The field of periodontics is the branch of dentistry that specializes in the care of the hard and soft tissues surrounding and supporting the teeth. Often times, this is the area neglected by patients because when patients think about “dentistry,” they think only about teeth and not about the gum and bone in which the teeth reside. As a dental office in Spring, TX, we see a lot of patients needing periodontal work and below we discuss some of the most common concerns patients have in this subject.
What exactly does the soft and hard tissue surrounding teeth do and look like?
The tissues surrounding and supporting teeth include both hard and soft components. The hard component is the alveolar bone or housing in which the teeth themselves are socketed. The soft component is the “gingiva” or gum tissue that is visible to the naked eye. Both of these components are critical to the long-term health and stability of teeth, just like the foundations for a house.
I hear a lot of mention in TV commercials about gingivitis.
What is this exactly and what causes the condition?
Gingivitis is the condition in which the gingiva, or gum tissue, becomes inflamed due to a constant, long-term build-up of plaque or calculus next to it, and especially if buildup happens below the gum line. Because of this presence of bacterial activity and the general unhealthful effects of debris, the gum tissue experiences a biological reaction in which the blood vessels become engorged with blood and the area swells due to a natural inflammatory reaction. This is why patients suffering from gingivitis most often has gum tissue that looks reddish-purplish and bleeds easily on brushing or touching.
I am not sure I understand what plaque and calculus is.
These words are publicized a lot but what are these things really?
The human mouth is a hotbed for bacterial activity and whenever we eat, food debris that is not cleansed away can combine with bacteria and natural mineral salts to form plaque, a soft, initially transparent layer of biofilm that sticks to teeth. This biofilm layer then grows in density and eventually becomes ‘mature plaque’ which is soft and whitish in appearance. Finally, if this is not cleaned away, it evolves to become calculus (a.k.a. tartar) that is extremely hard, often colored in appearance, and sticks to teeth extremely tightly. Once calculus forms, it normally cannot be removed by patients alone and would require a professional cleaning.
My dentist says that I also have something called periodontitis and mentioned something about bone loss. What does this mean and how did this happen?
When gingivitis is not treated, the calculus that forms eventually secretes enough bacterial toxins to cause gum and supporting bone to become inflamed for a long period of time. This prolonged inflammatory reaction (years usually) causes the supporting bone to become resorbed or lost and this is why people who have long-term gum disease usually have receding gum lines and gaps between teeth. Gum disease in this form in which bone loss is involved is called periodontitis.
How do you treat gingivitis or periodontitis? And does it hurt?
There are various treatment modalities, but the most common treatment is Scaling/Root Planing, colloquially known as “deep cleaning.” This treatment involves removing not only the plaque/calculus that is visible, but also that which has accumulated below the gum line. This “invisible” buildup is actually the most dangerous and harmful part, as it is hard to remove and directly damages the periodontium. The deep cleaning involves using scalers to go deep below the gum line to remove all of this buildup. The process is a bit time consuming but usually produces no pain. In the scenario where the patient already has a lot of pain coming in, local anesthesia is more than enough to control and eliminate any discomfort present so that the procedure can be done.
My dentist told me that I have periodontitis and after I did my deep cleaning I noticed that my gums have receded a bit and I have some black triangles appearing between my teeth.
How did this happen and can I do anything about it?
After a deep cleaning takes place, the periodontium will heal because the inflammatory cause is now gone. The gum will become pink and healthy-looking again and shrink as the swelling is eliminated. However, this also means that some gum recession might occur as the swelling goes down. If bone loss has also occurred, some ‘black triangles’ may also pop up between the teeth. While the gum recession may be addressed with a procedure called “gum grafting,” (see below), bone loss is permanent and can’t be reversed. This is why we consider gum disease to be a ‘silent killer’ because by the time patients detect it, often substantial damage is already done.
So a “deep cleaning” is enough for all cases of gum disease?
I don’t have to worry about anything else after that?
A deep cleaning is usually enough for the majority of cases of gum disease, but if the gum disease is too severe and the buildup too deep below the gum line, some surgical periodontal procedures would have to be considered. One such procedure is called pocket reduction. This is a minor surgical procedure aimed to access calculus buildup too deep for conventional deep cleanings.
You mentioned something about gum grafting. What is it and how is it done?
Gum grafting is a very useful procedure to address gum recession and has a very high successful rate, provided that the situation is appropriate. In this procedure, a piece of gum tissue is harvested from the roof of the patients own mouth and then immediately transplanted to the site where recession has occurred. This donor gum tissue is then sutured in well and allowed to heal and “take” at the acceptor site. Success probability is very high. This procedure is used to address areas in of sensitivity or cosmetic concerns and usually works well unless considerable bone loss has occurred.
If my gum disease is extremely severe, what can I do?
In cases where gum disease has been present for a long time and allowed to progress to an advanced stage, bone loss most likely will have made the teeth noticeably loose. In these cases, the teeth may no longer be savable and would need to be removed and replacements considered in the way of dental prostheses or implants.
