Gum Treatments

Gum Treatments

  • The oral hygiene you practice at home—brushing at least two times a day and flossing every day—is great for keeping your smile healthy and beautiful between visits to your dentist, but it doesn’t take the place of the more in-depth cleaning we’re able to perform during your regular hygiene visits. Here we can also perform fluoride and desensitizing treatments, take actions to prevent or reverse gum disease, or even tell you about a variety of dental options to keep your breath feeling and smelling fresh!

  • Before-Full Mouth Disinfection
    After-Full Mouth Disinfection
    Before Full Mouth Disinfection After
Dr. Malav's Multispeciality Dental Clinic

  • Periodontal disease, also known as gum disease, is the most common disease known to mankind. 75% of all adults have had it or will have it at some time. Gum disease can cause bleeding gums, sensitive teeth, and bad breath and in advanced cases, lead to loose teeth, tooth loss and adversely affect your ability to eat, speak and smile properly..
  • Full-mouth disinfection is for the treatment of gum disease in adults. Periodontal disease affects the bone and gum that provide support for your teeth, which if left untreated can result in your teeth becoming loose and falling out.
  • Chronic Periodontitis is treated by removing bacteria and hard deposits that affect root surfaces underneath the gum.
  • Aim: To complete this procedure within a short time frame of 24 hours. This is in order to minimise the chance of re-infection with bacteria coming from other areas of the oral cavity, such as tongue, tonsils and interdental spaces.
  • This procedure is to try and minimise and stabilise the loss of bone support and tissues which help keep the teeth firm within the dentition and in the long run prevent tooth loss.

  • Periodontist will prescribe a mouth wash and will give advise on tongue cleaning which will need to be started a couple of days before your appointments. This helps to reduce infection and reduce the microbial load in the mouth. He will take measurements around your teeth so they can assess the severity of your periodontal disease. They will then explain how they intend to carry out your treatment and show you techniques you can use to keep on top of periodontal disease.
  • The treatment will take one or two appointments. If second appointment is scheduled, it will be within 24 hours of the first appointment. If deep cleaning is required, the treatment is usually done under local anaesthetic. This will make it much more comfortable for you.
  • During these appointments the periodontist will spend time removing any hard tartar and soft plaque from around the teeth and under the gums. This procedure typically involves scaling and also root planing. They will also remove any extrinsic staining from your teeth. Aids of interdental cleaning will then be demonstrated to you and a customised hygiene programme will be discussed.
  • After your treatment and depending on the severity of your gum disease—you will be asked to return in few weeks for re-evaluation so that we can again measure around your teeth and assess how healthy your gums are, whilst also assessing your progress on home cleaning. At this appointment, your teeth will be cleaned again removing any reformed plaque.
  • Our Hygiene program is committed to preventing and eliminating this destructive disease. Periodontal disease is caused by a large build-up of the bacteria found in plaque, which erode the soft and underlying hard tissues of the mouth.
  • The early stages (gingivitis) are marked by red, inflamed, bleeding gums. If it is detected in these early stages, gum disease can often be reversed.
  • For more advanced cases of gum disease multiple appointments may be required and a shorter interval between professional hygiene appointments may be recommended to maintain health
  • Sufficient treatment for periodontal disease has never been so important. There are a number of links proven between periodontal disease and other health problems. Periodontal disease has also been shown to increase the risk of Heart disease, Respiratory disease, increase the severity of Diabetes, and increase incidence of Premature births, Rheumatoid Arthritis, Obesity, Alzheimer’s Disease.
  • The success of your periodontal treatment relies highly on excellent oral hygiene. This is why it is so important that you take into account all of the information, advice and aids recommended to you by your periodontist (Gum specialist).

  • In order to complement non-surgical therapy in gum disease, there are multiple options of antimicrobials, such as metronidazole, chlorhexidine, minocycline, doxycycline and tetracycline, which can be locally delivered into the mucosa.
  • These drugs are used in periodontal pockets and can inhibit or eliminate microorganisms as well as modulate/modify the inflammatory response of tissues.
  • These antimicrobial drugs are used as an adjunct following surgical and/or non-surgical therapies.
  • The adjunctive use of local drug delivery systems with controlled release properties may provide a defined, but limited, beneficial response on periodontal pockets (sign of gum disease).
  • Furthermore, local drug delivery as an active treatment or maintenance therapy depends on clinical findings, responses to treatment, desired clinical outcomes, and patient’s dental and medical histories, including their past usage of antimicrobials.

