Periodontal Treatment

We know that periodontal disease is an infectious disease caused by the bacteria that colonise the mouth on a regular basis and which causes bleeding gums. It occurs in people who have let their guard down in their personal care and have accumulated an excessive amount of local irritants, such as plaque, tartar or food debris, thus overwhelming their defence capacity. Disease also occurs very frequently in people who are genetically predisposed to it. These people are more vulnerable because their defence system at the gum level works less well.

Despite being a disease caused by bacteria, we do not use antibiotics systematically for its treatment because the bacteria that cause it are bacteria that are common in the oral environment and when the effect of the antibiotic wears off, they colonise the gums again. Antibiotics are used at specific times at the discretion of the professional.

The first step in the treatment of bleeding gums is to perform what is commonly called a "mouth cleaning". This term refers to the mechanical removal of surface tartar with a cleaning device that removes the tartar (calculus) by emitting ultrasound and water. This is a basic and simple procedure and is usually considered only as the first step before proceeding to clean the really important tartar that accumulates under the gum.

The periodontal treatment will consist of eradicating the existing infection by mechanically eliminating local irritants such as tartar, bacteria inside the bags and the toxins that they have produced and have become impregnated on the surface of the root. That is why to treat this problem it is not enough to perform a "cleaning" of the mouth, since this treatment is useful for people without special gum problems and who have simply accumulated superficial tartar.

Dental scaling and root planing

Patient with bone loss and dental scaling of infection with curette, care of bleeding gums

People with special problems or at risk of suffering from them need to have one or more scaling or also called Curettage. This is a specialised technique that removes the infection from the depth of the pocket, reaching non-visible areas, which is very important for the correct care of bleeding gums. It requires a high level of expertise because it is often done blindly and in very small spaces, where the touch of the well-trained person is the only weapon to effectively remove bacterial irritants. Properly performed scaling drastically reduces gum bleeding immediately. After curettage we always do a root planing to make the tooth surface less receptive to bacteria.

It is often necessary to do several scaling and root planing sessions, in which we treat the whole mouth each time the patient visits us. The reason why we scrape the whole mouth and not in quadrants, as they do in other clinics, is that we only scrape as far as the gum allows and in successive visits we can scrape deeper, removing the deep calculus until it is eradicated. This process has great advantages over other ways of working, such as the reduction of possible discomfort, thanks to the use of the gum's capacity to deflate after each treatment, and the fact that anaesthesia is unnecessary in most cases.

The patient will be informed on how to perform their personal oral hygiene, as we observe that most of our patients think before coming to our practice that they are brushing properly, although in reality this is not the case.

Collaboration between practitioner and patient is essential for both to work together to not only eliminate the infection effectively, but to maintain the desired results over time.

In special cases, the Full Mouth scaling technique can be used, which consists of completing the entire dental scaling in a single day. This requires a long session of at least two hours, usually using anaesthesia. This technique would only be used for people with very little time or who have to travel a long way to the clinic, but it does not have the same effectiveness as the conventional technique.

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Resolving inflammation after periodontal treatment for the care of bleeding gums

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Another case of bleeding gum inflammation

SURGICAL PHASE. DEBRIDEMENT SURGERY

Sometimes the practitioner is unable to remove all bacterial irritants using the scraping and smoothing technique, either because the pockets are too deep or there are other access difficulties.

When the bleeding gums have not been eliminated and the tissues have not been completely de-inflamed, the professional will consider the use of Periodontal Surgery. This is a technique that aims to access the entire root surface to clean it perfectly and create conditions of health and shape of the gum that facilitate the maintenance of the health situation in the future.

There are more conservative and more aggressive surgical techniques that will be recommended by the professional, as each of them has its own indications.

The surgical procedure basically consists of anaesthetising the area to be operated on, cutting the gum with a scalpel, making an incision close to the neck of the tooth, separating the gum from the tooth and the bone so that both can be perfectly visualised, eliminating any existing infection and carrying out bone remodelling or regeneration procedures as required by the situation. Finally, the gum is sutured so that it is well adapted to the bone and the tooth.

SITUATIONS LIMITING THE EFFECTIVENESS OF SCALING AND ROOT PLANING

  • Deep pockets, especially in areas of irregular bone.
  • Pockets in multi-rooted teeth.
  • Anatomical variations of the roots (concavities).
  • Poorly positioned and crowded teeth.
  • Fibrous gum.
  • Faulty restorations.

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Periodontal surgery procedure for subgingival calculus removal

GINGIVAL PLASTIC SURGERY

This is a set of procedures that aim to improve the aesthetic and functional aspect of the gum. Within this chapter we will highlight gingival grafts with or without root coverage, frenectomy, crown lengthening, deepening of the vestibule, etc.

scheme

GUM GRAFTS

They consist of providing gum where it does not exist, for which donor areas of the mouth are sought that can provide the necessary tissue, without this being detrimental to the donor area, i.e. it is a requirement of this technique that the donor area fully regenerates the tissue it has provided. The donor area is usually the palate.

To do this, the area to be operated on is anaesthetised, a bed is prepared in the area that will receive the graft, and the gum removed from the palate is placed. It is sutured properly.

This technique is often intended to cover gum recessions that disfigure the smile, but this is not the only indication for this procedure.

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Gum grafting procedures to cover denuded roots

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Gum grafting procedure to improve the aesthetics of a fixed prosthesis

It aims to remove or displace an existing frenulum, which is pulling on the gum, hinders the mobility of the lip or is inserted between two teeth, mainly incisors, creating a space between them.

CROWN LENGTHENING

It is a surgical procedure that, as the name implies, moves the gum into a higher position so that the amount of exposed tooth after the procedure is greater than before.

It is useful when the tooth has a neck cavity that is partially covered by the gum and the dentist needs to visualise the entire cavity in order to fill it.

It is also useful in situations of tooth crown fracture, when the fracture reaches beyond the gum, in situations of severe tooth wear and, in general, in all those situations in which the dentist needs more vision or retention to place a crown.

In addition to opening the gum, this procedure requires the removal of superficial bone around the tooth to create space to move the gum to a higher position.

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Crown lengthening procedure

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Crown lengthening procedure on an upper molar

bleeding gums care
Crown lengthening procedure for improved aesthetics

MAINTENANCE PHASE

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Patient maintained in good health

It is this part of the treatment that ensures that the results achieved during active treatment are maintained over the years. Even if the practitioner has completely eliminated the inflammation during treatment, this does not guarantee that the mouth will remain free of infection over time unless both the patient and the practitioner form a good team and work together to keep the mouth free of active infection. It is up to the patient to keep the surface clean and up to the practitioner to remove deposits that accumulate in areas inaccessible to the patient.

It is essential to attend these visits as often as indicated by the professional so that the amount of bacteria accumulated over time does not exceed the tolerance limit of the patient's gums, and to maintain good gum care to prevent them from becoming bleeding with good oral hygiene.

Remember:

  • Periodontal surgery is used to access the infection that is inaccessible from the outside.
  • It is also useful for bone regeneration procedures.
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