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Gum Disease

Dentist031 Alero_Licensed

GINGIVITIS

 

▸ DEFINITION OF GINGIVITIS

An inflammation of the gums characterized by a change in color from normal pink, to red, with swelling, bleeding, and often sensitivity and tenderness.

These changes result when a layer of bacteria accumulates along the gum line and triggers the body’s inflammatory response.

The pocketing or probing depths of tissues are less than or equal to 4mm with bleeding upon probing.

▸ Gingivitis Symptoms

  • Swollen gums.

  • Shiny appearance to gums.

  • Bacteria, plaque, and tartar accumulation.

  • Bleeding gums (blood on toothbrush or floss even with gentle brushing and flossing).

  • Bright red or red-purple appearance to gums.

  • Gums that are tender when touched, but otherwise painless.

  • Persistent bad breath or bad taste in mouth.

▸ Risk Factors for Gingivitis

  • Tobacco, Nicotine use.

  • Poor nutritional health.

  • Defective or rough dental restorations.

  • Poor oral hygiene (lack of flossing, brushing, rinsing).

  • Pregnancy.

  • Systemic diseases, such as diabetes, leukemia, autoimmune diseases.

  • Certain medications, such as steroids, some anti-epilepsy, and cancer therapy drugs, some calcium channel blockers, oral contraceptives.

▸ Gingivitis Treatment Options

Gingivitis therapy aims to remove the irritating plaque and prevent its return.

To help avoid the occurrence of gingivitis or to reverse gingivitis, you should:

BRUSH twice a day for a minimum of 2 minutes with fluoride toothpaste that contains an antibacterial and anti-inflammatory ingredient.

Brush with a soft-bristled toothbrush held at a 45° angle to the line where your teeth and gums meet.

Move the brush in small circular movements along the gum line and chewing surfaces of your teeth.

A power toothbrush may make brushing easier and more efficient.

FLOSS daily.

Hold the floss tight.

Gently bring it down between the teeth.

Do not pop the floss against the gum.

Curve the floss around the tooth and gently rub up and down.

Adjust the floss so you use a fresh section for each tooth, including the back side of the last teeth.

Alternate flossing methods are available for patients who have difficulty flossing or who cannot floss.

RINSE with an antiplaque, anti-gingivitis mouthwash that contains either cetylpyridinium chloride or essential oils.

Listerine and Colgate Advanced Proshield are popular brands of antiseptic rinses.

 

VISIT our team of highly trained dentists and hygienists at Bathurst College Dentistry ® every 3 to 6 months, depending on the severity of the gingivitis. We will help you manage gingivitis by reviewing your risk factors and oral hygiene habits to create a home-care regimen that works for you. We can get to areas in your mouth that you are not able to properly access at home even with good home care.

To get a comprehensive assessment of your gum health, book appointment today: Call – 416 925–0154 | Email – info@bcddental.com | Visit our team of highly trained dentists and hygienists at Bathurst College Dentistry ® – 474 College Street, Suite 103 Toronto, Ontario M6G 1A4

GUM RECESSION

 

▸ DEFINITION OF GUM RECESSION

The process through which the gum tissue surrounding the tooth wears away, or pulls back, thereby exposing the tooth’s root.

Gum recession is a common dental problem, and due to its gradual progression, patients are not often aware they have recession.

▸ CAUSES OF RECESSION

• Periodontal disease

With insufficient dental care, bacteria from sugars and acids build up on teeth and cause gum inflammation.

This inflammation will eventually eat away at the bone surrounding the teeth, causing loss of both bone and tissue support.

• Genetics

Some people may be more susceptible to gum disease.

Specifically, some people have thin or weak connective tissue and/or bone that will easily be worn away.

• Aggressive tooth brushing

If you brush your teeth too hard or with poor technique, it can cause the gums to recede.

We prefer extra-soft bristled brushes or an electric toothbrush and sensitivity toothpaste.

• Grinding and clenching your teeth

These actions put too much force on the teeth, contributing to bone loss and gum recession.

• Crooked teeth or a misaligned bite

When teeth do not come together evenly, too much force can be placed on the specific areas of the teeth and bone, allowing for bone loss and gum recession.

• Orthodontic Treatment

If teeth are moved too fast, the bone does not have sufficient time to recycle and can be lost.

Lack of sufficient bone leads to deficient tissue and gum recession.

▸ RISKS OF RECESSION

Exposure of the tooth root to the sugars, acids, and abrasion of normal diet and function.

Increased sensitivity to temperature and sweets due to the exposure of the delicate root, which provides access to the nerve.

Notching or loss of the root surface over time, when left untreated, this can lead to nerve exposure or tooth fracture.

TREATMENT OPTIONS

Important Note:

Unfortunately, once we experience recession or loose connective tissue, we cannot get it back naturally.

Our best treatment for recession is prevention with ideal home care.

Ideal home care includes:

  • Daily flossing

  • Antiseptic mouth rinse at least once a day.

