Gum Disease Treatment

Gum disease mainly concerns gingivitis and periodontitis, two conditions that are developing mainly due to the existence of dental plaque, i.e. a biofilm, usually of a pale yellow color, that grows attached to the teeth and gums. Periodontitis is considered by many experts to be the irreversible stage of gingivitis, resulting in tooth loss.

If you have not brushed your teeth correctly and do not use dental floss, food and bacteria remain on our teeth, which over time accumulate and create a plaque. Plaque accumulates in parts of the oral cavity, where the growth of microbes is easier (e.g. interdental spaces). Although these accumulations are initially microscopic, the bacteria themselves produce chemical substances, which cause local inflammation. This inflammation causes swelling and sensitivity of the gums.

Gingivitis, although an inflammation, is a reversible condition. In contrast, periodontitis is destructive and irreversible, resulting in losing teeth. It has been shown that gum disease does not only affect the oral cavity. A person who will lose some of his teeth has an increased chance of experiencing some psychological disorder, such as reduced self-esteem, reduced self-confidence and even depression. On the other hand, gum disease has been shown to be related to the occurrence of multisystem diseases, such as diabetes mellitus and dementia.

In general terms, other examples of complications of gum disease may be:

• Infection or abscess in the oral cavity
• Mouth ulcers
• Swollen lymph nodes
• Premature delivery and low birth weight
• Alzheimer’s disease and dementia
• Strokes
• Acute myocardial infarction
• Angina pectoris
• Atherosclerosis
• Hypertension
• Diabetes mellitus
• erectile dysfunction
• idiopathic bowel diseases (Crohn’s disease, ulcerative colitis)
• pancreatic cancer

In general, as long as the person uses the daily oral hygiene methods (brushing your teeth at least twice a day, using dental floss, etc.), the risk of developing gingivitis and by extension periodontitis is reduced. Conditions that increase the risk of developing the above diseases are:

• Increased age
• Osteoporosis
• Poor oral hygiene
• Incorrect use of dental care methods
• Sleep apnea
• Brackets
• Dry mouth (Sjogren’s syndrome)
• Smoking
• Genetic factors
• Stress
• Psychiatric diseases (e.g. depression)
• Diabetes mellitus

More generally, the symptoms of gingivitis are non-specific and mainly concern the characteristic signs of inflammation:

• Swollen gums
• Gum color change
• Sensitive gums
• Pain
• Bleeding gums
• Bad breath

If the disease reaches the stage of periodontitis, it is unfortunately irreversible. But in the early stages, periodontitis has very few symptoms, and in many people the disease is already advanced by the time it is diagnosed. Symptoms can be:

• Gum sensitivity, redness and/or bleeding
• Swollen gums
• Blood loss after brushing teeth
• Bad breath
• Persistent metallic taste in the mouth
• Shrinking of the gums
• Loose teeth
• Tooth loss

Examination by the dentist is the only way to correctly assess the hygiene and to make the correct classification of the disease. In addition, after the clinical classification of the disease is done with a special tool, x-rays must be taken to assess the condition of the bone.

Basic periodontal examination: inserting a periodontal probe into the gingival sulcus to locate periodontal pockets, where tissue and bone have been lost due to the disease. It is very important that the dentist makes a periodontal chart. This examination takes a few minutes and is very important for the individual treatment plan.

Imaging tests: they are the most important test to diagnosing gum disease. Depending on the complexity of the case, a simple x-ray examination is sufficient and consists of 2 images, while in more complex cases, up to 14 x-rays or a panoramic x-ray may be performed.

Laboratory tests: are used to identify the bacteria that accumulate in the gums and thus carry out a more specialized therapeutic treatment.

If you have gingivitis, of course! The disease can be prevented through regular, daily and correct oral hygiene. Rigorous and specialized plaque control programs, as well as the use of an individualized patient periodontal chart, have also been shown to be helpful. For any question about oral hygiene, do not hesitate to contact us.

The main therapeutic method of treating gingivitis is the removal of dental plaque. The goal of this method is to reduce the oral bacteria. The method includes regular visits to the dentist and adequate and daily oral hygiene at home. Thus, many of the methods used to prevent gingivitis can also be used to treat it, such as mouthwashes containing chlorhexidine or hydrogen peroxide and flossing. Dental cleanings are necessary and are recommended to be done every 6 months. If the problem is controlled, a simple dental cleaning procedure is done, while if it is extensive (e.g. necrotizing gingivitis, periodontitis), surgical cleaning is recommended.

