Periodontal Treatment

We know that periodontal disease is an infectious disease caused by the bacteria that regularly colonize the mouth and that causes bleeding gums. Disease occurs in those people who have lowered their guard in their personal care and have accumulated an excessive amount of local irritants, such as plaque, tartar or food remains, thus overwhelming their defense capacity. Disease also occurs very frequently in those who are genetically predisposed to it. These people are more vulnerable because their gum-level defensive system works worse.

Despite being a disease caused by bacteria, we do not use antibiotics systematically for its treatment because the bacteria that produce it are common bacteria in the oral environment and when the effect of the antibiotic wears off, they colonize the gums again. Whether antibiotics will be used at specific times according to the professional's criteria.

The first step in the treatment for the care of bleeding gums is to do what is commonly called "Mouth Cleaning". This term is understood as the mechanical removal of superficial tartar with a cleaning device that descales the tartar (calculus) by emitting ultrasound and water. This is a basic and simple procedure that is usually considered only as the first step to then proceed to clean the truly important tartar, which is the one that accumulates under the gums.

Periodontal treatment will consist of eradicating the existing infection by mechanically removing local irritants such as tartar, bacteria from inside the pockets and the toxins that they have produced and have remained 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.

Patient with bone loss and tooth scraping from infection with curette, bleeding gums care

People with special problems or at risk of suffering from them need to have one or several Scrapings or also called Curettage . This is a specialized 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 specialization because it is often done blindly and in very small spaces, where the touch of a well-trained person is the only weapon to effectively eliminate bacterial irritants. Proper dental scaling drastically reduces bleeding gums immediately. At the end of the curettage we always do a Root Planing to leave the tooth surface less receptive to bacteria.

Many times it is necessary to do several sessions of scaling and root planing, in which we treat the entire mouth each time the patient visits us. The reason why we scrape the entire mouth and not in quadrants, as they do in other clinics, is that we scrape only as far as the gums allow it and on successive visits we can scrape deeper, removing the deep calculus until its eradication. This process has great advantages over other ways of working, such as the reduction of possible discomfort , thanks to the use of the ability to reduce inflammation of the gums after each treatment, and that makes anesthesia unnecessary in most cases.

The patient will be informed of how to carry out their personal oral hygiene since we observe that most of our patients think before coming to our consultation that they brush properly, although in reality this is not the case.

Collaboration between professional and patient is essential so that both work together in order not only to eliminate the infection effectively, but also to maintain the desired results over time.

In special cases, the Full Mouth scaling technique can be used, which consists of finishing all the dental scaling in a single day. This will require a long session of at least two hours and usually using anesthesia. This technique would only be used in people with very little time or who travel from distant places to the consultation, but it does not have the same efficacy as the conventional technique.

Resolution of inflammation after periodontal treatment for the care of bleeding gums

Another case of disinflammation of bleeding gums

SURGICAL PHASE. DEBRIDEMENT SURGERY

Sometimes the professional cannot get to eliminate all the bacterial irritants by using the scraping and smoothing technique, either because the pockets are too deep or there are other access difficulties.

When it has not been possible to eliminate bleeding gums and completely reduce inflammation of the tissues, the professional will consider the use of Periodontal Surgery. This is a technique that aims to access the entire surface of the root to clean it perfectly and create healthy conditions and shape of the gums 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, since each of them has its indications.

The surgical procedure basically consists of anesthetizing 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 bone to be able to perfectly visualize both, eliminate all existing infection and perform remodeling procedures. or bone regeneration as the situation requires. Finally, the gum is sutured so that it is well adapted to the bone and tooth.

SITUATIONS THAT LIMIT THE EFFECTIVENESS OF SCALING AND ROOT PLANING

• Deep pockets, especially in areas of irregular bone.
• Pockets in teeth with several roots.
• Anatomical variations of the roots (concavities).
• Badly positioned and crowded teeth.
• Fibrous gum.
• faulty restorations.

Periodontal surgery procedure for subgingival calculus removal

GINGIVAL PLASTIC SURGERY

It 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, vestibule deepening, etc.

GUM GRAFTS

They consist of providing gum where it does not exist, for this donor areas of the mouth are sought that can provide the necessary tissue, without this being detrimental to the donor area, that is, it is a requirement of this technique that the donor area fully regenerates the tissue you have given. Usually the donor area is usually the palate.

To do this, the area to be operated on is anesthetized, a bed is prepared in the area that will receive the graft, and the gum extracted 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.

Gum graft procedures to cover bare roots

Gum grafting procedure to improve the aesthetics of a fixed prosthesis

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

CROWN LENGTHENING

It is a surgical procedure that, as its name says, places the gum in a higher position so that the amount of tooth exposed after the intervention is greater than before it.

It is useful when the tooth has neck caries that is partially covered by the gums and the dentist needs to see all of the caries in order to fill it.

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

To perform this procedure, in addition to opening the gum, it is necessary to remove superficial bone around the tooth in order to create space to be able to move the gum to a higher position.

Crown lengthening procedure

Crown lengthening procedure on an upper molar

Crown lengthening procedure to improve aesthetics

MAINTENANCE PHASE

Patient kept healthy

This part of the treatment is what ensures that the results achieved during active treatment are maintained over the years. Even if the professional has completely eliminated the inflammation during the treatment, this does not guarantee that the mouth will remain free of infection over time unless both the patient and the professional form a good team and take care of keeping the mouth free of active infections. It is up to the patient to keep the superficial part clean and to the professional to eliminate all those 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 inaccessible infection from outside.
• It is also useful for bone regeneration procedures.