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 Periodontology

​It is a specialty of dentistry that examines the clinical and microscopic structures of hard and soft tissues surrounding gingiva, diagnosis the diseases effecting these tissues, administers the treatment, thereafter maintains the acquired health. Gingival diseases (periodontology) are named as gingivitis in the early period. The symptoms of gingival diseases: gingival bleeding; red, swollen, sensitive gingiva; detached gingiva that can easily be separated from the teeth; inflammatory discharge between teeth and gingiva; teeth that swing and gradually move away from each other, permanent bad breath. Reversing the gingival disease (periodontology) might be possible at this stage. Sometimes just a better oral care and professional dental cleaning may be enough to cure it. Dental specialists (periodontists) might suggest curettage and smoothing root surface depending on the level of the gingiva disease (periodontology) besides oral cleaning. Using special dental instruments, plaques and tartars are removed from the gingival pockets. Then the root surfaces are smoothed and the gingiva is tightly adhered to the tooth. In cases which this treatment is not sufficient, gingival operations may be recommended. Gingival diseases (periodontology) do not heal by themselves by using antibiotics, mouthwashes, vitamins. It must be treated by a specialist. Early diagnosis will preserve the health of teeth as well as gingiva. If left untreated, it might result in tooth loss. It is still one of the most common reasons of tooth loss since it usually does not cause any pain. In terms of general health; It is supported by increasing scientific evidences that the size and severity of periodontal diseases are important risk factors. Brushing teeth at least twice a day in an accurate way, using dental floss at least once a day, and regular dental visits every six months are required to prevent gingiva diseases (periodontology). 

Bacterial plaque, a common enemy of teeth and gingiva, is a sticky, discolored microbial layer that accumulates on teeth and leads to dental caries and gingiva diseases. Factors such as crooked teeth, dental caries, poorly made stoppings and prostheses, breathing by mouth and dryness of mouth increase microbial dental plaque accumulation. 

Bacterial plaque combines with the sugar in the food we eat and forms a kind of acid, which weakens the tooth enamel (protective hard layer covering our teeth) and leads to decay in the tooth in time.

Bacterial plaque is soft and can be easily cleaned by the patient, if it is not cleaned and accumulates, it turns into tartar by hardening with the effect of calcium and phosphate ions from saliva.  Tartar can only be removed by dentists from teeth surfaces. Tartar causes bacteria plaque, which is the main cause of gingiva diseases, to accumulate more easily on teeth. Therefore, it is not harmful to clean tartar. Tartar should be cleaned professionally to prevent the progression of gingiva diseases. 

Gingiva diseases (periodontal diseases) are infectious diseases that affect the tissues surrounding and supporting teeth. Periodontal diseases affect all age groups including children. However, it is more common in adults. Even the teeth that do not have any dental caries can be lost due to this disease. The symptoms are often difficult for patients to recognize because it is usually painless and late diagnosis occurs in most of the cases. 

Gingivitis

The beginning of gingiva disease is gingivitis. This disease causes the redness and swelling of gingiva and also it causes bleeding during brushing and flossing.

A healthy gingiva has a dusty rose color, it is firmly adhered along the surface of teeth and ending keen like a knife edge. If the bacterial plaque, the main reason of gingiva disease, is not removed from the teeth; the gingiva's health worsens, it becomes red, swells slightly and loses the ability to adhere along the teeth. 

The most important and earliest symptom of gingiva disease is the bleeding occurs when brushing and/or biting something hard. In this case, it is necessary to visit a periodontist. 

Periodontitis
Gingivitis is fully healed with dental treatment and good oral care. However, if it is not treated, it turns into a progressed version which is called "periodontitis" in a long period of time. In this disease, the fibers that connects tooth root to jaw bone dissolve, in this way a gap between teeth and gingiva occurs called "pocket". More bacteria, toxins of bacteria and food residues accumulate in the pocket, so that the infection spreads through deep tissues and the bone supporting the teeth also dissolves and it causes loss of teeth. Researches have shown that periodontal diseases are the leading causes of tooth loss in adult population with a rate of 60-70 %. 

Early periodontitis may also develop without visible symptoms. For this reason, regularly visiting a doctor is very important for early diagnosis of the disease.  

