Category Archives: Periodontal Health & Treatment

Gingivectomy

This procedure is conducted to remove excess gum tissue that may be overgrown on the teeth to provide a better aesthetic result and a better area to clean the teeth.

Gingiva Overgrowth

Several reasons why there is an overgrowth of gum:

Inflammatory -induced:

  •  biofilm (bacteria) and the host response, resulting in familiar forms of periodontal disease such as gingivitis and periodontitis. Swelling, erythema, and bleeding are signs of these diseases.
  • Usually due to poor oral hygiene, orthodontic appliances 

Some mediation might trigger the growth of the gum tissue, such as:

  • Anticonvulsants (phenytoin, phenobarbital, lamotrigine, vigabatrin, ethosuximide, topiramate, and primidone)
  • Antihypertensives (calcium channel blockers such as nifedipine, amlodipine, and verapamil)
  • Immunosuppressant (cyclosporine)

Systemic diseases such as:

  • Pregnancy or puberty and vitamin deficiencies (mostly vitamin C) are some of the more common causes in this category.
  • Benign neoplasms—such as giant cell granuloma, papillomas, and fibromas—can cause enlargement of the gingiva.
  • Other more serious causes of gingival enlargement include leukemias, malignant neoplasms/carcinomas, as well as many forms of granulomatous diseases.

All these gum overgrowth can be corrected by reduce the cause factors or gum surgery (gingivectomy)

A case of Gingivectomy

A young lady complained that she didn’t have great smile. On examination, we found out that she had a very short teeth. Oral hygiene just moderate.

Using a dental chi gauge, it was confirmed that the patient had a short crown height

Dental scaling was done to improve oral hygiene

After taken radiograh to determain the bone height and biological width, surgical excision of 2mm of gum tissue above the gingiva margin.

Immedate post surgery
2 days after surgery

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Gingivoplasty

Gingivoplasty

A procedure to correct the gum shape and contour thus improve the smile line. Gingivoplasty surgery is usually done on the upper front teeth (can be up to the premolar region) where the gums here can be seen when smiling.

Most of these gum defects are usually caused by gum diseases (eg. periodontitis). However, in certain cases, the gum recedes due to over brushing or probably just because the gum itself is thin (thin biotype).

In gingivoplasty, a gum graft can be done where the tissue is taken from the roof of the mouth (this is called a graft) and then stitched into place on either side of the tooth that is recessed.

Here, is a case of a young male presented with receded gum due to over brushing…

He didn’t like his teeth and gum for a few aesthetic

reasons:

  • The teeth are uneven
  • The gums on his left are simply too high!!

We found out that he was a right-handed person, using his toothbrush to brush his left teeth too hard!! That causing the gum to shrink upwards.

Secondly, his gums were thin biotype and the previous dentist had over-filled his abrasion cavity  with composite preventing the gum from ‘coming down’

Objectives of treatment:

Correct his over-brushing technique

  • Modified the over-filled composite restoration
  • Correct the Shape of his teeth
  • Gum surgery to thicken his thin biotype gum and bring his gum down at the same time

Final Result

Before Treatment
After Treatment
Continue reading Gingivoplasty

Gum disease – Gingivitis

Periodontal-Health-&-Treatm

Sequela of gum disease
Sequela of gum disease

Gingivitis
Gingivitis

Gingivitis is the inflammation of the gingiva due to bacterial infection that can occur at any age but most frequently arises during adolescence. It is a disease that requires the presence and maturation of bacterial plaque

Gingivitis is diagnosed by bleeding and by changes in the colour, contour and consistency of the gingiva. Features include red swollen marginal gingiva; loss of stippling; red-purple, bulbous interdental papillae; and the increased fluid flow from the gingival crevice. Gingival bleeding and pain are induced by tooth-brushing and slight probing.

Treatment of gingivitis consists of frequent and regular removal of plaque through dental scaling and root planing. If gingivitis is left untreated for a long period of time, it will lead periodontitis which will result in loosing teeth.

Continue reading Gum disease – Gingivitis

Gum Disease – Periodontitis

Periodontal-Health-&-Treatm

After the age of 35, gum disease or periodontitis is the major cause of tooth loss in adults, far more so than tooth decay. In fact, about 80% of tooth loss can be ascribed to periodontal disease in this age group. A lot of time and money could be saved by early detection and treatment of the disease and many more people would keep their teeth if they were aware of this fact.

Sequela of gum disease
Sequela of gum disease

Periodontal disease affects the support structures of the teeth: the bone, gums and ligament (Click here for Dental Anatomy). It is long-term and slow-moving disease: painless in its initial stages, but later presenting as a chronic inflammation that damages both the gums and bone holding the teeth in place. Bacterial plaque is the main culprit here, and only fastidious daily brushing and flossing can effectively remove it.