A frenectomy is a minor surgical procedure performed to remove a section of the frenulum (soft tissue), usually as a dental procedure. The frenulum is a type of tissue that connects the lips and tongue to the jawbone. It may be too short, long or tight and need surgical intervention.

There are 2 different types of frenulum in the mouth, the lingual frenulum located beneath the tongue and the labial frenulum which is located along the upper and lower gums and lips.

Problems with the lingual frenulum are common among children as the frenulum may be too tight which can cause problems with speech, and is often referred to as “tongue-tie“.

A labial frenectomy is commonly performed on patients who require dentures or Envisaging, as the frenulum may cause irritate the dentures or may be attached high up on the gums. It can help with gum recession or with removing space between the teeth.

Indications

  • Babies born with a short, long, or tight frenulum which may cause difficulty breastfeeding
  • Patients who have speech difficulties as a result of the frenulum
  • Patients who are being fitted with dentures or braces

In cases where frenulum has caused spaces between the teeth & gum recession.

  • The ligating, tying, or joining of periodontal involved (mobile) teeth to one another in order to stabilize and immobilize the affected teeth is called “Splinting”.
  • Mobile lower anterior teeth is a common complaint of dental patients with fairly advanced periodontal disease. The treating of these mobile teeth is often not very successful. The mobility is caused by a loss of supporting bone around the roots of the teeth.
  • Even comprehensive periodontal treatment cannot replace this missing bone and the prognosis for these teeth is poor. In the majority of cases the lower four incisors (the four teeth between the two lower canine teeth) are the teeth showing the first signs of mobility.
  • The most logical way to treat the mobility once the active periodontal disease is under control would be to splint these mobile teeth.
  • Materials & methods used for splinting:
    • orthodontic stainless steel wire:
    • Most frequently used technique.
      • Steps: It is bonded (sticked) on to the lingual surface (or inside) of the teeth with composite (white filling material) which acts as a splint. This method has some success

 

  • Disadvantages:
    1. Metal wire is quite rigid, and this type of splint tends to debond and fail in time.
    2. There is no true bonding between the metal wire and the composite filling material.
    3. Aesthetic compromise
  •    The concept is good and these splints are an option if nothing better is available.
    • Alternative: Fiber reinforced splint
  • Advantages:
    1. Good bonding between composite resin and the splint
    2.  It is flexible
    3. Esthetics is better compared to orthodontic wire.
  • Options other than splinting:
    • It is mostly invasive and non-reversible. They can involve extraction of the mobile teeth, and replacing the extracted teeth with a dental implants, crown/bridge or removable partial denture.

This is a surgical dental procedure involving the removal of gum tissue and bone to expose more tooth surface area.

Why is Crown Lengthening performed?

Crown lengthening is often performed when a tooth needs to be fixed, but not enough of the tooth protrudes above the gum to support a filling (restoration) or crown. This can happen when:

  • A tooth cracks off at the gum line
  • Crown or filling falls out of a tooth and there is tooth decay underneath.
  • A tooth has decay below the gum line.
  • Crown lengthening can also be used in cosmetic dentistry to fix a “gummy smile” – when a patient has a lot of gum tissue around their upper teeth. Excess gum tissue is removed to create a more aesthetically pleasing appearance.

Dr. Malav's Multispeciality Dental Clinic

What are the steps before Crown lengthening surgery?

  • Before the surgery, the patient may require a professional tooth cleaning.
  • If the patient needs a crown, the surgeon may place a temporary crown. The temporary crown protects the tooth and allows the surgeon to gage how much soft tissue or bone needs to be removed.

How is Crown Lengthening performed?

  • The crown lengthening procedure is performed under local anesthesia.
  • The periodontist will excise and peel the gums away from the teeth to expose the roots of the teeth and the surrounding bone. The surgeon will then remove the gum tissue and sometimes bone from around the roots of the teeth. Bone is removed using a combination of hand instruments and rotary instruments.
  • Once enough of the tooth has been exposed, the area will be irrigated with sterile salt water and the gums will be stitched together. The periodontist may cover the surgical site with a periodontal dressing.
  • Even if only one tooth needs crown lengthening, the surgeon may include neighbouring teeth so that the gum tissues are evenly reshaped. Post-surgery, the teeth will appear elongated because the gums are now shorter than before the surgery.

