Gum Diseases(Perio)

• Why do I have to get my teeth cleaned every 6 months?

A sticky and tenacious film called plaque gathers around teeth. If this film is not cleaned periodically by brushing and flossing then it hardens and forms a deposit that cannot be removed with regular brushing. This is called tartar. Deposit of plaque and tartar harbors billions of bacteria and chemical toxins which are injurious to gums, teeth supporting structures and bone which anchors the teeth. If you don’t undergo professional cleaning of your teeth every 6 months, then these deposits around the neck of the teeth keep growing. This will result in substantial deterioration of teeth supporting structures and will result in teeth becoming mobile and falling prematurely due to inadequate support of unhealthy bone.  

Before cleaning with tartar on lower front teeth

After cleaning

• My teeth have become sensitive, feel “light” and “loose” after cleaning procedure. Is this normal?

Yes, especially if you are getting cleaning done infrequently or for the first time. Teeth loose its “support” of tartar built around its neck due to removal of large deposits of accumulated tartar during cleaning. This makes teeth feel a little mobile and extruded from its socket. This is temporary, with cleaned teeth feeling normal and stronger within a week.

 Removal of large chunks of tartar can expose a part of the tooth under the tartar. Such teeth are temporarily sensitive to presence of hot or cold liquids or to sweet or sour foods. This is self limiting and will settle within a week’s time. This sensitivity can also be reduced by limited use of tooth pastes which contain medications that can desensitize exposed surfaces of sensitive teeth.  

• My gums bleed occasionally. Is there any solution to this problem?

Gums get inflamed and infected with accumulation of sticky film of plaque or deposition of tartar and hence are more prone to bleeding on slightest provocation. Depending upon the severity of the problem, your doctor will advise routine cleaning which is removal of these deposits. In more severe cases curettage may be advised which involves cleaning of necks of teeth and their root surfaces, and removal of small masses of loosely attached unhealthy tissue.

• I have foul odour coming from my mouth. How can this be treated?

Foul odour or malodor from the mouth is usually due to infected gums due to accumulation of plaque and tartar and inadequate oral hygiene. The treatment would be cleaning of teeth or cleaning in combination with curettage of infected gum tissue. More severe cases of malodor may require further investigations to find source of malodor and more extensive treatments such as flap surgery  with or without augmentation of bone. Overall improvement of oral hygiene including brushing, flossing and tongue scrapping will be of paramount importance. It must be remembered that in a few cases the malodor may be due to some problem related to ears, nose or throat (ENT) or due to some gastro intestinal disorder. Some hormonal disturbances or disease like diabetes may also give rise to malodor.  

• My doctor advises me that my gum bleed cannot go away completely with cleaning of teeth. I will require a flap surgery. What is flap surgery?

Gums get inflamed and infected with accumulation of sticky film of plaque or deposition of tartar. If conservative treatments such as cleaning or curettage are not carried out periodically than the tooth supporting structure called periodontal ligaments and the jaw bone anchoring the tooth is affected leading to its degeneration and loss. Such teeth can still be saved by doing a procedure called flap surgery. Irreversibly inflamed gum tissue is removed and the tooth surface is thoroughly cleaned of all the irritants and toxins. The underlying bone is restructured or “grown” if required. The residual tissue than heals restoring health and function to the tooth.  

Swollen gums with infection	After flap surgery

• I was advised flap surgery. I got cleaning of my teeth done as preparation of this surgery. My gums now feel much better. Why should I undergo flap surgery in such a situation?

After the cleaning procedure your gum bleed may have reduced or stopped completely and obvious inflammation around them may have improved substantially thus giving you a feeling of healthy gums. The reason you have been advised a flap surgery by your doctor is because you have lost some amount of tooth supporting structure called periodontal ligaments, and jaw bone that anchors your tooth. This problem still persists, and in absence of effective treatment will further deteriorate leading to tooth loss. Flap surgery will halt this damage and restore health to your tooth/teeth and it’s supporting structures. A regular follow up with your doctor and home care regimen will serve you well in future.

• What other procedures can be done besides flap surgery for making my gums healthy?

Dental science dealing with gum diseases and their management called Periodontology offers a lot of procedures to make your gums healthy and strong or more esthetic in appearance. The least invasive procedure is cleaning of teeth, which involves removal of a sticky and tenacious film called plaque  and tenacious calcified deposit called tartar. In case of more damage to your gums the doctor may prefer to do curettage which involves cleaning of necks of teeth and their root surfaces and removal of small masses of loosely attached unhealthy tissue.

If a conservative treatment such as cleaning is not carried out periodically then the tooth supporting structure called periodontal ligaments and the jaw bone anchoring the tooth is affected leading to its degeneration and loss. If the resulting damage is minimal then a procedure called gingivectomy will suffice. While more extensive damage calls for flap surgery. 

• I do not like the way my teeth and gums look when I smile. Can you help me smile better?

Yes of course your smile can be improved. You do not like your gums when you smile probably because too much of your gums show while smiling or the gum line being uneven with gums on some teeth placed higher than the rest. It can also be because you have very dark, pigmented gums. A procedure called gingivoplasty, which involves sculpting your gums to achieve more esthetic contours will help. Occasionally some cosmetic treatment of the teeth combined with gingivoplasty will have more satisfactory outcome.

(You may not like your smile because you have cavities on your front teeth or have crooked, broken, discolored or protruding teeth. Please refer to “Esthetic Dentistry” for these problems related to your teeth.) 

• I got a lot of gum treatment done. But my gums have gone bad once again. Why has this happened?

Single largest reason for occasional failure of extensive gum treatment remains inadequate home care and lapse in periodic check up and cleaning of teeth.

Gum disease initiates and progresses due to some underlying cause/s. The commonest cause is accumulation of disease producing plaque and tartar. Other factors such as genetic predisposition, irregular placement of teeth, intake of certain medications, hormonal changes, certain systemic diseases, nutritional disorders etc influence the disease process. The gum disease may reappear in a few cases if any of these factors persist.

   
 After gum treatment 

    
 Tartar has reappeared due to poor hygiene           

• My doctor informs me that I have lost a lot of bone around my teeth. Can this bone regrow?

Yes. Certain types of bone loss defects due to gum disease can be halted and the bone “regenerated”. This is done with the use of bone regenerative materials to fill up the bone defects during flap surgery procedure. Materials termed membranes may also be used during such procedures to shield the area where the bone is regrowing. This may make regrowth of bone more predictable.

• I have mobile teeth and have been advised removal of these teeth. Is it possible to retain these teeth by doing some treatment?

Yes. The process involves “splinting” the mobile teeth to adjacent healthy teeth with the help of reinforced fibres or stainless steel wires. Splinting can be done only for mobile front teeth and after the diseased gums are made healthy by cleaning of teeth or other procedures such as curettage, gingivectomy or flap surgery. Back teeth or the premolars and molars cannot be splinted effectively due to large forces exerted on these teeth during function.