A healthy and beautiful smile also depends on healthy gums (gingiva). Such symptoms as exposure of the tooth necks, hypersensitivity to temperature changes, elongation of tooth crowns, dilatation of gaps between the teeth, loosening or even loss of teeth, an unpleasant odour from the mouth, and bleeding, swelling and redness of the gums indicate a disease of gums and other tissues adjacent to the teeth, known as periodontosis. Periodontics (periodontology) is a dental speciality that deals with all the above-mentioned problems. The speciality includes the whole range of therapeutic methods; however, irrespective of the form and development of the disease, oral hygiene plays the first role in the treatment process. In the Villa Nova Dental Clinic, each patient with symptoms of periodontal disease is provided with comprehensive care based on well-established knowledge and involving modern therapeutic methods.

INSTRUCTION IN ORAL HYGIENE

The hygiene instruction includes detailed guidelines on the principles of care of the oral cavity. After examining the patient, the dentist selects individually appropriate toothbrushing technique, depending on the patient's needs, condition of his or her teeth and periodontium, and dexterity. The dentist also advises the patient on the selection of a suitable toothbrush and toothpaste, as well as additional accessories, to help with the problem of cleaning the smooth tooth surfaces, interdental gaps and spaces difficult to reach. The presentation of oral hygiene agents is commonly associated with a practical demonstration of their use on models or the patient's own mouth. The advisory visit may also include advice on the diet and fluoride prevention.

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SUPRAGINGIVAL SCALING

Supragingival scaling consists of the removal of the hard dental deposit (tartar) which has accumulated on the crowns of the teth by means of ultrasonic device, known as a dental scaler. The latest-generation scalers used in our Clinic allow rapid and efficient cleaning of tooth surfaces and are absolutely safe for the patient. Scaling is usually painless; some pain may occur only in the case of inflammation of the tissues adjacent to the tooth, and then local anaesthesia is applied. Each scaling procedure is completed with polishing the tooth surfaces, which prevents further build-up of the dental plaque and gives the patient a pleasant sensation of smooth teeth. After professional tooth scaling, the application of fluoride varnish is recommended to:
- protect the teeth against dental caries;
- protect the hypersensitivity of the necks of the teeth.

SUBGINGIVAL SCALING

Subgingival scaling is applied in the case of the presence of tartar deposit under the level of the gums, and involves the use of both ultrasonic scalers and manual tools, so-called curettes. In particularly sensitive patients additionally local anaesthetic agents are used. The final stage of the procedure is root planing (levelling of root surfaces) and the application of a fluoride varnish.

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TOOTH SANDBLASTING

Sandblasting is the procedure of removing the deposit and discoloration of tooth crowns caused by tea, coffee, red wine and smoking. For that purpose a special air-powder device, a so-called sandblaster is used, that produces a thin high-pressure stream of fine sand and water mixture, which efficiently removes deposit and discoloration which are impossible to clean off with a toothbrush. After the procedure, fluoridation would be recommended. Tooth sandblasting is a safe procedure and the only contra-indication for the procedure is acute inflammation of the gums.

TOOTH SPLINTING

Periodontal diseases may commonly lead to the loosening of teeth. If chewing comfort is significantly compromised, tooth splinting is applied, i.e. the connection of single teeth into a block, which strengthens the loosened teeth and prevents their levering and migration. Teeth may be splinted temporarily, e.g. after surgical procedures or permanently. The following appliances may be used for that purpose:
- locked prosthetic crowns or bridges;
- splinting systems (Splint-Lock, Bio-Splint, Fiber-Splint, FiberCorr);
- glass fibre + composite material..
The disadvantages of tooth splinting include difficulties in hygiene procedures and a compromised appearance.

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CLOSED CURETTAGE

This is the most common procedure applied in periodontal diseases, in the case of periodontal pockets (gaps between the teeth and gums deepened due to the development of periodontosis). The curettage consists of cleaning the debris from the periodontal pocket causing persistent inflammation, in particular debris of the dental tartar infected with bacteria, which allows elimination of the inflammation and healing of the lesion. Of course the procedure is performed under local anaesthesia in such a manner that the adjacent tissues are saved and will not affect the patient's general condition

OPEN CURETTAGE

Open curettage is applied in the case of deeper periodontal pockets and differs from the closed one in the retraction of the gum edge, which allows the pocket to be cleaned under visual control. Advantages of the procedure include faster healing of the lesion, minimum discomfort for the patient and a good aesthetic result.

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FLAP PROCEDURES

Flap procedures are applied in the case of more advanced periodontosis, where the disease has damaged the bone tissue covering the roots of the teeth. After gaining access to the bone, the flap procedure allows the inflammatory focus to be removed. The bone defect may also be filled with special materials promoting bone tissue reconstruction.