The most common form of periodontitis is adult periodontitis. It can be localized or generalized and appears to progress episodically. During periods of exacerbationthere is advancing loss of epithelial attachment, increase periodontal pocket depth, increased gingival crevicular fluid, loss of alveolar bone and connective tissue attachment and gingival bleeding.

The predominant species associated with adult periodontitis ace Actinobaccillus actinomycetemcomitans (25-30%), Actinomyces naeslundii, Bacteriods forsythus, Campylobacter rectus, Eikenella corrodens, Eubacterium species, Fusobacterium nucleatum, Peptostreptococcus micros, Prevotella intermedia, Prophyromonas gingivalis, Selenomonas sputigena, Streptococcus intermedius and Treponema species

Types of periodontitis

Adult periodontitis can be devided into  3 types base on severity:

i) Mild (Early) Adult Periodontitis

Mild periodontitis. From Colour Atlas of Common Oral Disease
Mild periodontitis. From Colour Atlas of Common Oral Disease

Clinical features:

  • 3mm epithelial attachment loss or less (gum recession)
  • periodontal pocket depths of 3-5mm (determine by using a periodontal probe)
  • class I furcation involvement
  • alveolar bone loss of 2mm or less (Alveolar bone loss is determined by vertical periapical bitewing radiograph)

ii) Moderate Adult Periodontitis

Moderate periodontitis. From Colour Atlas of Common Oral Disease
Moderate periodontitis. From Colour Atlas of Common Oral Disease

Clinical features:

  • 4-5mm epithelial attachment loss
  • periodontal pocket depths of 4-6mm
  • alveolar l bone loss of 3-5mm
  • gingival exudate and bleeding
  • horizontal, vertical  bone loss and osseous defects
  • mobile teeth and class II furcation involvement

iii) Advanced Adult Periodontitis

Advanced periodontitis. From Colour Atlas of Common Oral Disease
Advanced periodontitis. From Colour Atlas of Common Oral Disease

Clinical features:

  • At least 6mm epithelial attachment loss
  • periodontal pocket depths exceed 6mm
  • alveolar crestal bone loss is more than 5mm
  • gingival recession
  • significant tooth mobility and class III furcation involvement (A through-and-through bony defect)

 Other types of periodontitis

  • Early-onset periodontitis which can be prepubertal periodontitis and juvenile periodontitis
  • Rapidly progressing periodontitis
  • Necrotizing ulcerative periodontitis (HIV periodontitis)
  • Responsiveness to therapy (refactory periodontitis)

Treatment

Treatment depends on the causal factors but generally involves:

Dental Scaling
Dental Scaling

  • the removal of plaque, calculus and diseased cementum by scaling, curettage and root planing
  • Topical antibiotics, short-course therapy with systemic antibiotics (tetracycline and metronidazole)
  • periodontal surgery

More info

Treatments of gum disease:

Oral Health Matters

Why it is important?

  • Improper oral hygiene leads to plaque build-up
  • Plaque formation can lead to gingivitis, an early form of gum disease
  • If left untreated, gingivitis can progress to periodontitis, a more severe form of gum disease
  • Recent evidence indicates that periodontitis is associated with certain medical conditions

That is why it is important for your overall health to understand the importance of good oral hygiene.

 

Plaque

Plaque

What is plaque?

  • A colourless film of harmful bacteria that sticks to your teeth
  • It is constantly form on the tooth surface.
  • Combination of saliva, food and fluids produce these deposits that collected on teeth and where teeth and gums meet.

Why prevent it?

  • Plaque build-up can lead to gum irritation, gingivitis, periodontal disease, cavities, and even lead to tooth loss
  • Plaque build-up may also harden into tartar

 

Tartar

  • Tartar trapped between the teeth and gum

    Tartar or calculus is a crusty deposite that can trap stains on the teeth and cause discolouration.

  • It creates a strong bond to the tooth surface, making it difficult to be remove by using dental floss or brushing
  • Tartar formation may also make it more difficult to remove new plaque and bacteria
  • Tartar can only be removed with dental scaling by a dental professional

Tartar attach on the extracted teeth

 

Plaque and Tartar will lead to dental problem such as:

Gingivitis

Periodontitis and tooth loss

Dental Caries

 

Poor Oral Health Could Mean Poor Overall Health

Oral health is integral to general health – from the Surgeon General’s Report on Oral Health, 2000

What is the association?

  • The mouth is directly connected to the body by the bloodstream and the digestive system
  • Left untreated, plaque and inflammation can lead to gingivitis
  • Untreated gingivitis may progress to periodontitis
  • Recent evidence suggests that periodontitis is associated with systemic diseases such as heart disease (eg. heart attack, stroke) and diabeties.