The most frequent symptoms of periodontitis are red, swollen gingiva, gingival recession / enlargement, sensitive gingiva, gingival bleeding, gingival recession in an advanced stage, sensitivity on tooth root surfaces exposed, cavity on tooth root, inflammation from the space between teeth and gingiva, spaces occurred between teeth, lengthening, rotation, dangling, abscess formation in teeth, bad breath and tooth loss. While early and moderate periodontitis is treated with non-surgical methods, advanced periodontitis is treated with additional surgical methods.

The effects of periodontal disease, which is one of the most common health problem in the world, on the general health of body are well known today. This type of infection does not only affect the mouth health, but also affects the general health of the individual through inclusion of bacteria in bloodstream. Recent studies have shown that the risk of developing some systemic diseases increases in individuals with gingivitis. As a result of these studies, gingivitis has been associated with diabetes, cardiovascular diseases, atherosclerosis, some respiratory system diseases, low birth weight in infants and premature birth. Therefore, teeth and mouth tissues should be considered as an inseparable part of body and it should be remembered that health and disease conditions have an effect on the whole body. 

TREATMENT OF GINGIVAL DISEASES 
Periodontal diseases are diseases that can be prevented and controlled substantially. The most important step in periodontal treatment is being sure that the patient knows how to maintain sufficient oral health by cleaning the gingiva, teeth and space between teeth effectively and regularly. Early gingival diseases, plaque and tartar are removed from the pocket by using special dental instruments. In addition to tooth cleaning, curettage and smoothing root surface may be recommended. In cases which this treatment is not sufficient, gingival operations may be recommended. Gingival diseases (periodontology) do not heal by themselves by using antibiotics, mouthwashes, vitamins. Early diagnosis will preserve your teeth as well as your gingival health. In the presence of systemic diseases, the medical doctor should hold a consultation and try to bring the disease under control. 

In addition to that, during early period treatment, the following applications must be performed; removal of local factors facilitating bacterial adherence such as renovation of bad and overflow fillings, filling of decayed teeth, correction of prostheses not in conformity with gingival margins and have wrong shapes, etc., root canal operations and pulling out hopeless teeth if there is any.

Patients should be regularly examined by dentists for plaque control and removal of new tartar after periodontal treatment. But it should not be forgotten no procedure can be more beneficial than effectively applying the daily oral care in order to maintain acquired health with periodontal treatment. 

Mechanical and surgical periodontal treatments with effective plaque control are usually sufficient for treatment or control of periodontal diseases. However, periodontal destruction is observed to continue in some cases despite the ideal care. In these cases, that do not respond to traditional treatments, positive response is achieved with antibiotic treatment in addition to traditional treatment. Also, antibiotics might be used for protective purposes in patients with uncontrolled diabetes, endocarditis,      organ transplantation,   coronary bypass, patients who have undergone heart valve replacement and the other risk groups for protective purposes after surgical treatment and against the risk of spreading microorganisms in the mouth through the blood during periodontal therapy. After all, in the vast majority of cases of gingivitis and periodontitis, the use of antibiotics is not necessary. The unnecessary and incorrect use of systemic antibiotics creates a serious bacterial resistance and poses a risk to the individual and society. 

GINGIVAL RECESSIONS 
It has been reported that different factors influence gingival recession. These are mainly structural factors, irritant factors, gingivitis and periodontal diseases. Irritant factors such as trauma, incorrect brushing, duration and frequency of brushing, abnormal orthodontic forces, bacterial plaque, tartar, bad habits (frequent use of toothpick, put in stuff like needles between teeth, nail-biting, pen-biting, etc.), incorrect filling and prostheses in addition to structural factors such as long muscle attachments, morphology of tooth roots, wrong tooth structure, and the presence of teeth outside dental arch cause gingival recessions. These are; 

  1. Root / tooth sensitivity
  2. Root cavities
  3. Aesthetic problems
  4. Fear of losing teeth
  5. Pulp diseases

Clinical crown size of teeth is lengthening as a result of gingival recession. Particularly in the front region, the patients feel like their teeth are lengthening and it causes aesthetic problems. For many patients, this situation is more important than extreme sensitivity and root cavity. 

