Periodontics

What is periodontics?

Periodontics is the field of dentistry that diagnoses and treats periodontal disease (gum disease) and its consequences. Periodontal disease affects the gums and the bone that supports the teeth. It is important to look after this periodontal tissue to avoid tooth loss.

Types of periodontal disease

There are several stages of periodontal disease that should be treated by a dentist specialising in periodontics.

Good daily dental hygiene is essential for keeping your mouth and teeth healthy. Without good dental hygiene, there can be a build-up of bacterial plaque which if not removed will cause inflammation of the gums or gingivitis. As well as causing gingivitis, this bacterial plaque can also turn into dental tartar and damage the bone supporting the teeth, a condition known as periodontitis.

If not treated in time, periodontal disease can have irreversible consequences in the patient’s mouth.

Gingivitis

What is gingivitis?

When dental plaque builds up, it creates inflammation in the gum, called gingivitis. Usually the first symptom the patient notices is bleeding gums, especially when brushing their teeth. As well as bleeding gums, the gums look swollen and dark in colour on areas around the teeth, known as the gingival contours. Anyone noticing these changes should visit our dental clinic to be seen by a dentist specialising in periodontics and make sure the gum disease does not reach the bone and produce irreversible changes.

Gingivitis is usually reversible. If the patient makes sure they have good dental hygiene and brushes correctly, the gum inflammation will reduce, and the gums will return to good health.

Common causes of gingivitis or gum inflammation

The gums are constantly under attack from bacteria and physical damage. Although saliva goes some way to protect the gums from these constant threats, microorganisms in the gums cause inflammation and the more microorganisms there are, the more gum inflammation will be created.  These microorganisms, as well as causing inflammation, produce substances that damage the cells of the gums. This creates swelling of the gum tissue and allows the microorganisms to penetrate even deeper into the gum.

Periodontal disease is caused by bacteria in the mouth, meaning that anyone who does not practise good dental hygiene is at risk from gum disease.

The mouth naturally has bacteria. However, if these healthy bacteria in the mouth coexist with the type that forms periodontopathogenic bacterial plaque (a cause of gum disease), the solution is not to eliminate all bacteria, but to control the type that causes gum disease. Only thorough dental hygiene can stop these bacteria multiplying and prevent damage to the tissues that support the teeth.

Gingivitis phases

Inflammation is present in all stages of gum disease, from the mildest to the most severe cases.

To begin with, the way the gums react to the bacteria in the bacterial plaque is very mild and the patient does not notice. In this stage there is slightly increased blood flow, which in some cases may result in the gums bleeding during brushing.

In the second phase, the patient notices swelling of the gums and if they go to a dentist specialising in periodontics at the dental clinic, the gums will bleed when tested using the periodontal probe.

In the third phase, the gums take on a very deep red appearance. In this stage the gum inflammation is considered moderate to severe.

Other causes of gum inflammation

Sometimes, the main cause of gingivitis is not bacterial plaque. It can be due to hormonal changes, for instance with pregnancy gingivitis or puberty gingivitis or can be a result of systemic diseases such as acute herpetic gingivostomatitis or some skin diseases.

Anyone noticing signs of inflammation or bleeding gums should visit a dentist specialising in gums or periodontics, to decide whether the cause is bacterial and to arrange a treatment plan.

Ways to prevent gingivitis

• Brush your teeth after every meal.
• Brush your teeth for at least two minutes at a time.
• Use good brushing technique, with circular movements combined with sweeping movements.
• Brush your tongue.
• Use additional cleaning methods like dental floss and mouthwash.
• Visit your dentist at the dental clinic for a general check-up every six months.

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Periodontitis

The long-term build-up of dental plaque leads to dental tartar forming. Dental tartar then creates an inflammatory reaction called periodontitis, an inflammation of the bone surrounding the teeth. This inflammation results in an irreversible process of bone loss, weakening the support for the teeth. In these cases, the gum begins to recede downwards from the lower teeth and upwards from the upper teeth, exposing the roots on the affected teeth. When this happens, it is important to be assessed at our dental clinic so that a dentist specialising in periodontics can decide on the correct treatment.

When gum disease is more advanced, it begins to create irreversible damage. When dental tartar penetrates below the gum line, it begins to destroy the bone that supports the teeth and once this happens it is not possible to restore the lost bone.

What is periodontitis?

Periodontitis is the most common type of gum disease and is produced when inflammation extends from the gum and reaches the tissues that support the teeth, such as the bone.

Gum disease or periodontitis can affect single teeth or be more generalised, when affects more than 30% of the bone around the teeth.

Common causes of gingivitis or gum disease

As with gingivitis, periodontitis is usually produced by bacterial plaque. This bacterial plaque can be made worse by the presence of dental tartar, defective reconstructions (fillings in poor condition) or food debris between the teeth.

Signs and symptoms of periodontitis or gum disease

Periodontitis is usually accompanied by chronic inflammation of the gum, with bone loss and periodontal pockets, which is when the gum separates from the tooth and forms a pocket where bacteria and food debris collect.

In advanced cases, there begins to be tooth mobility and a change in the position of the teeth and even weeping gums.

