Periodontal Treatment

Gum disease also called Periodontal Disease in scientific terms is one of the most common diseases worldwide. Almost 95 percent of the population has some form of Gum Disease. Rahman & Rahman Dental Surgeons is the only dental group in Pakistan which has a group of specialists who have been trained in world renowned dental institutions. These specialist are available full time to treat your dental and periodontal problems in a comprehensive manner.
The team leader Dr Amin ur Rahman has a three year specialization from the Harvard School of Dental Medicine and our other specialists are trained from Hong Kong, Singapore and Pakistan. We have been providing specialized gum disease care to our patients for over 30 years.

We are providing this detail for our patients and it will be a comprehensive overview in laymans terms to explain what gum disease is, what are the types of gum diseases, how are they treated, what is the scientific research behind the way we treat gum diseases, what are the expectations for you the patient and what are the best possible treatment options.
At Rahman & Rahman you can be sure that you will be given a complete analysis of your oral condition, a frank and open discussion with regards to treatment options and always a true and trust worthy answer which can be corroborated by any specialists worldwide.
Feel free to contact any of our doctors to answer your questions.

• Teeth have two parts. The part that is visible inside the mouth is called the CROWN. There is another part of the tooth that is under the gum tissue called the ROOT. (See Fig 1)
  The root of the tooth is attached to the BONE of the jaw by fibers called the Periodontal Ligaments. The most important part of the whole complex is the BONE. It is the jaw bone that the root is attached to NOT the gum tissue. This is a very important part to understand. Most of our patients think that teeth are attached to the gum…….the root of the tooth is attached to the bone and COVERED by the gum tissue.
  As you read along you will understand that when you have advanced gum disease you start to loose bone. When bone is lost then you start to have all the problems that are associated with gum disease, bleeding from your gums, loose gums, receding gums, loose teeth and finally when all the bone is lost the teeth literally fall out.
  When you have a cavity it is mostly on the crown surface, and when you go to your dentist he does a filling in the crown part of your tooth, on rare occasions when you have receding gums the cavity can start from the root surfaces also. See figure 2
  Gum disease consists of a number of diseases, Gingivitis, pregnancy gingivitis, gum recession and bone loss divided into mild periodontitis, moderate and severe periodontitis. In addition you can have specific gum problems around implants called mucositis and peri-implantitis. We will discuss each and every of these diseases in detail so that you have a clear understanding of what each disease is and how to treat it.

• Gingivitis is inflammation or infection of the gum tissue. (Fig3) The basic cause of gum infection is bacteria or GERMS, that stay in the mouth during the day and night. If teeth are not brushed properly or not at all, the bacteria in the mouth along with the salivary minerals deposit along the gum line and this bacterial or germ deposits start to cause infection in the gums. This is the basic cause of gingivitis.
  Research has shown that almost half of adults do not brush their teeth at night, either they are lazy, forget. Or are too tired to brush their teeth. In a 24 hour period we are awake for around 17 hours, equivalent to 1,020 minutes. You only need to spend four minutes brushing your teeth in a day to avoid having problems with your teeth and gums.
  If you don’t brush your teeth you are putting yourself at risk for cavities, gum diseases and even tooth loss not to mention the bad smell in your mouth. Characteristics of gingivitis include:
  1- plaque present at the gum margin,
  2- change in color of the gums,
  3- the contours of the gums change, the pointed papilla become blunted,
  4- there is bleeding from the gums when you brush your teeth
  5- there is no bone loss
  You can also have gingivitis if you are a female and are pregnant, during your mensturation period. In addition a number of medicines that are commonly used can lead to gum enlargement and inflammation such as antihypertensive drugs, or drugs used to treat epilepsy. There is a very specific gum disease which causes severe destruction of the gums, bad smell in the mouth and severe pain, in the past it was called Trench mouth or Vincents disease, nowadays its called Necrotizing Ulcerative Gingivitis and is can be found in young adults who are under a lot of stress for example during exam times. This is a specific disease and has a specific treatment with antibiotics.
  

The treatment of Gingivitis is simple………………….remove the bacteria or germs from around the gums and you will be cured. This is done by your dentist or hygienist by a process called Dental Prophylaxis, Scaling and Polishing or simple cleaning. In this procedure a mechanical instrument called the scaler or cavitron is used. This machine is basically a very fast vibrating tip which removed the germs and washes it away with water. Some dentists also use hand scalers in which the plaque and calculus is removed by hand instruments. Both methods are Ok although it is much better to use the machine. Once the mouth is cleaned with the scaler the teeth are then polished the patient is instructed to brush their teeth at least three times a day and floss the teeth regularly. Research has shown that the plaque and calculus (Germs) start to build up slowly and it takes six months on average, for the gums to get infected again and cause Gingivitis. This is why dentists recommend to have a cleaning every six months. If you do this you will have a pristine mouth and we can check for any cavities or other problems.
It is Ok to use a mouth wash like Listerine once a day, mouthwashes also keep the bacteria under control.
Necrotizing Gingivitis has a specific treatment which includes scaling and polishing as well as the use of antibiotics and stress reduction.
The most commonly asked question by our patients is that the cleaning process removes the enamel from the tooth surface and makes the teeth weak. Keep in mind that enamel is the hardest substance in the body even harder than your bone, the process of scaling DOES NOT remove any enamel, yes you can have sensitivity after scaling but that is because you have gum recession and even if you do it is temporary. So contrary to popular belief scaling actually FIRMS the teeth more as the bacteria is removed and gums are brought back to health.