GUIDED REGENERATION OF PERIODONTAL AND BONE TISSUES

Periodontal diseases lead to irreversible loss of tissues adjacent to the teeth, and even with a lack of signs of acute inflammation (redness, bleeding and swelling of the gums) some lesions persist as periodontal pockets and bone defects, which may, in turn, lead to tooth loss. The only hope for such endangered teeth are methods of the guided regeneration of tissues and bone. These techniques, applied successfully in our Clinic, involve the use of the most recent development of material engineering, i.e. barrier membranes and materials promoting bone tissue reconstruction (Endogain), biomaterials (Bio-Oss(R)), bioglass (Biogran(R)), thus allowing efficient regeneration of lost or damaged tissues.

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PROCEDURES ON FRAENA

Fraena (sing. fraenum) of the lips and tongue are small tissue bands that connect a lip or tongue with the alveolar process; there are common abnormalities of the fraena, such as fraena located too close to the teeth, a too short or too thick fraenum, which negatively affects the periodontium, teeth position or maintenance of removable dentures. Repair of the above-mentioned abnormalities involves some procedures, such as fraenectomy or fraenotomy. Fraenotomy is a simple procedure of undercutting a too-short fraenum that restricts the mobility of the tongue or lip; the procedure is performed under local anaesthesia. Fraenectomy consists of the resection of a too-thick fraenum of irregular position, usually of the upper lip, and sewing it in to the proper position.

COVERING OF GINGIVAL RECESSION

Gingival recession is an abnormality consisting of the exposure of the roots of the teeth, which leads in particular to an increased sensitivity of the teeth to temperature changes, caries of the roots, problems in maintenance of good oral hygiene and aesthetic defects. The cause of the gingival recession is not completely clear; however, dental plaque, improper tooth brushing and malocclusion (irregular bite) are considered the main predisposing factors. Surgical treatment of the gingival recession may involve the application of:
- pedicle movable flap;
- mucous membrane graft;
- guided tissue regeneration
The selection of the optimal method depends on the form of the recession, its localisation, development, and the patient's age and expectations.

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PRZEBIEG LECZENIA

The first visit is designed for periodontal examination, which includes, as with any medical examination, taking the patient's medical history, clinical examination and, if necessary, additional investigations.
- The medical history is needed to provide information on the reason for which the patient is visiting the dentist, his or her general health condition, practices of hygiene and needs and expectations from the treatment.
- The clinical examination involves a thorough examination of the patient's teeth, correctness of bite, and oral hygiene, with particular attention given to the condition of the periodontium, such as shape, colour and the texture of the mucous membrane and gums, and possible abnormalities (in particular gum bleeding or tooth loosening).
- Among additional investigations, X-ray imaging and blood analyses (blood count and blood glucose) are the most useful in the diagnosis of periodontal diseases.
The dentist, having considered the data collected during the first visit, develops the treatment plan and presents it to the patient.
Further treatment depends on the form of the disease and may be limited only to a conservative procedure or may involve surgery.
Usually the first stage of treatment is professional teeth cleaning and instruction in oral hygiene, as perfect oral hygiene is a cornerstone of periodontal treatment. The essential element of periodontal treatment is check-up visits designed for the assessment of hygiene level and the results of the treatment.

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FAQ

1. What is periodontosis?
2. What is the difference between dental plaque and dental calculus?
3. Have smoking and stress any effect on the development of periodontal diseases?
4. What complications may occur after professional tooth cleaning?
5. Is tooth elongation always a symptom of a disease?
6. What type of toothbrush should I choose?
7. How frequently should I replace my toothbrush?
8. How should I brush my teeth?
9. Is a toothbrush alone sufficient?
10. What toothpaste should I choose?
11. How can dental plaque be combated, apart from cleaning the teeth?

1. What is periodontosis?

Periodontosis is a widespread disease of the tissues adjacent to the teeth, the periodontium, which consists of the loss of tissues fixing the tooth to the bone, which leads to loosening of the teeth, their migration and protrusion, exposure of tooth roots, and eventually spontaneous tooth loss. The principal cause of periodontosis is the dental plaque, being a reservoir of bacteria attacking the periodontium; however, there are several factors influencing the development and course of the disease, such as:
- genetic factor;
- older age;
- smoking;
- stress;
- diabetes;
- osteoporosis;
- other systemic diseases.
Periodontosis is a curable disease, but combating it requires patience and the commitment of both the patient and dentist (perfect oral hygiene, self-descipline, regular attendance at check-up visits and observation of the dentist's recommendations).

2. What is the difference between dental plaque and dental calculus (tartar)?

Dental plaque is a strongly adherent, soft, white to yellowish deposit that occurs on the surface of the teeth, gums and prosthetic appliances. It comprises various organic material (elements of saliva, food debris, dead cells) and a wide range of bacteria. Tartar is a further stage in the development of plaque - mineralised dental plaque, which is formed due to its saturation with minerals contained in the saliva.

3. Have smoking and stress any effect on the development of periodontal diseases?

Numerous studies have undoubtedly confirmed the effect of smoking and stress on the development of periodontal diseases. Smoking increases the build-up of dental deposit, reduces immunity of the body and promotes the growth of harmful bacteria. The effect of stress may consists of hygiene negligence, improper nutrition, frequent smoking and decreased immunity, which are commonly associated with stress.

