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  Gum Disease  
     
 
 
 
Gum disease or periodontal disease, a chronic inflammation and infection of the gums and surrounding tissue, is the major cause of about 70 percent of adult tooth loss, affecting three out of four persons at some point in their life.

What causes gum disease?

Bacterial plaque - a sticky, colorless film that constantly forms on the teeth - is recognized as the primary cause of gum disease. Specific periodontal diseases may be associated with specific bacterial types. If plaque isn't removed each day by brushing and flossing, it hardens into a rough, porous substance called calculus (also known as tartar).Toxins (poisons) produced and released by bacteria in plaque irritate the gums. These toxins cause the breakdown of the fibers that hold the gums tightly to the teeth, creating periodontal pockets which fill with even more toxins and bacteria. As the disease progresses, pockets extend deeper and the bacteria moves down until the bone that holds the tooth in place is destroyed. The tooth eventually will fall out or require extraction.

Are there other factors?

Yes. Genetics is also a factor, as are lifestyle choices. A diet low in nutrients can diminish the body's ability to fight infection. Smokers and spit tobacco users have more irritation to gum tissues than non-tobacco users, while stress can also affect the ability to ward off disease. Diseases that interfere with the body's immune system, such as leukemia and AIDS, may worsen the condition of the gums. In patients with uncontrolled diabetes, where the body is more prone to infection, gum disease is more severe or harder to control.

What are the warning signs of gum disease?

Signs include red, swollen or tender gums, bleeding while brushing or flossing, gums that pull away from teeth, loose or separating teeth, puss between the gum and tooth, persistent bad breath, change in the way teeth fit together when the patient bites, and a change in the fit of partial dentures. While patients are advised to check for the warning signs, there might not be any discomfort until the disease has spread to a point where the tooth is unsalvageable. That's why patients are advised to get frequent dental exams.

What does periodontal treatment involve?

In the early stages, most treatment involves scaling and root planing-removing plaque and calculus around the tooth and smoothing the root surfaces. More advanced cases may require surgical treatment, which involves cutting the gums, and removing the hardened plaque build-up and recon touring the damaged bone. The procedure is also designed to smooth root surfaces and reposition the gum tissue so it will be easier to keep clean.
How do you prevent gum disease?
Removing plaque through daily brushing, flossing and professional cleaning is the best way to minimize your risk.

What is the role of the general dentist?

The general dentist usually detects gum disease and treats it in the early stages. Some general dentists have acquired additional expertise to treat more advanced conditions of the disease. If the general dentist believes that the gum disease requires treatment by a specialist, then The dentist and periodontist will work together to formulate a treatment plan for the patient.

Is maintenance important?

Sticking to a regular oral hygiene regimen is crucial for patients who want to sustain the results of therapy. Patients should visit the dentist every 3-4 months (or more, depending on the patient) for spot scaling and root planing and an overall.

Periodontal Procedures

Following are some of the procedures that periodontists use to treat patients diagnosed with a periodontal (gum) disease. The main cause of periodontal disease is bacteria in the form of a sticky, colorless plaque that constantly forms on your teeth; however, many other factors can cause periodontal (gum) disease or influence its progression.

Non-Surgical Treatments
Scaling and Root Planing
Periodontal Surgery
Pocket Depth Reduction
Regeneration
Crown Lengthening & Gingioplasty

Non-Surgical Treatments - Scaling and Root Planing

Scaling and Root Planing is the first treatment for periodontal disease. It removes all of the irritants under the gums to eliminate inflamation and infection. Half of the mouth may be numbed so that the we can comfortably remove hardened food from below the gums. This is called scaling and it's like removing the scales from a fish. Most hygienists also use ultrasonic vibrating tools to blast deposits off of teeth. It leaves a rough surface so planing is needed.
Like a carpenter planes a door to make it smooth. we surgically planes the root surfaces which allows the gums to regenerate without irritation. The gum tissue shrinks and tightens around the teeth because there is no longer anything irritating. It also reduces bleeding gums. After scaling and root planing is completed the gums heal and the results determined by charting the patient's pocket depth. The goal is a 1 to 3 mm thickness.

In some patients, scaling and root planing is the only treatment needed. It can often eliminate the inflamation and infection that promotes the tissue destruction around teeth from periodontal disease. Because it's a non-surgical treatment, patients often feel comfortable with it, however, it is most effective is treating early periodontal disease.

Periodontal Surgery

If you're diagnosed with periodontal disease, your periodontist may recommend periodontal surgery. Periodontal surgery is necessary when your periodontist determines that the tissue around your teeth is unhealthy and cannot be repaired with non-surgical treatment. Following are the four types of surgical treatments most commonly prescribed:

Pocket Reduction Procedures

Regenerative Procedures

Crown Lengthening

Pocket Depth Reduction

Your bone and gum tissue should fit snugly around your teeth like a turtleneck around your neck. When you have periodontal disease, this supporting tissue and bone is destroyed, forming "pockets" around the teeth.