Periodontitis is usually painless, although in some cases there may be some sensitivity, for instance in teeth with exposed nerves because of bone loss and receding gums.

Sometimes, because of the deep periodontal pockets, eating is painful because food touches the pockets on the affected gums during chewing.

When there is infection in a tooth that creates a periodontal abscess, chewing or any pressure on the tooth produces a stabbing pain on and around the tooth.

Patients with these abscesses and weeping gums usually suffer from bad breath too.

Periodontitis treatment

After diagnostic tests to determine how advanced the periodontitis is, the dental tartar will be removed from the teeth, both around the crown and the root, under the gum.

The most important stage of this treatment is that the patient understands the problem and begins to use good dental hygiene habits and follows the periodontist’s advice.

OTHER CASES THAT SHOULD BE TREATED BY A PERIODONTIST

The pathological process in the gum and the bone supporting the teeth must also be treated. At our dental clinic in Barcelona, we work with dentists specialising in periodontics, who can offer complementary treatments like reconstructive treatment using prostheses and esthetic dentistry.

Crown lengthening or dental crowns

There are two main cases where this treatment can be used.

1. Severe loss of tooth structure, because of deep decay or deep cracks. In these cases, if the damage extends under the gum line, the natural tooth must be exposed so that the specialist dentist who fixes the crown or porcelain inlay has enough dental material available to support the final reconstruction. This also ensures that it does not invade the gum and stops it from becoming constantly inflamed.
2. Short teeth or smiles with excess gum. In these cases, at our dental clinic in Barcelona, Barcelona Dental Studio, we use very sophisticated techniques and very advanced esthetic dentistry treatments to help us remodel our patients’ smiles.

Periodontal treatments help patients keep their teeth strong and their mouths healthy.

What is crown lengthening?

Crown lengthening is a surgical treatment that aims to remodel the gum contour to make it easier to fit a prosthetic crown and, in some cases, to improve the look of the smile.

When to use crown lengthening

1.Very damaged teeth that need a prosthetic crown

When damage to the tooth extends below the gum, the gum contour must be modified to expose the tooth structure as this increases the surface area that can be used to cement the prosthetic crown and keep the crown above the gum line to prevent it invading the biological space.

2.Smiles with excess gum and very short teeth

This method is used for patients with high smile lines. These are smiles where excess gum can be seen and in some cases the gum covers part of the crown, making the teeth look very small.

For patients who want longer teeth because when they smile they reveal excess gum, the best esthetic solution is crown lengthening and then adding porcelain crowns.

In these cases, where the procedure is for esthetic reasons, the treatment should be coordinated by a dentist specialising in esthetic dentistry and is usually applied to all the anterior/front teeth that are visible when smiling.

Steps involved in crown lengthening

For molars with badly damaged crowns

The molar must be treated to eliminate surface decay and endodontic treatment (root canal) if necessary.

Once the tooth is free from decay, the patient is referred to a periodontist for surgery and suturing.

A week later, the patient returns to the periodontist for a check-up and to have the sutures removed.

Between two and three weeks after the sutures have been removed, the tooth is reconstructed, and a prosthetic crown is then added, or a porcelain inlay or a composite inlay.

For high smile lines or short teeth

Following assessment by a dentist specialising in esthetic dentistry and a periodontist, the smile will be analysed esthetically, and a digital design produced to create a surgical guide that will be used to lengthen the crowns of the teeth being treated.

For crown lengthening of anterior teeth to improve the smile, there is usually a wait of around three months between surgery and fitting the porcelain crowns.

Scaling and root planing

What is scaling and root planing?

Scaling and root planing is a treatment option offered by the periodontist in Barcelona for patients with periodontal disease.

In Barcelona, this treatment is commonly known as curettage. However, curettage refers to removal of the affected or infected soft tissue which also helps to separate the inflamed gum from the tooth and speed up recovery after the treatment. Root planing is the removal of hard substance that forms on the teeth created by bacterial plaque. This hard substance is called dental tartar.

In scaling and root planing treatment the periodontist eliminates all the dental tartar that is attached to the tooth and its root, to improve the health of the supporting tissues that surround the affected tooth.

Steps involved in scaling and root planing

1. Evaluation of the full mouth x-ray.

The periodontist will examine the full mouth x-ray to see whether there is any bone loss and whether it is localised or more general.

2. Periodontal probe

When dental tartar has penetrated between the gum and the tooth, the gum becomes inflamed and separates from the tooth forming what is known as a periodontal pocket. This is like a flap that allows bacterial deposits and food debris to build-up and worsens the condition of the gum even further.

When these deposits build-up inside the gum they also begin to affect the bone and gradually destroy it.

The periodontist can use the periodontal probe to decide how deep these periodontal pockets are and how much bone has been lost. The dentist can determine how severe the gum disease is and how far down he will need to clean to correctly treat the gums.

3. Scaling and root planing

The periodontist uses ultrasonic equipment and sharp, narrow instruments to penetrate the inflamed gum and remove the dental tartar attached to the surface of both the crown and the tooth root as well as removing infected dental tissue.

This procedure is usually done in quadrants; the mouth is divided into four quadrants and each is cleaned in turn. It is very important that all sections are cleaned quickly to stop the clean sections being contaminated by those not yet cleaned.