Periodontics

Scaling and polishing

Scaling and polishing also referred to as Professional dental cleaning or dental prophylaxis is usually performed by registered Dental Hygienists. Your scaling and polishing appointment involves removal of plaque and calculus, teeth polishing and oral hygiene instructions. Plaque is a sticky, almost invisible film that forms on the teeth. It is a growing colony of living bacteria, food debris, and saliva. The bacteria produce toxins that inflame the gums. This inflammation is the start of periodontal disease.   Calculus (tartar) is hardened plaque that has been left on the tooth for some time and is now firmly attached to the tooth surface. Calculus forms above and below the gum line and can only be removed with special dental instruments.

 

Teeth polishing is a process of removing stains and plaque that are not otherwise removed during tooth brushing and scaling.

 

Subgingival curettage

Subgingival curettage refers to the removal of subgingival calculus and debridement of ulcerated epithelial and granulation tissues found in the periodontal pockets.  In laymen term, curettage means the scraping of the inside of the gingival wall of a periodontal pocket to separate diseased soft tissue.

The objective of curettage is to remove chronically inflamed granulation tissue, dislodged calculus, bacterial colonies. Removal of these elements will fasten the healing process and promote healing and reduction in periodontal pocket depth.

 

Reason for curettage:

–In the treatment of infection and inflammation of gums.

– In cases of recurrent periodontal infection.

–In conjunction with gum surgery.

 

Note: Curettage cannot eliminate the complete cause of periodontal infection, so it is always preceded by scaling and root planing. The procedure is usually done under mild local anesthesia, using special hand instrument.  Post operative analgesic and antibiotics may be prescribed where necessary.

 

 

Gum therapy

Gum therapy (or Scaling and root planing) is the most effective way to treat gum disease.  Gum disease (also called periodontal disease) is an infection of the tissues surrounding and supporting the teeth. It is a major cause of tooth loss in adults. Because gum disease is usually painless, you may not know you have it. Gum disease is caused by plaque, a sticky film of bacteria that constantly forms on the teeth. These bacteria create toxins that can damage the gums. In the early stage of gum disease, called Gingivitis, the gums become red, swollen and bleed easily. At this stage, the disease is still reversible and can usually be eliminated by daily brushing and flossing. In the more advanced stages of gum disease, called Periodontitis, the gums and bone that support the teeth can become seriously damaged. The teeth can become loose, fall out or may have to be removed by a dentist.

 

If you notice any of the following signs of gum disease, please see your dentist immediately:

–New spacing between teeth (caused by bone loss).

–Loose teeth.

–Receding gums (loss of gum around a tooth).

–Tenderness or discomfort.

–Red, swollen or tender gums.

–Bad breath that doesn’t go away.

 

There are two ways to treat periodontal (gum) disease:  Surgically and Non-surgically. Majority of patients can be adequately treated non-surgically, if the disease is discovered and treated before it becomes too advanced.

Gum therapy which is a non-surgical approach which involves two appointments:  Active therapy and Re-evaluation appointments. The first appointment- Active therapy consist of measuring the gums to determine the extent of the disease, scaling and root planing of the teeth to promote healing, irrigation to fight unwanted bacteria, and home care instruction to equip you to restore and maintain health.   The re-evaluation appointment , which should be scheduled about a month after the active therapy is an opportunity to measure the amount of improvement obtained, evaluate any problem areas that remain, and discuss the best possible options for maintaining periodontal health in years to come.

 

Root Planing

Root planing is a method of treating severe gum disease. When having gum disease, inflammation of the tissues will lead to separation of gum from the root surface, which creates a tiny space known as a periodontal pocket. This makes it very difficult to keep clean and allows bacteria to accumulate. Root planning is the meticulous cleaning of root surfaces to remove dental plaque and calculus.

 

Purpose of root planning is to remove the dental plaque and calculus on the root surface inside the periodontal pocket in order to get rid of the bacteria that causes gum disease, hence achieving reduced inflammation and ultimately full recovery from gum diseases.

 

Procedure for root planning:

Before carrying out the treatment, the dentist will use periodontal probe and take radiographs to confirm the severity of the gum disease. Using local anesthesia to numb the area, special instruments will be used to remove existing plaque and calculus on the root surfaces. Where needed, the dentist may perform periodontal surgery that flips the gum, exposing the root surface for direct and thorough cleaning.

 

Points to note after root planning:

–In the first few days after the procedure, it is common to have mild discomfort and bleeding from the gum. Keep on with good oral hygiene, and the discomfort and bleeding will subside eventually. The gum will become healthy again.

 

–Good oral hygiene is essential for gum healing after root planning. Proper daily oral care should be performed which includes brushing the teeth twice daily, using floss or interdental brush to clean adjacent tooth surfaces.

 

–Smoking will adversely affect the recovery from gum disease, so should be avoided after the treatment.

 

–The entire course of treatment on gum disease usually involves multiple appointments, remember to follow the schedule of appointments and to keep regular dental check-up.

 

 

Gingivectomy /Gingivoplasty

Gingivectomy is the surgical removal of gum tissue(gingiva). A gingivectomy is necessary when gums have pulled away from the teeth creating deep pockets. The pockets make it hard to clean away plaque and calculus. Gingivectomy is usually done before gum disease has damaged the bone supporting the teeth. The procedure involves removing and reshaping loose, diseased gum tissue to get rid of pockets between the teeth and gums. By removing the pocket walls, gingivectomy provides visibility and accessibility to remove calculus and thoroughly smoothen the tooth roots. This creates a favourable environment for gingival healing and restoration of the gingival contour. Although gingivectomy was initially developed to treat periodontal disease, it is now a common cosmetic surgery also. It is used to remove overgrown gum tissue and improve the appearance of the gums.

 

Gingivoplasty  is the surgical reshaping of gum tissue around the teeth. It is often done simply to make gums look better. They may have an unusual shape or may not be formed properly. The causes can be genetic, or due to disease or trauma. Gingivoplasty reshapes the gums to make them look more natural. It is often done alone, but can be done during or after a gingivectomy. Gingivoplasty can also be done along with a gum graft. This type of surgery adds tissue to the gum line.

Both procedures are done under local anesthesia and involve only one or two quadrants per visit. Normal activities are encouraged after the procedure. It takes a few days to weeks for the gums to completely heal. Ibuprofen (Advil) or acetaminophen (tylenol) is very effective for pain. Dental visits for the first one year after the surgery will be scheduled every three months to remove plaque and tartar build up. After a year, periodontal cleaning is required every six months.

 

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