The classic dental cleaning method is simple and painless. During the visit, the dentist takes an accurate medical history and performs a clinical examination. Using a dental tool with a mirror on its end, the doctor can assess the whole oral cavity and assess the oral hygiene. Using ultrasound, dental plaque is removed and disease-causing bacteria are killed. If the bacterial plaque remains, it is removed with special periodontal tools. Finally, the pigments are removed and the teeth are polished with a diamond paste. This procedure has to be done every 6 months and everyone has to use a daily oral hygiene routine.

If there is uncontrolled and extensive disease in the oral cavity (caries, periodontitis), your dentist will recommend subgingival scaling. In this procedure, not only the dental plaque that is on the surface of the teeth is removed, but also the one that is under the gums. With dental tools, the specialist scales the gums and cleans the area. In this way, the plaque is eliminated and the gums are able to grow normally. The method is performed under local anesthesia.

The bacteria that cause gingivitis can be reduced by using a mouthwash daily containing an antibiotic. Amoxicillin, cephalexin, or minocycline 500 grams of non-alcoholic fluoride mouthwash is an effective mixture.

Finally, the treatment of comorbidities can help in the treatment of gingivitis (e.g. taking drugs for diabetes mellitus).

The cornerstone of successful periodontal treatment is the proper oral hygiene. People with periodontitis have to realize that this disease is a chronic inflammation and requires lifelong treatment at home and dental visits.

Subgingival curettage:
The removal of the bacterial plaque is essential to achieving perfect oral hygiene. The first step is the non-surgical dental cleaning below the gum line. This procedure is called subgingival curettage, is carried out using special tools and often requires several sessions and local anesthesia. However, it is a method, with which, if done correctly, the dentist removes a huge amount of bacteria that cause the problem of periodontitis. Before preparing the root canal, the dentist must have treated any other problem in the oral cavity, so that this technique gives the best result.

Revaluation:
After the subgingival scaling is done, the patient has to visit his dentist again in 4-6 weeks, so that the latter can assess the stage of the disease. Normally, oral hygiene should have improved and the inflammation should have been reduced. This can be seen during the periodontal examination, in which the depth of the periodontal pockets should be between 4-5 mm. For an even better assessment of the stage of the disease, the dentist can make a periodontal chart, in which the patient’s characteristics will be recorded, so that the treatment can be personalized. Signs of unsuccessful treatment of the disease are bleeding gums and periodontal pocket depth of more than 5 mm.

Surgery:
In severe cases of periodontitis, proper oral hygiene and subgingival scaling are not enough to control the disease. The inflammation continues and the loss of the jaw bone and teeth is even greater. In this case, surgical treatment is indicated. There are various methods of surgical approach to the disease, which are chosen depending on the characteristics of the patient’s disease. Examples of such methods are bone surgery, surgically guided periodontal tissue regeneration and bone grafting. The goals of surgical treatment are not only the definitive removal of the bacteria, but also the management of the bone deficits that the disease has caused. Studies have shown that in cases of severe periodontitis, surgically treated cases that have been combined with adequate daily hygiene and frequent visits to the specialist, have a much better course and the patient loses periodontal tissue at a much slower rate. In fact, in many studies the inhibition of tooth loss was achieved in 85% of patients.

Bone surgery is indicated in severe periodontitis with bone loss. It aims to create a healthy environment in the oral cavity, in which the growth of microorganisms will not be favored. The jawbones and periodontal pockets are reshaped, while the gums are placed closer to the bone. This procedure usually requires several sessions. Often, the patient may experience gum sensitivity during the treatment, which is why the use of a special toothpaste is recommended.

The surgically guided regeneration of the periodontal tissues aims to strengthen and regenerate the gum’s and the supporting tissues of the teeth. Specialists place an absorbable membrane. This prevents bacteria from growing in the spaces between the teeth. This allows the slow-growing bone-producing cells to grow, so in about 6 months the tooth will have a new supporting tissue.

In bone grafting, the specialist fills the gaps that have been created in the disease-damaged bones with graft material. The material can either come from the patient’s body (autologous transplant), or be cadaveric (allograft), animal (xenograft) and artificial. The choice of the graft is always made after a discussion with the dentist about the advantages and disadvantages of each material, but also about the transplantation process.

Localized use of drugs:
In recent years, studies have shown that topically administered drugs have much greater efficacy and fewer side effects than systemically administered drugs. Commonly used drugs are tetracycline, doxycycline and statins. In addition, today, microbiological cultures can be taken so that the antibiotics administered can be personalized.

Maintenance:
Once successful periodontal treatment, surgical or nonsurgical, has been completed, an ongoing periodontal maintenance therapy is required. This includes regular checks and thorough dental cleanings every three months to prevent the re-proliferation of disease-causing microorganisms.