Goal-directed treatment must be applied for gingival recessions and then gingival recession may be closed by performing various surgical methods if necessary. For example; if the recession occurs because of incorrect and hard brushing, these factor must be resolved first, or if the reason is periodontal disease, the disease should be controlled and progression should be prevented. Restorative procedures like filling and crown might be applied at problematic advanced cases which cannot be treated surgically. 

EFFECTS THAT CAUSE GINGIVAL DISEASES
The main factor of periodontal disease is bacterial plaque, also factors like cigarettes, systemic diseases, medicines, stress and nutrition may affect the gingival health. As well, diseases or conditions that affect the general body system should be treated with caution in order not to create any complications during dental treatment and the dentist must be informed about the disease or condition.

Cigarette
Besides the general harm, smoking increases the risk of periodontal disease. Studies show that smoking might be a very important risk factor in the development and progression of periodontal disease. These studies reported that smokers have more tartar than non-smokers, smokers have deeper pockets and more loss of bone and tissues supporting teeth. In addition, the chemical substances in cigarettes and the effect of heat hides the symptoms of gingivitis in many cases. For this reason, the patient is often unaware of periodontal disease and other problems because the gingiva with infection cannot bleed. 

Puberty, Pregnancy and Climacteric
During this special periods, as well as many tissues of the body, the gingival tissues are affected due to the changes in the hormones, and during these periods the response of the tissues to microorganisms is greater. For this reason, it is very important to take extra care for daily brushing and flossing to control the bacterial plaque during these periods. 

Systemic Diseases
Some systemic diseases such as diabetes and diseases affecting the immune system also affect the severity of periodontitis and the response to the treatment. 

Diseases affecting the body defense system such as leukemia and AIDS can make the conditions of gingiva worse. Gingival diseases are usually much more severe when people are defenseless to infections and it is more difficult to take it under control. 

Diabetes
Diabetes is a disease that cause special complications with hyperglycemia due to the absence, insufficiency or ineffectiveness of insulin hormone. The most typical change in diabetic patients is dryness of mouth that does not significantly change the flow rate or amount of saliva. In the mouths of uncontrolled diabetics; dryness, burning, loss of taste sensation in taste bud papilla may occur. Also, as blood sugar increases in diabetics, the amount of glucose in gingival crevices doubles.  Thus, the bacterial flora in mouth is also negatively affected because of the increased glucose in salivary glands and gingiva. 

The risk of developing infections in diabetic patients is high. That's why periodontal diseases in diabetics may develop more easily and lead to more severe disruption. Especially, the severity of periodontal disease and disruption of tissues in uncontrolled diabetes increase. It has been shown that diabetes is a factor accelerates and exacerbates alveolar bone destruction in patients with periodontal disease. Diabetes is a risk factor for periodontal disease and periodontal disease is a complication of diabetes. In other words, it is known that patients with diabetes are more likely to develop periodontal disease and the severity of it is much higher. Including, as it is the case with all other infections, the presence of periodontal infection makes the metabolic control of diabetes more difficult. 

In patients with diabetes, oral care should not be more than it should be under normal conditions. Diabetics need to be careful about oral-dental care and should visit dentists regularly. If there is a problem in mouth or there are many dental cavity, this situation may increase blood sugar by creating an infection. Difficulties may arise in the control and regulation of diabetics with severe and widespread oral-dental problems. 

Medications
Some medications have negative effects on oral health by causing special changes on gingiva and affecting other tissues in mouth. These are birth control pills, anti-depressions, some high blood pressure-hearth medications, immunosuppressant, medications used in the treatment of epilepsy, some medicines in the form of a spray containing cortisone for asthma treatment. In such a case, dentists and medical doctor should hold a consultation.

Birth control pills are synthetic progesterone and estrogens that prevent ovulation by imitating pregnancy. When birth control pills are used, an extreme response to local irritants in gingiva occurs.  Inflammation may consist of mild swelling and redness or may be more severe. Studies report that as the duration of birth control pills usage increases, inflammation also clinically increases.

Stress
Studies have reported stress is also a risk factor for periodontal diseases. These studies have shown stress makes it harder to fight against infections and increases the susceptibility to periodontal diseases. 

