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Gum diseases

Gum disease or periodontitis  is a surreptitious disease affecting the health of your teeth. It often goes unnoticed as patients tend to ignore small signs like bleeding gums. These small signs should be seen as early warning that something is wrong with one’s teeth. In this chapter, we would like to help you recognise these signs so you can see a dentist in time and keep your natural teeth.

How do you know you have gum disease?

The following signs indicate that you have gum disease:

  • Red, bleeding, and inflamed gums
  • Excessive tartar formation
  • Teeth shifting in position
  • Loose teeth
  • Bad breath

If you recognise these symptoms, it is a good idea to see a periodontist – a specialist in the treatment of periodontal diseases – as soon as possible.

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What does gum disease or periodontitis actually mean?

When we eat, a thin biofilm called plaque forms on the surface of our teeth. Plaque is a rich breeding ground for the bacteria living in the mouth. If we do not clean our teeth and the gaps between them thoroughly, this thin layer of plaque hardens over time, forming tartar. Tartar harbours bacteria that induce gum inflammation. As a consequence, the gum swells and de-taches from the surface of the tooth, opening up the way for further bacterial ingress. Patho-gens get lodged in between the tooth and the gum and also induce inflammation. This leads to the necrosis of the tissues surrounding the tooth and the formation of so-called periodontal pockets.

The resulting condition is called periodontitis or gum disease, and it comes with an unpleasant symptom: bad breath. At this stage, seeing a periodontist is a must in order to prevent the in-flammation from spreading to the bone tissue of the jaw. Unless the condition is treated, the structure supporting the teeth weakens and the teeth become loose, shift out of position, or even fall out.

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What causes gum diseases?

There are four factors that play into the development of gum diseases:

  1. Hereditary factors: Over time, the periodontium loses some of its natural self-protection ability and cannot resist certain inflammation-inducing bacteria. While he-reditary factors cannot be influenced, improved oral hygiene and regular periodontal check-ups at least once every six months can help prevent the development of severe consequences.
     
  2. Acquired factors: Untreated tartar and plaque build-up offers a breeding ground to a multitude of bacteria that may induce chronic inflammations. Regular scaling helps eliminate this risk almost completely. A pain-free thirty-minute treatment once every six months helps prevent the development of severe consequences.
     
  3. Irritations: Poorly fitting fillings and restorations may cause continuous irritation while also opening a gate for bacteria to settle between the tooth and the gum. In such cases, the old, poorly fitting fillings and restorations must be replaced in order to reduce the risk of developing gum diseases.
     
  4. Environmental factors: There are a number of medications and chemicals that may damage the periodontium. These include certain heart disease medications, a number of drugs used in the treatment of epilepsy, and chemical residues on fruits and vegeta-bles. Increased background radiation, smoking, and diabetes may also promote the de-velopment of gum diseases.

 

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What are the potential consequences if gum disease is neglected?

Gum disease and its consequences are major risk factors not only in terms of our teeth but also in terms of our overall health. The bacteria involved in gum disease also produce toxins that harm blood vessels. International studies clearly suggest a relationship between this effect on the one hand and heart failure, stroke, and premature births on the other.

It is possible to prevent these risks. When it comes to gum diseases, health awareness and ap-propriate home oral hygiene are key. Of course, our overall lifestyle, nutrition, and possible bad habits (such as, for example, smoking) also contribute significantly to gum problems.

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How can gum disease be treated?

If detected in time, the progress of gum disease can be reversed. In more severe cases, it can be stopped and treated. There are several ways to successfully treat gum disease:

  1. Regular dental hygiene treatment: As tartar often leads to gum disease, scaling helps efficiently prevent the development of the condition. During the oral hygiene treatment, tartar and stains are removed using a special ultrasonic scaler. This is a gentle in-tervention that does not harm dental enamel at all. The surface of the teeth is then pol-ished smooth with special brushes and polishing paste. This prevents plaque from form-ing again. Finally, high-pressure water and a very fine salt mixture are airbrushed onto the teeth to gently remove any impurities from even the most difficult to reach gaps.
     
  2. Removing tartar from under the gum line (deep or subgingival scaling): Any visible tartar built up on the exposed surfaces of the tooth is removed during the dental hygiene treatment. However, tartar also builds up under the gum line, and while this is invisible to the naked eye, it is in fact even more of a hazard in terms of the development of gum diseases. Deep subgingival scaling helps remove tartar and other deposits from the unexposed surfaces of the teeth, making sure that bacteria cannot settle there again.
     