4. What complications may occur after professional tooth cleaning?

In general, the only complication that may occur after tooth cleaning with a toothbrush, as well as by means of scaling or sandblasting, is hypersensitivity of the teeth to temperature changes. An excellent remedy for the problem is the application of a fluoride varnish, which relieves it instantly and permanently.

5. Is tooth elongation always a symptom of disease?

Tooth "elongation" may not necessarily indicate disease, as there is a phenomenon called senile atrophy of the periodontium. The process begins at 25-30 years of age and develops up to the end of life. It consists of a slow migration of the connection between the tooth and adjacent tissues in the direction of the end of the tooth root. The tooth crown elongates with associated lowering of the gum level. The process is in general painless, but unavoidable.

6. What type of toothbrush should I choose?

The selection of an appropriate toothbrush is of significant importance to oral hygiene. As there is a huge diversity of toothbrushes available, you may have some problem in choosing the most suitable. The most important is that the size and bristle hardness of the toothbrush is matched individually to the patient's needs. The toothbrush should not be too big and should have a long thin neck, allowing access to molar teeth. Usually medium or medium-hard toothbrushes with multiple bunches, made of synthetic bristle of gently polished and rounded tips, are recommended. In the case of any periodontal disease, a soft toothbrush with a flexible neck that reduces pressure on the gums should be used. There are various versions of bristle pattern. The bristle may be of various lengths or serrated to improve cleansing of dental gaps (longer tips easily penetrate between the teeth) and to massage the gums.

7. How frequently should I replace my toothbrush?

In general your toothbrush should be replaced every two months. After that period the bristles stiffen and irritate gums. Some toothbrushes have a wear indicator in the form of a bristle bunch in a different colour, which discolours as the toothbrush wears. To function properly, the toothbrush needs to be taken care of. After brushing your teeth, the toothbrush should be thoroughly rinsed and stored in a place where it can dry. You should also pay attention to whether the bristle in your toothbrush is crushed, if it is, this indicates that you press your toothbrush against your teeth too firmly.

8. How should I brush my teeth?

In general, each method of brushing the teeth is good provided that it is efficient and not harmful to teeth and gums. Ideally, the tooth brushing technique should be chosen individually by a dentist or hygienist depending on the patient's needs, the condition of his or her dentition and gums and dexterity. Regular tooth brushing should last at least three minutes. The minimum frequency of the procedure should be twice a day: in the morning after breakfast and in the evening after the last meal. However, in some circumstances, e.g. in patients wearing permanent braces, teeth should be brushed after each meal.

9. Is a toothbrush alone sufficient?

Efficient tooth care requires that all their surfaces (facial, lingual, masticatory and interproximal ones) be cleaned. However, only the first three of them are accessible to a toothbrush; thus, a toothbrush alone is not sufficient for maintaining appropriate oral hygiene. You should use additional tools:
- Dental floss - a bunch of waxed silk threads formed into a band, used for cleaning interdental spaces where teeth are close together;
- Dental toothpicks made of soft, non-splintering wood and saturated with fluorine compound are designed for people with spaced or missed teeth;
- Interdental toothbrush - a bristle spiral used similarly to a toothpick, and also for maintaining oral hygiene in people with permanent braces;
- irygator - urz?dzenie dzia?aj?ce na zasadzie bicza wodnego, strumie? p?ynu oczyszcza przestrzenie mi?dzyz?bowe i kieszonki dzi?s?owe, masuje dzi?s?a;
- Dental irrigator - a device producing a water stream that cleans interdental spaces and gingival pouches, as well as massaging gums.
A single bunch toothbrush used for cleaning difficult to reach back teeth.

10. What toothpaste should I choose?

The selection of toothpaste is not as important as the selection of the toothbrush; however, the use of an appropriate toothpaste may improve the efficiency of brushing. Most of the toothpastes marketed conform to basic requirements and contain clinically proven substances, such as polishing agents (help in the removal of dental plaque and deposit), foaming agents, fluorine compounds (sodium fluoride, calcium fluoride or amine fluorides). In particular circumstances you may choose a toothpaste containing appropriate additional ingredients:
- protective toothpastes containing fluorine;
- herbal toothpastes containing herbal extracts that relieve the gums;
- whitening toothpastes that remove food-related discolorations (caused by tea, coffee, smoking and red wine);
- multi-action toothpastes, that include the above-mentioned properties.

11. How can dental plaque be combated, apart from cleaning the teeth?

A very efficient method of combating dental plaque, which assists but does not replace mechanical tooth cleaning, is the use of a disinfecting mouthwash. In particular, chlorhexidine-based mouthwashes (Corsodyl, Eludril) are recommended, as the substance efficiently inhibits the build-up of the plaque and kills bacteria. However, note that the period of use of such mouthwashes should be limited up to two weeks, to prevent a side effect, i.e. discoloration of the teeth, dental fillings and tongue. Other recommended products are fluorine mouthwashes.

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