Undernutrition
Insufficient and poor nutrition makes the fight against infections more difficult by affecting the immune system in a negative way. Periodontal diseases are also severe infections; in case of undernutrition the severity of gingivitis might be increased. 

BAD BREATH
Bad breath may be due to poor oral hygiene or an oral disease such as an advanced gingival disease, cavities, partially erupted wisdom tooth, or it may be due to a serious systemic disease requiring diagnosis and treatment. However, it is frequently originated from the in-mouth. Treatment should be directed to the underlying cause. 

Bad smell affects a large part of the population and causes significant social and psychological problems in affected people. The reasons are:

  1. Dental problems such as poor oral hygiene or advanced gingival disease, cavities,
  2. Many foods and drinks, especially garlic and onions can make a temporary bad breath,
  3. Cigarettes, sometimes alcohol, anticholinergics causing dryness in mouth, anti-depressions, diuretics, anti-parkinson and chemotherapeutic agents,
  4. Systemic diseases such as diabetes, stomach related problems, liver diseases, throat infections, sinus,
  5. Wrong restorations (overflowing restorations, leaking crowns) and nutrition accumulation areas,
  6. Many vitamins and minerals deficiencies such as vitamin A and vitamin B12, iron or zinc deficiencies cause dryness in mouth and fissuring of mucous which contributes to the adherence of food and tissue and thus halitosis. 

The treatment; oral hygiene training, professional oral care, especially the treatment of periodontal diseases, and if necessary, referring the patient to a medical doctor or specialist physician. 

CLEANING TARTAR
Is tartar cleaning a painful procedure?

During tartar cleaning, there is usually no pain. Tartar cleaning is one of the simplest and painless treatments applied in dentistry. Usually local anesthesia is not needed. However, in individuals with low pain thresholds or in individuals with severe gingival recession, local anesthesia can be applied to remove the sensitivity. So, the patients will not feel any discomfort. 

Does cleaning tartar damage teeth?

No. Because in tartar cleaning process, not the dental tissue but the formations (plaque, tartar) that do not belong to the tooth surface are removed. In addition, manual tools or ultrasonic devices used in used in tartar cleaning do not cause starches on tooth surface. 

Does cleaning tartar cause bleeding?

It is natural that very little bleeding occurs during tartar cleaning, and often the patient is unaware of it. Individuals with advanced gingival disease are expected to have a little more bleeding. However, there is no bleeding as in surgical procedures. 

Is it okay if I do not have tartar cleaning? 

Tartar is the contributing factor in all gingival diseases. Tartar cleaning is a necessary treatment for the health of tooth and gingiva. As a result of dental control every six months; the tartar that forms in areas we cannot brush are cleaned by the dentist. And there is no harm with that. If you don't have tartar too often, you should visit your dentist for tartar cleaning in accordance with the intervals recommended by your dentist. 

Are teeth cleaning or fillings done first?

Firstly, gingival diseases must be treated by cleaning tartar, then teeth treatments such as fillings, prostheses, implants, etc. must be performed. 

Do you get tartar again after cleaning the tartar on your teeth?

If you think you have tartar again just after cleaning your teeth, you should go through your brushing style. It is in your hands to prevent the formation of tartar after dental cleaning. You will get the desired oral health by brushing your teeth and using interdental brush as shown by your dentist. 

It is so easy for me to get tartar buildup, what should I do?

If tartar cleaning is done too often, it means that your oral hygiene is not good. Staying away from practices that maintains oral hygiene with the mentality of "my dentist will clean it" causes formation of tartar after every cleaning. The important thing is not to clean tartar but keeping the teeth clean. Regular and accurate brushing prevents the formation of tartar. It is absolutely not recommended to apply tartar cleaning frequently because there is not sufficient brushing. 

Will there be gaps between my teeth after cleaning tartar?

Sometimes large gaps might be felt after cleaning extreme tartar and root surfaces exposed might cause some sensitivity; in such cases, the patients might labor under a delusion by thinking that the cleaning has harmed them. However, such cases occur because of late treatment. 

Remember that tartar cleaning is not a cosmetic task, but a form of treatment. Not cleaning tartar causes gingival disease, and consequently gingival recession, bad breath and in the long term dangling and falling out of the teeth on their own.

güncelleme: 12.5.2018 14:24