Over time, these pockets become deeper, providing a larger space for bacteria to live. As bacteria develop around the teeth, they can accumulate and advance under the gum tissue. These deep pockets collect even more bacteria, resulting in further bone and tissue loss. Eventually, if too much bone is lost, the teeth will need to be extracted.

A pocket reduction procedure has been recommended because you have pockets that are too deep to clean with daily at-home oral hygiene and a professional care routine.

During this procedure, your periodontist folds back the gum tissue and removes the disease-causing bacteria before securing the tissue into place. In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. This allows the gum tissue to better reattach to healthy bone.

What are the benefits of this procedure?

Reducing pocket depth and eliminating existing bacteria are important to prevent damage caused by the progression of periodontal disease and to help you maintain a healthy smile. Eliminating bacteria alone may not be sufficient to prevent disease recurrence. Deeper pockets are more difficult for you and your dental care professional to clean, so it's important for you to reduce them. Reduced pockets and a combination of daily oral hygiene and professional maintenance care increase your chances of keeping your natural teeth - and decrease the chance of serious health problems associated with periodontal disease.

Regeneration
Your bone and gum tissue should fit snugly around your teeth like a turtleneck around your neck. When you have periodontal disease, this supporting tissue and bone is destroyed and pockets develop. Eventually, if too much bone is lost, the teeth will need to be extracted.

Your periodontist may recommend a regenerative procedure when the bone supporting your teeth has been destroyed. These procedures can reverse some of the damage by regenerating lost bone and tissue.

During this procedure, your periodontist folds back the gum tissue and removes the disease-causing bacteria. Membranes (filters), bone grafts or tissue- stimulating proteins can be used to encourage your body's natural ability to regenerate bone and tissue.

There are many options to enhance support for your teeth and to restore your bone to a healthy level. Your periodontist will discuss your best options with you.

What are the benefits of this procedure?

Eliminating existing bacteria and regenerating bone and tissue helps to reduce pocket depth and repair damage caused by the progression of periodontal disease. With a combination of daily oral hygiene and professional maintenance care, you'll increase the chances of keeping your natural teeth - and decrease the chances of serious health problems associated with periodontal disease.


Crown Lengthening & Gingioplasty

Periodontal procedures are available to lay the groundwork for restorative and cosmetic dentistry and/or to improve the esthetics of your gum line.

You may have asked your periodontist about procedures to improve a "gummy" smile because your teeth appear short. Your teeth may actually be the proper lengths, but they're covered with too much gum tissue. To correct this, your periodontist performs crown lengthening.

During this procedure, excess gum and bone tissue is reshaped to expose more of the natural tooth. This can be done to one tooth, to even your gum line, or to several teeth to expose a natural, broad smile.

Your dentist or periodontist may also recommend crown lengthening to make a restorative or cosmetic dental procedure possible. Perhaps your tooth is decayed, broken below the gum line, or has insufficient tooth structure for a restoration, such as a crown or bridge. Crown lengthening adjusts the gum and bone level to expose more of the tooth so it can be restored.

What are the benefits of this procedure?

Whether you have crown lengthening to improve function or esthetics, patients often receive the benefits of both: a beautiful new smile and improved periodontal health - your keys to smiling, eating and speaking with comfort and confidence.



Mouth Ulcers :

Mouth ulcers are a common condition and usually appear suddenly, causing pain. They are like small sores that appear on the inside of your cheeks. They can also be found on the edge of, or underneath your tongue, and rarely, on the roof of the mouth.

They usually go away in one to two weeks without treatment but can come back within three months in some people.

  • WHAT CAUSES MOUTH  ULCERS?

No one knows the exact cause but some people tend to get them more often than others, especially if there is a family history of mouth ulcers.

Mouth ulcers are most common in children and young adults. Students and people who are under a lot of stress may get them often. Some women can get them before their period or during pregnancy.

Other causes of mouth ulcers can be:

  • Damage to the inside lining of your mouth by very hot or acidic food and drinks.
  • Biting your inner cheek.
  • Brushing your teeth and gums very hard.
  • Poorly fitted dentures.
  • A very dry mouth - due to a medical condition or from some medicines.
  • Eating food you are allergic to.
  • Scraping of the mouth lining by sucking hard sweets.
  • Being stressed or lacking certain vitamins and minerals in your body such as folic acid, the B-group vitamins or iron.
  • Certain medicines - your self care pharmacist can advise you if your medication could be the possible cause and refer you to your doctor.
  • SIGNS AND SYMPTOMS
    • Mouth ulcers are round or oval shaped, and usually less than 1cm in size. They are yellow to grey in colour on the inside, with a swollen red edge.
    • They can be very painful, especially when eating or drinking.
    • Some people can get a tingling or burning feeling, 1-2 days before the ulcers appears.
    • Small blisters or sores on the outside of your lips are usually cold sores. Check with your Self Care Pharmacist and refer to the Cold Sores remedies.
  • TREATMENT
  • Mouth ulcers can heal within 7-14 days without treatment, but medicines can provide relief.

