disease, a branch of dentistry, deals with all problems arising from acute and/or chronic bacterial, viral, fungal (fungal) infections along with physiological and genetic factors in the periodontal tissues surrounding your teeth. Unless it progresses to advanced stages, it generally does not cause pain. Gum disease is one of the most common diseases in the community and can progress over many years without significant symptoms in the mouth. If left untreated, it can cause even healthy teeth, without decay, to fall out due to loss of supporting tissue. Gum disease can affect one or more teeth together or separately.
Causes of Gum Disease
The main factor in the development of gum disease is bacterial plaque. For a healthy mouth, bacterial plaque needs to be removed from the environment through oral hygiene procedures. If plaque is not removed from the teeth, minerals in saliva eventually adhere to the teeth, forming tartar. If there is no bacterial plaque on the teeth, minerals in saliva cannot adhere to the teeth, and thus tartar cannot form.
The byproducts of bacteria in plaque affect the periodontal ligaments that attach the tooth to the bone, causing destruction of the attachments. The gum moves away from the tooth, and a periodontal pocket forms. Due to the periodontal pocket, bacteria can easily penetrate deeper tissues, and over time, destruction of the surrounding bone begins.
Factors contributing to the formation of plaque include:
Inadequate and incorrect tooth brushing. Click here for proper tooth brushing.
Not using auxiliary hygiene materials such as dental floss or mouthwash.
Failure to regularly check for tartar buildup plays a significant role.
Other factors contributing to gum disease include:
– Genetic Factors: Genetic predisposition is identified in certain forms of gum disease. In such cases, the disease progresses rapidly and causes tooth loss at an early age. Therefore, it is beneficial for individuals with a family history of early tooth loss to be under the control of a gum disease specialist (periodontist) from adolescence onwards.
– Systemic Diseases: Diseases affecting the body’s immune system, such as leukemia and AIDS, as well as diseases such as diabetes (sugar) and anemia (anemia), can adversely affect gum health.
– Medication Use: It has been found that some medications have adverse effects on the gums.
– Pregnancy: Hormonal changes during this period affect the gums. Click here for oral and dental health during pregnancy.
– Stress
– Unbalanced Diet
– Smoking
– Teeth grinding (bruxism), teeth clenching
– Gum trauma and injuries due to toothpick use
Symptoms of Gum Disease
– Bad breath
– Loose teeth
– Gum recession
– Sensitivity when drinking cold beverages
– Teeth no longer fit together properly
– Bleeding gums while brushing
– Newly formed gaps between teeth
– Constant mouth ulcers
– Recent swelling and redness of the gums
The early stage of gum disease is “gingivitis”. Gingivitis is a clinical condition where only the gums are affected by the surrounding tissues of the tooth. The beginning of the disease is when the bacteria in the plaque infect the gums.
Plaque is a sticky, colorless film layer that constantly forms on the teeth. During this stage, redness, bleeding, and swelling are observed in the gums. Pain is generally not present during this stage.
In Gingivitis:
– There is bleeding when brushing the gums.
– Gums are red and swollen.
– The contours of the gums are distorted, and the surface is shiny.
– There is no pain.
It usually occurs due to inadequate oral hygiene, and quick healing can be achieved with professional dental cleaning or regular oral care at home. If left untreated, the disease progresses to the periodontitis stage. Periodontitis is the destruction of the tooth-supporting gum fibers and alveolar bone as a result of the inflammatory process that begins in the gum due to bacterial influence. In healthy gums, there is a physiological gum sulcus of 1-2 mm where the gum attaches to the tooth. In periodontitis, this groove deepens over time due to bacterial attack, turning into a periodontal pocket.
In Periodontitis:
– There is bleeding when brushing the gums or spontaneously.
– Gums are red and swollen.
– The contours of the gums are distorted, and the surface is shiny.
– There is bad breath and taste in the mouth.
– As the disease progresses, gum recession occurs. As a result of gum recession, the sensitive root surface of the teeth is exposed, leading to sensitivity to hot and cold.
Treatment of Gum Disease
The primary goal of gum treatment is to reduce and slow down the inflammatory reaction. In the initial stage of treatment, the aim is to remove the tartar, bacterial plaque, and pockets causing inflammation. Hand tools and ultrasonic devices (cavitrons) that work with sound waves are used to remove dental calculus and bacterial plaque. As with other diseases, it is very important to start treatment early. Periodontal destruction can be slowed down or stopped with treatments using hand tools and ultrasonic devices.
If the gum disease is in the gingivitis stage, dental scaling and professional oral care are sufficient. If the disease has progressed to the periodontitis stage, i.e., if pocket formation and bone destruction have begun, dental scaling and root planing (smoothing of the root surface) are required. Root planing treatment can be performed by a gum disease specialist (periodontist) in 1-4 sessions. At the end of this process, the root surface becomes polished and smooth. Thus, adhesion of tartar and bacteria to the surface is prevented. Reattachment between the gum and bone is expected during the healing phase. The healing process takes 4-6 weeks.
In advanced cases of periodontitis, surgical operation (flap) may also be required after scaling. In this operation, the gums are lifted to the level of the bone surface, and the root surfaces and remnants of inflamed tissue are cleaned. Bone grafts and biomaterials such as membranes may be applied around the tooth to regenerate bone, and the gums are sutured into the appropriate position. Stitches are removed after 7–10 days. The healing process after flap operations takes 6-8 weeks.
In addition to the mechanical treatments applied by the dentist, mouthwashes and systemic antibiotics may be necessary.
Since the diagnosis, the individual’s oral hygiene is also very important alongside all these treatments. If there is no cooperation from the patient, the success rate of the treatment methods applied decreases.
Patients with periodontitis are in the high-risk group, and there is a possibility of disease recurrence, so follow-up is very important. The patient is called in for regular checks.
Additional treatments such as replacement of worn-out fillings and prostheses that cause gum inflammation and progression and ideal cleaning of semi-embedded or malpositioned (not in the chewing plane) teeth due to tooth decay in the mouth may be necessary.