  3. Closed curettage: Closed curettage drastically reduces the number of inflammation-inducing bacteria in the periodontal pockets. It also helps reduce the size of the pockets, or possibly eliminate them altogether. In mild cases of gum disease, our dental specialist will use the appropriate manual or ultrasonic tools to clean and disinfect the periodontal pockets. As the next step, any uneven root surfaces are planed smooth to prevent recurring deposit formation and bacteria from settling on the surface again. Thanks to local anaesthesia, this intervention is pain-free. The success of the intervention should be checked in six weeks’ time; complete success may take several consecutive interventions.
     
  4. Open curettage: In more severe cases of gum disease, when inflammation affects not only the tissues around the root but also those inside it, the periodontist will explore the areas affected by inflammation, clean the root surface, remove any plaque, and disin-fect the entire area. This method is usually reserved for the treatment of persistent periodontal pockets located at a depth of more than six millimetres that cannot be reached by manual tools. This intervention is considered minor surgery: the top part of the gum is separated from the tooth to grant access to the root and the periodontal pockets. Once the pockets have been cleaned out, any infected and damaged tissues are also removed.
     
  5. Guided tissue regeneration: If the pockets have reached a certain critical depth, our periodontist will apply open curettage to gain access to the root surface and to remove any inflamed tissues. However, this in itself is not enough for complete regeneration; it only stops or slows down the progress of bone loss. To reconstruct the original structure of the tissues, a membrane is inserted during the intervention to help the gradual re-generation of the original structure of the periodontium. This procedure is referred to as guided tissue regeneration. The membrane is tissue-friendly and does not induce allergic reactions. Depending on the condition of the gums and bone tissues, bone grafting may also be performed at the same time as the membranes are inserted. Alternatively, a special bone regeneration gel may also be injected into the pockets. These bone grafting com-posites consist of minerals and inorganic materials matching the composition of natural bone and serve as the basis of bone matter growth. When injected into the periodontal pockets resulting from gum diseases, the gel fills the pockets and helps tissues regener-ate, while also promoting ossification. In some cases, the gel may also replace the membranes.
     
  6. Treating gingival retraction by surgery: Gum diseases or excessive teeth brushing trauma – years of vigorous brushing with long horizontal strokes along the gum line – may cause the gum line to recede, which in turn may make the teeth sensitive or even loose. If gingival retraction is excessive, surgical reconstruction may just be unavoidable. There are two possible procedures:
     
    a. Root coverage with lateral sliding flap: The periodontist makes incisions to ob-tain a gum flap which is then moved laterally towards the crown of the tooth. The flap is stitched into its new position by suture. This intervention can only be performed if the patient has enough gum attached tightly to the bone. The in-tervention is performed under local anaesthesia and is therefore pain-free.
     
    b. Free gingival graft surgery: If you do not have enough gum attached tightly to the bone, the area affected by gingival retraction is first prepared for the inter-vention, and then a tiny peace of gum is grafted from the roof of your mouth, which is then transplanted to the critical area. The wound is stitched up, and af-ter the necessary healing period, the transplanted gum will integrate with the tissues of its new location. In order to facilitate swift healing, the site where the draft was taken from is also stitched with suture. This intervention is also per-formed under local anaesthesia and is therefore pain-free.
     
  7. Gum reduction with crown-lengthening: If the crown of a tooth is affected by excessive gum disease or dental decay, and neither filling nor a crown are possible ways of restoration, a crown-lengthening procedure is performed. This routine surgery involves the removal of a certain amount of bone tissue. As a result of the intervention, the reduced gum line will attach lower (on the lower teeth) or higher (on the upper teeth) than before. If the treatment sufficiently increases the available tooth surface by lowering the gum line and the level of the bone around the root, a crown is also an option. In this case, the crown can fully surround the root surface, improving stability. This intervention is performed under local anaesthesia and is therefore pain-free.
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What should you do if you recognise the symptoms of gum disease?

When it comes to gum disease, time is very important.

The sooner you see a specialist the eas-ier it is to stop and reverse the progress of gum disease.

Call +36 30 206 9532 and ask for a consultation appointment for periodontal screening in our dental clinic in down-town Szeged and prevent the unpleasant consequences of gum disease!

We look forward to seeing you!

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