DIC Dental Implantology and Cosmetic dentistry

Periodontitis (pyorrhea) is a severe

form of gingivitis in which the inflammation of the gums extends to the supporting structures of the tooth. Periodontitis is one of the main causes of tooth loss in adults and is the main cause in older people. Infection erodes the jawbone, which holds the teeth in place. The erosion weakens the ligaments and loosens the teeth. An affected tooth may eventually fall out or need to be pulled out.

Causes

Most periodontitis results from a long-term accumulation of plaque and tartar between the teeth and the gums. Pockets form between the teeth and gums and extend downward between the root of the tooth and the underlying bone. These pockets collect plaque in an oxygen-free environment, which promotes the growth of aggressive forms of bacteria. If the disease continues, eventually so much jawbone near the pocket is destroyed that the tooth loosens and could fall out.

1.Tartar 2. Accumulated plaque 3. Inflamed and swollen gums
4. Tartar accumulation in the gingival pocket 5.Bacterial infection
of the root surface 6.Tartar 7. Right picture: Inflammation
of the soft and hard tissues, gum recession, loosening of the tooth

    The rate at which periodontitis develops differs considerably, even among people with similar amounts of tartar. That is because plaque contains different types and numbers of bacteria and because people have different responses to the bacteria. Periodontitis may produce bursts of destructive activity that lasts for months followed by periods when the disease apparently causes no further damage.
    Many diseases and disorders, including diabetes mellitus, Down syndrome, Crohn's disease, leukopenia, and AIDS, can predispose a person to periodontitis. In people with AIDS, periodontitis progresses quickly.

Symptoms

    The early symptoms of periodontitis are bleeding, red gums, and bad breath (halitosis). Dentists measure the depth of the pockets in the gums with a thin probe, and x-rays show how much bone has been lost. As more and more bone is lost, the teeth loosen and shift position. Frequently, the front teeth tilt outward. Periodontitis usually does not cause pain until the teeth loosen enough to move while chewing or until an abscess (a collection of pus) forms.

Treatment

    Unlike gingivitis, which usually disappears with good self-care, periodontitis requires repeat professional care. A person using good oral hygiene can clean only 2 to 3 millimeters (1/12 inch) below the gum line. A dentist can clean pockets up to 4 to 6 millimeters deep (1/5 inch) using scaling and root planning, which thoroughly remove tartar and the diseased root surface. For pockets of 5 millimeters (1/4 inch) or more, surgery is often required. A dentist or periodontist may access the tooth below the gum line surgically (periodontal flap surgery) to thoroughly clean the teeth and correct bone defects caused by the infection. A dentist or periodontist may also remove part of the infected and separated gum (a gingivectomy) so that the rest of the gum can reattach tightly to the teeth and the person can then remove the plaque at home.
    A dentist may prescribe antibiotics, especially if an abscess has developed. A dentist may also insert antibiotic-impregnated materials (filaments or gels) into deep gum pockets, so that high concentrations of the drug can reach the diseased area. Periodontal abscesses cause a burst of bone destruction, but immediate treatment with surgery and antibiotics may allow much of the damaged bone to grow back. If the mouth is sore after surgery, a chlorhexidine mouth rinse used for 1 minute twice a day may be temporarily substituted for brushing and flossing.

   Gingivitis is inflammation of the gums (gingiva) - Gingivitis is an extremely common disease in which the gums become red and swollen and bleed easily. Gingivitis causes little pain in its early stages and thus may not be noticed. However, gingivitis that is left untreated may progress to periodontitis, a more severe gum disease that can result in tooth loss.
    Plaque-Induced Gingivitis - Inadequate brushing and flossing is by far the most common cause of gingivitis.
    Drug-Induced Gingivitis - Some drugs can cause an overgrowth of gum tissue, so that removing plaque becomes more difficult, and gingivitis often develops.
    Gingivitis due to Vitamin Deficiency - Vitamin deficiencies, in rare cases, can cause gingivitis. Vitamin C deficiency (scurvy) can lead to inflamed, bleeding gums.
    Gingivitis due to Infections - Viral infections can cause gingivitis. Acute herpetic gingivostomatitis is a painful viral infection of the gums and other parts of the mouth caused by the herpes virus.
    Gingivitis due to Pregnancy - Pregnancy can worsen mild gingivitis, primarily because of hormonal changes.
Gingivitis due to Menopause - Menopause can cause a condition called desquamative gingivitis, a poorly understood, painful condition that occurs most commonly in postmenopausal women.
    Gingivitis due to Leukemia - Leukemia can cause gingivitis. In fact, gingivitis is the first sign of disease in about 25% of children with leukemia.
   Gingivitis due to an Impacted Tooth - Gingivitis can develop in the gums surrounding the crown of an impacted tooth (a tooth that has not fully emerged).

    Gum recession is the loss of gum tissue from the base of a tooth with exposure of the root surface.
     Recession usually occurs in response to overaggressive brushing but can also result from injury or as the natural progression of thin, delicate gum tissue. Most people have some slight recession.
     Bruxism is very frequent cause for the gum recession.

    Recession may make the teeth very sensitive to cold, to sweet foods, or to touch. It may be accompanied by bone loss and may make the teeth more vulnerable to root cavities.
Treatment is needed when the gums or teeth are sensitive or when plaque accumulates and is difficult to remove. Treatment involves a grafting procedure, in which soft tissue is removed from the roof of the mouth or from donor tissues and stitched to the area.

Cosmetic Gum Surgery Procedures

    It is important to emphasize the significance of the healthy and beautiful soft tissue around the tooth, crown or implant for an overall esthetics. It is like a frame around the painting. No matter how beautiful the painting can be, if the frame is not adequate the painting lose attractiveness. The same with teeth; if the gums are not beautiful, no one will notice your beautiful teeth or excellent veneers, and your smile will be everything but nice and sexy.
    The gums can be hypertrophic, with or without pockets, receded, and therefore subject to a cosmetic gum surgery. The goal is to reshape the soft tissue, cover the exposed roots or implant neck, substitute soft tissue that’s missing,etc.
    “Gummy smile” is a problem where your teeth appear shorter than normal because so the gum sculpting can be solved by plastic surgery techniques called gingivoplasty and gingivectomy along with osteoplasty if necessary.
    The "Long in the Tooth" smile, due to gum recession, can be solved by cosmetic gum surgery, or periodontal plastic surgery, as well. As we age, our gums may shrink and recede which makes our teeth look longer. While this is often age-related, it can also occur due to a bad bite. A cosmetic dentist or a periodontist can correct this to such an extent, that you'll have a very youthful appearing smile.