                                                   PERIODONTAL DISEASE (GUM DISEASE)
Gum disease (periodontal disease) is the terms used to describe a disease of the mouth which involved the gum tissue and the bone surrounding the root of the tooth.  Periodontal disease can affect a single tooth, a number of teeth or it can affect the whole jaw both upper and lower.
The hallmark of periodontal disease is the loss of supporting bone around the teeth. This bone loss can be just a little bit or a lot, so that the root of the tooth can have very little bone loss or almost all the bone around the tooth is lost with the tooth moving and almost falling out.
The cause of periodontal disease is bacteria or germs. The germs that cause periodontal disease are different from the germs that cause gingivitis, in technical terms the germs causing gingivitis are mostly gram positive and the germs causing periodontal disease are gram negative. In addition the germs are of a very specific nature.
In general, you always have gingivitis first and then periodontitis, but you can have gingivitis and no periodontitis. Therefore it is imperative that you see your gum disease specialist the moment you have bleeding gums so that the disease does not spread any further than your gums.
There are different type of periodontal diseases including, Site specific periodontitis,adult periodontitis, generalized periodontitis, Aggressive periodontitis also called Juvenile periodontitis, gum recession, Necrotizing periodontitis, and specific causes of periodontal diseases for example in diabetes, cancer, bone loss due to trauma etc.

The most important concept to understand is that gum disease in all its forms is caused bu germs, or bacteria. So the treatment is directed towards removing or reducing the bacterial load is the prime aim for treatment of gum disease.

                        SITE SPECIFIC PERIODONTITIS
It is important to understand that in a lot of cases a person can have bone loss around a single tooth, a number of teeth in the jaw or all the teeth can have bone loss. Therefore when your specialist or dentists does a examination of your mouth he puts in a pointed metal instrument under the gums called a Periodontal proble which has calibrated markings on it. What he is doing is measuring your pocket depths, this means how deep does the proble go before it reaches the bone, in normal cases this should not be more than 2-3 mm. So if he/she is probing and all of asuuden one spot has a 100 mm pocket depth that means there is some problem in that area or a number of areas.
Site specific disease means that in the whole mouth you might have one area of bone loss and that site should be treated.
In site specific periodontal disease your specialist will aim towards removing the bacteria from the sites that he has determined by means of periodontal surgery or scaling and root planning.

                                                                    ADULT PERIODONTITIS.
As the name signifies Adult Peridontitis is a form of gum disease which is found in adults mostly over the age of around 40, but could be found earlier. In this case it is a slow progressing bone loss around the teeth. It is diagnosed by taking x-rays of thewhole jaw to see the bone levels around the teeth.
The treatment in most cases is to do a cleaning of the teeth followed by gum surgery to eliminate the pockets around the teeth so that no more bacteria can colonize the root surfaces under the gums. In most cases there is almost 100% recovery and if you do good oral hygiene and visit your specialist regularly you should be abe to keep your teeth for a long time.

AGGRESSIVE PERIODONTITIS.
Aggressive periodontitis if not treated in a very forceful manner will result in the loss of teeth. This form of periodontitis can attack the gums at any age and is usually found in young adults almost from the age of 10 onwards.
The cause of aggressive periodontitis is a specific bacteria that colonizes the pocket depth resulting in severe loss of bone around the teeth and if not treated early will result in the loss of teeth. The disease progresses very fast and unless and until a specialist sees you it can have devastating consequences.
The treatment of aggressive periodontitis includes immediate gum surgery, possible grafting procedures and the aggressive us e of antibiotics. It is imperative that after surgery you visit your dentist every three months for a cleaning and observation.

                          GUM RECESSION.
Gum recession is one of the most common complaints that we see in our office. Gum recessions can be around one tooth, around a few teeth or even around all the teeth in the mouth. The causes of gum disease varies but can be due to a hard tooth brush, malaligned teeth, after you have braces put on, due to bone loss around the teeth, deposit of plaque and germs around your gums.
The treatment of gum recession is very much possible. The procedure is called a gum graft (specifically a connective tissue graft). In some cases the surgery is done to prevent further loss of gum tissue and in some cases we can cover the exposed root surfaces.

DIABETES AND OTHER SYSTEMIC DISEASES.
Diabetes has a major role to play in gum disease. All the research has shown that people with diabetes have more gum disease. This may be due to the excessive sugar in their blodd, or maybe due to the low resistance that most diabetics have when they have an infection. Similarly cancer patients, patients who have Hepatitis and other generalized medical conditions need to make sure that they have a germ free mouth and their gums are in very good health.
There is a lot of research now showing that gum disease is one of the risk factors for heart disease. The bacteria found around the gums have been found in heart vessels so it is imperative that if you have any form of cardiovascular disease you must visit our specialists who will advise you on how to keep your mouth healthy.
Ongoing research has also shown that gum disease is a risk factor for uncontrolled diabetes. We have shown that once your gum disease is under control, it helps lower your blood sugar, HbA1c levels and lower diabetes medications.