 

 

 

Prevention is better than cure

Daily Oral Care: Cleaning In Between

1. Dental Floss

Step 1

Step One:

Take about 18 inches (50cm) of floss and loosely wrap most of it around each middle finger (wrapping more around one finger then the other) leaving 2 inches (5cm) of floss in between

 

 

 

Step 2

Step Two:

With your tumb and index fingers holding the floss taut, gently slide it down between your teeth, while being careful not to snap it down on your gums.

 

 

 

 

Step 3

Step Three:

Curve the floss around each tooth in a “C” shape and gently move it up and down the sides of each tooth, including under the gumline

 

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How to floss your teeth

 

2. Interdental Brushes and Threading Floss

Threading Floss

For people with widely spaced teeth, braces, bridges or implants, they may benefit from an interdental toothbrush.

Interdental Brush

 

Daily Oral Care: Brushing Teeth

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Video: How to brush your teeth – source howcast.com

 

Twice yearly: To visit a dentist for dental check-up & dental scaling

Consultation01 [1600x1200]

More info

Treatments of gum disease:

 

 

Gum Disease and Diabetic

Periodontal-Health-&-Treatm

Diabetic patients are more likely to develop periodontal disease, which in turn can increase blood sugar and diabetic complications.

People with diabetes are more likely to have periodontal disease than people without diabetes, probably because diabetics are more susceptible to contracting infections. In fact, periodontal disease is often considered the sixth complication of diabetes. Those people who don’t have their diabetes under control are especially at risk.

A study in the Journal of Periodontology found that poorly controlledtype 2 diabetic patients are more likely to develop periodontal disease than well-controlled diabetics are.

Research has emerged that suggests that the relationship between periodontal disease and diabetes goes both ways – periodontal disease may make it more difficult for people who have diabetes to control their blood sugar.

Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. This puts diabetics at increased risk for diabetic complications. Thus, diabetics who have periodontal disease should be treated to eliminate the periodontal infection.

This recommendation is supported by a study reported in the Journal of Periodontology in 1997 involving 113 Pima Indians with both diabetes and periodontal disease. The study found that when their periodontal infections were treated, the management of their diabetes markedly improved.

-Source: perio.org-

Gum Disease and Heart Disease

Periodontal-Health-&-Treatm

Researchers have found that people with gum disease are almost twice as likely to suffer from coronary artery disease. – American Academy of Periodontology

Heart Disease

Several theories exist to explain the link between periodontal disease and heart disease. One theory is that oral bacteria can affect the heart when they enter the blood stream, attaching to fatty plaques in the coronary arteries (heart blood vessels) and contributing to clot formation. Coronary artery disease is characterized by a thickening of the walls of the coronary arteries due to the buildup of fatty proteins. Blood clots can obstruct normal blood flow, restricting the amount of nutrients and oxygen required for the heart to function properly. This may lead to heart attacks.

Another possibility is that the inflammation caused by periodontal disease increases plaque build up, which may contribute to swelling of the arteries.

Researchers have found that people with periodontal disease are almost twice as likely to suffer from coronary artery disease as those without periodontal disease.

Periodontal disease can also exacerbate existing heart conditions. Patients at risk for infective endocarditis may require antibiotics prior to dental procedures. Your periodontist and cardiologist will be able to determine if your heart condition requires use of antibiotics prior to dental procedures.

Stroke

Additional studies have pointed to a relationship between periodontal disease and stroke. In one study that looked at the causal relationship of oral infection as a risk factor for stroke, people diagnosed with acute cerebrovascular ischemia were found more likely to have an oral infection when compared to those in the control group.

-Source: perio.org-

When you have heart disease, maintaning goor oral health is important. Remember:

  • Make sure your dentist and hygienist know you have a heart problem
  • Have regular dental checkups
  • Maintain good oral health by brushing and flossing twice a day
  • Eat healthily, exercise, and if you smoke, quit

Air Polishing with EMS:Air Flow®

Air polishing is an alternative, non-contact, method of polishing teeth using a polishing cup and paste after teeth scaling. It requires a special ultrasonic unit (e.g. Air Flow from EMS) that allows use of this insert in the handpiece.

Air polishing uses medical-grade sodium bicarbonate and water in a jet of compressed air to “sandblast” the surface of the enamel smooth. Examples include the Prophy-Jet® and Cavitron Jet® (Dentsply Ltd.). The nozzle is held 3 to 5 mm from the tooth, centred on the middle third of the tooth. Use at 60° to the long axis of the root. Do not direct into the gingival sulcus.

Air polishing with EMS Air Flow®

Before air polishing

Afer air polishing

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