    Medicine can numb the pain, protect the ulcer from further damage or decrease any possible bacteria infection. Some medicines may speed up healing if used early enough.

    Pasters

    • Form a protective layer over the ulcer which allow it to heal faster and can help with the pain.
    • Some pasters contain anti-inflammatory medicines, which if applied at the tingling stage, can prevent the mouth ulcer from developing further. You need to dry your mouth first before applying the paste.
    • Dab it on rather than rubbing.

    Gels

    • Form a protective layer over the mouth ulcer.
    • Some also contain medicins that numb the pain. Avoid using large amounts of gels, especially in children under 12 years old.

    Mouth Washes

    • Are useful for hard to reach ulcers.
    • Can help to prevent bacteria causing an infection.
    • Some mouth washes can also numb the pain.
    • They work best if you start to use them as soon as you feel the tingling sensation.

    Liquid Paste

    • Form a protective layer over the mouth ulcer but need to be re-applied often.

    Ask your Self Care Pharmacist to help you choose the most suitable treatment for your mouth ulcer. Apply paster and gels as directed during the day. Also apply at bedtime to allow longer contact with the mouth ulcer.

    Take a pain reliever, eg paracetamol, if the pain of the mouth ulcer is very severe. Check with your Self Care Pharmacist first. if you are pregnant, breast-feeding or before giving medicines for mouth ulcers to children.

  • SELF CARE
    • Suck on ice to help reduce the pain of mouth ulcers.
    • Avoid spicy or acidic food and drinks when you have a mounth ulcer.
    • Avoid very hot food and drinks.
    • Brush your teeth with a soft toothbrush straight after eating. If you can't brush, rinse your mouth with warm water or chlorhexidine mouthwash bought from your pharmacy.
    • If dentures cause your mouth ulcers, have their fiting re-checked.
    • Take vitamin B and C supplements if you are run down, especially for women and students who get mouth ulcers often.
    • Learn some relaxing tips to help with stress.
    • Drink lots of water to avoid a dry mouth.
    • Eat a healthy well-balanced diet or fruit and green vegetables.
  • IMPORTANT

    See your doctor or dentist if you have mouth ulcers that:

    • are larger than 1 cm or you have lots of tiny ulcers that join together to form a larger ulcer.
    • do not heal within 3-4 weeks even with medicines.
    • bleed a lot.
    • occur in every shot periods of time, eg every 1-2 weeks.
    • come with a sore throat or a rash on your face or any part of your body.
    • are not painful at all.
    • occur with diarrhoea as well.

    These warning signs may mean you need prescription medicines or have some other serious medical condition.

  • GUM SURGERY

     

    What Is Periodontal (Gum) Disease?

    Periodontal literally means "around the tooth." Periodontal or gum diseases are serious infections affecting the tissues surrounding the teeth. These tissues include the gums and bone supporting the teeth. Without treatment, periodontal disease can result in tooth loss

    Periodontal disease is usually a slow, painless, progressive disease. Most adults with periodontal disease are unaware they have it. If diagnosed and treated early the teeth can be saved

     

    How Is It Treated?

    Chances are that if you have been diagnosed with periodontal disease, periodontal surgery may be recommended. Surgery is indicated when non-surgical methods are not enough to stop the disease process. 

    Depending on how advanced your particular case is, treatment may involve any of the following:

    • Scaling and root planing. Scaling involves the removal of the plaque and calculus deposits on the tooth surfaces, while root planing is the smoothing of the root surfaces in order to promote reattachment of the gum tissue to the tooth.

    periodontal_4.jpg (14855 bytes)

    Plaque and tartar (yellow or brown Hardened plaque) are scraped off the tooth's crown and roots.

    periodontal_5.jpg (13776 bytes)

    After Scaling, the rough surfaces of the root are smoothed, providing a healthy surface for healing.

    •  
    • Flap/Osseous Therapy allows the periodontist to gain access to the root of the tooth for removal of plaque, calculus, and diseased tissue. The gum is then carefully sutured back into place. Flap therapy may sometimes be accompanied by minor osseous (bone) shaping or removal in order to ease tissue positioning, facilitate home care, and simplify your maintenance appointments.

    periodontal_10.jpg (10533 bytes)

    The gum is lifted from the tooth and bone, and diseased tissue is removed.

    The uneven bone may also may be reshaped.

     

    periodontal_11.jpg (10877 bytes)

    After surgery, the gum is repositioned and sutured in place.

     

    •  
    • Guided tissue regeneration(GTR) involves the use of a biocompatible membrane material, often in combination with a bone graft, that promotes the growth of lost tissue and bone around your tooth. Not every case is suitable for grafting so ask your dentist or Dr.'s Nejat & Aldredge if this procedure can benefit you. 

    periodontal_12.jpg (13775 bytes)

    In some cases, destroyed tissue between teeth or roots can be partially regenerated.

     

    periodontal_13.jpg (11625 bytes)

    Once the damaged area is prepared and special membranes are inserted, new tissue can grow over a period of weeks and months.

     

 
     
     

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