Instructions after the procedure:

  • You will be given prescriptions for a pain relief on sos basis (as and when required in case of pain) and a mouth rinse.
  • Also, you will be asked to consume soft diet for atleast 2 days.
  • You can brush the teeth near the stitches, but avoid the gums. Remove food particles with a toothpick or a water irrigator.
  • An ice pack may be placed against the face, if there is any swelling.
  • The patient will be instructed in post-surgery care, and scheduled to return in 7 to 10 days for follow-up. The gums will be allowed to fully heal for one month then the tooth is prepared for the restoration or final crown.

  • In general, a vestibule is an entry way between the outside and inner chambers, and in the mouth, refers to the space between the inside of the lips and the teeth.  A Vestibuloplasty is a dental surgery usually considered only when there is insufficient bone and/or tissue to support dental prosthesis like dentures and implants.
  • Why vestibuloplasty is required ?
    • Vestibuloplasty is a comprehensive range of surgical procedures, usually done by an periodontist or oral surgeon, to :
      • Increase the height and width of the alveolar ridge of bone and gum tissue that holds the teeth.
      • To provide sufficient structure to securely hold dentures or dental implants.

All teeth missing since long + Wearing dentures

Lacking of tooth roots to stimulate the bone and keep it healthy and whole

The body reabsorbs the bone and it immediately begins to shrink both horizontally and vertically

The membranes and tissues covering the bone also become diminished.

The gums and underlying bone typically decease

Dentures become loose and need refitting for new dentures.  Dentures can be relined, but unfortunately that is only a temporary fix to postpone the surgical procedure.

Socket preservation is “Preserving Your Jaw Bone after Extraction”.

Sequence of events that follows after tooth extraction:

Extraction of teeth (because of pain, infection, bone loss or fracture of the tooth)

The bone ( that holds the tooth in place in the socket ) is often damaged by disease and/or infection

The surrounding bone and gums can shrink and recede very quickly ( in first 4 weeks after the extraction)

Unsightly defects and collapse of the lips, and cheeks

Deformity of the jaw

Creates major problems in performing restorative dentistry ( i.e dental implants, bridges or dentures )

Prevented and repaired by a procedure called socket preservation

Socket preservation can greatly increase your chances for successful dental implants for years to come & also improve your appearance.

Technique used to preserve the bone and minimize bone loss after an extraction:

Tooth Extraction

The socket is filled with bone or bone substitute

Covered with artificial membrane, or tissue stimulating proteins & gums

This encourages body’s natural ability to repair the socket

Socket heals eliminating shrinkage and collapse of surrounding gum and facial tissues

New bone is formed in the socket

Provides a foundation for future placement of implant to replace the missing tooth

  • Note: If you have been recommended tooth removal, be sure to ask if socket preservation is necessary. This is particularly important if you are planning on replacing the front teeth.

  • Implant dentistry is becoming an increasingly popular treatment choice. In order to achieve a long -term, predictable prognosis, eligible implant patients must have adequate bone volume.
  • Many patients lack sufficient horizontal or vertical bone, but there are various methods that can be used to augment new tissue growth and increase bone volume in these cases. Guided Bone Regeneration (GBR) is a technique that provides space for new bone using barrier membranes. These spaces can then be filled with new, guided bone growth. When used to fill in bone defects with new bone, GBR can provide the best, most predictable results and this technique helps to provide long-term stability to the augmented site.
  • Effectively chosen membranes will be porous to allow essential nutrients, fluids, bioactive materials and oxygen to pass through, but will also be impermeable to epithelial cells. Pore size is vitally important. A pore size that is too large will permit epithelial cells to overpopulate the space, inhibiting the growth of bone-forming cells. A larger pore size also increases the risk of bacterial contamination. On the other hand, if the pore size is too small, the migration of all cells will be limited.
  • After GBR, the augmented bone will have a greater volume than before, but gum tissue will remain unchanged. It may be necessary to release the underneath of the gum tissue so it becomes more flexible and can be carefully stretched and stitched over the new bone, without creating too much pressure and tension.
  • Generally, GBR is a predictable and successful procedure that will regenerate bone within four to six months or more. It is vital to ensure the deficit does not come under pressure during regeneration. Too much pressure could cause the membrane to collapse, affecting the contour of the newly regenerated area. Patient compliance is also important, as patients must look after the wound during healing and should closely follow all instructions for oral care.

