage. That is why regular prophylactic examinations are extremely important, as well as regular periodontal prophylaxis – at least once every 6 months.
When there is an advanced periodontal disease, one of the main consequences is the formation of periodontal pockets. Periodontal pockets are the result of the alveolar bone loss. When its normal level is lost, the space released, is filled by the body with a specific tissue called granulation tissue. It is soft, rich in blood supply and very susceptible to additional infection. Thus, the narrow space under the gums deepens pathologically. Normally it is up to 3 mm, and in periodontitis it can reach 10-15 mm.
Periodontal therapy is an object of periodontology – a branch of dentistry that deals with the diagnosis and treatment of gum diseases. Since the course of periodontal diseases often includes systemic factors (certain common diseases, taking specific medications, genetic predisposition, general processes in the body), modern dental literature often talks about periodontal medicine – the science bridge between the oral cavity and the body. In general, comprehensive periodontal therapy consists of 4 major phases: Initial therapy, Surgical therapy, Periodontal reconstruction and Periodontal maintenance.