  • You may need surgery for severe gum disease (periodontitis) if it cannot be cured with and scaling & root planing or antibiotics. A flap procedure cleans the roots of a tooth and repairs bone damage caused by gum disease. A gum specialist (periodontist) often performs the procedure.
  • Before the procedure, you will be given a local anesthetic to numb the area where the periodontist will work on your gums.
  • The periodontist will pull back a section of your gums to clean the roots of your teeth and repair damaged bone, if needed. The gum flap will be positioned  back into place and covered with periodontal dressing, if needed.

Bone may be:

  • Smoothed and reshaped so that plaque has fewer places to grow.
  • Repaired (grafted) with bone from another site or with man-made materials. The periodontist may place a membrane on the bone graft to help the bone grow back.

What to expect after surgery ?

  • Typically it takes only a few days to recover from a flap procedure. Be sure to follow the home care instructions that is given to you. If you have questions about your instructions, call the dentist. The following are general suggestions to help speed recovery:
  • When the effect of anesthesia wears off, you may have some discomfort which can be relieved by taking painkillers as prescribed by your periodontist.
  • A periodontal dressing has been placed around your teeth which serves a very useful purpose of protecting the surgical area coming in contact with external environment. So, it should not be disturbed.
  • The dressing will become semi rigid within a few hours. it can then withstand some of the forces of chewing without breaking. Limit yourself to semi-solid diet and avoid excessively hot foods for the first day. After this period, you may return to your regular diet. However, avoid eating on the side of dressing.
  • After 48 hours, you can rinse your mouth gently with warm salt water several times a day to reduce swelling and relieve pain, if it is present.
  • Relax after surgery. Avoid any strenuous physical activities as it may increase bleeding.
  • Eat soft foods such as gelatin, pudding, or light soup. Gradually add solid foods to your diet as the area heals.
  • Do not lie flat. This may prolong bleeding. Prop up your head with pillows.
  • Continue to carefully brush your teeth and clean the tongue.
  • Apply an ice or cold pack to the outside of your mouth to help relieve swelling.
  • Do not use sucking motions, such as when using a straw to drink.
  • Do not smoke & drink for atleast 4 weeks after the procedure.
  • A few days (7 to 10) after the procedure, your stitches will be removed.

Why is it done ?

  • The flap procedure is necessary when severe gum disease (periodontitis) has damaged the fibers and bones that support your teeth.

  • The root is the part embedded in the jaw. It anchors the tooth in its bony socket and is normally not visible.
  • The root is attached to the jawbone by a group of specialized connective tissue fibers called the periodontal ligament.
  • A tooth may have one or more roots. Normally, front teeth (incisors, canines) have a single root while premolars and molars can have two, three or more roots but this varies from individual to individual.
  • The periodontal ligament is a specialized connective tissue that attaches the cementum of a tooth to the alveolar bone. They are a network of elastic fibres that help support the tooth inside the alveolar bone socket. The functions of the periodontal ligaments include attachment of the tooth to the bone, support for the tooth, formation, and resorption of bone during tooth movement, sensation, and eruption. When pressure is exerted on a tooth, such as during chewing or biting, the tooth moves slightly in its socket and puts tension on the periodontal ligaments. This is called tooth physiologic mobility. The periodontium exists for the purpose of supporting teeth during their function; a constant state of balance always exists between the periodontal structures and the external forces.
  • Most of the times, periodontal diseases are caused by bacteria from the dental plaque which is adherent to tooth surfaces. In case of bacterial infections, the first barrier is the gum. In the absence of treatment, the infection progresses to the periodontal ligaments and the alveolar bone involving the progressive loss of the alveolar bone around the teeth which can lead to the loosening and subsequent loss of teeth.

  • The oral hygiene you practice at home—brushing at least two times a day and flossing every day—is great for keeping your smile healthy and beautiful between visits to your dentist, but it doesn’t take the place of the more in-depth cleaning we’re able to perform during your regular hygiene visits. Here we can also perform fluoride and desensitizing treatments, take actions to prevent or reverse gum disease, or even tell you about a variety of dental options to keep your breath feeling and smelling fresh!

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