  • Use of an electric toothbrush at the gentlest setting combined with a sensitivity / non-abrasive toothpaste.

Additionally, if the recession is being caused by a misaligned bite, our recommendation would be orthodontic treatment to eliminate the bite interference.

If orthodontics is not an option, we will recommend a night guard to protect the overloaded teeth during night-time grinding or clenching.

If the recession becomes so significant that we completely run out of protective, connective tissue, the now unprotected bone that supports the tooth is at high risk of rapid tissue and bone loss.

At this point, we recommend seeing our periodontist (tissue-specialist) to have a connective tissue graft completed to prevent future tooth loss.

This involves transplanting a flap of skin and subepithelial connective tissue from the roof of your mouth (palate) and then stitching that tissue around the exposed root.

ACTIVE PERIODONTITIS

ACTIVE PERIODONTITIS DEFINITION

A bacterial infection of the supporting tissues of the teeth, characterized by a rapid destruction of the periodontal ligament and supporting bone that may lead to tooth loss if not arrested.

Symptoms of Active Periodontitis

  • Bad Breath.

  • Dry Mouth.

  • Gums that are red, swollen, receding, bleeding, painful.

  • Pain during chewing, brushing, or flossing.

  • Teeth that are sensitive, mobile.

Periodontitis Risk Factors

  • Defective or rough dental restorations.

  • Immune dysfunction.

  • Irregular dental visits.

  • Poor nutrition.

  • Poor oral hygiene (lack of flossing, brushing, rinsing).

  • Pregnancy.

  • Systemic diseases, including severe or undiagnosed Diabetes, Downs Syndrome, AIDS, or Rheumatoid Arthritis.

  • Tobacco use.

▸ Treatment Options

• IN OFFICE

Scaling and Root Planing (SRP):

The area being treated is numbed, and dental scalers are used with the aid of water and sonic vibration to remove the bacterial plaque and tartar from the tooth surface above and below the gum line.

Tissues are treated by quadrant of your mouth (upper right, lower right, etc.) and half the mouth is usually done in one visit.

Visits are typically 7-10 days apart to give our BCD hygienist the chance to revisit the area that was initially treated and remove any bacteria that has since accumulated.

Periodontal Maintenance and Evaluation:

4-6 weeks after your SRP, our BCD hygienist will evaluate how your tissues have responded and get everything cleaned up again.

At this visit we will establish your recommended recall interval, typically 3-4 months.

• AT HOME

(Following in-office active therapy)

BRUSH twice a day for a minimum of 2 minutes with fluoride toothpaste that contains an antibacterial and anti-inflammatory ingredient.

Brush with a soft-bristled toothbrush held at a 45° angle to the line where your teeth and gums meet.

Move the brush in small circular movements along the gum line and chewing surfaces of your teeth.

A power toothbrush may make brushing easier and more efficient.

FLOSS daily.

Hold the floss tight.

Gently bring it down between the teeth.

Do not pop the floss against the gum.

Curve the floss around the tooth and gently rub up and down.

Adjust the floss so you use a fresh section for each tooth, including the back side of the last teeth.

Alternate flossing methods are available for patients who have difficulty flossing or who cannot floss.

 

RINSE with an antiplaque, anti-gingivitis mouthwash that contains either cetylpyridinium chloride or essential oils.

Listerine and Colgate Advanced Proshield are popular brands of antiseptic rinses.

 

VISIT our team of highly trained dentists and hygienists at Bathurst College Dentistry ® every 3 to 6 months, depending on the severity of the gingivitis. We will help you manage gingivitis by reviewing your risk factors and oral hygiene habits to create a home-care regimen that works for you. We can get to areas in your mouth that you are not able to properly access at home even with good home care.

▸ If the SRP is unsuccessful, other treatment options include

Placement of antibiotics under the tissues that have not responded to SRP.

Referral to our periodontist (gum tissue and bone specialist) for evaluation and potential surgery to augment the existing bone and tissue.

 

▸ Treatment Goals

  • Achieve ideal home care techniques with proper patient education.

  • Eliminate Bleeding and swelling.

  • Prevent recurrence of disease through regular periodontal maintenance visits following active therapy.

  • Remove factors that provoke inflammation (plaque, calculus, and endotoxins) from the root surface.

STABLE PERIODONTITIS

STABLE PERIODONTITIS DEFINITION

Stable periodontitis is defined as having had an active periodontal disease that has been treated clinically and is now considered stable.

The loss of bone remains, but no active infection is present.

Indications that the condition is stable include:

  • Presence of light plaque and tartar.

  • Lack of suppuration (pus).

  • Lack of tissue inflammation and redness.

  • Lack of moderate to heavy bleeding upon probing.

Potential Continuing Symptoms

  • Slight tooth mobility.

  • Irreversible but stable bone loss visible on x-rays.

  • Visible gum recession and root exposure.

▸ Risk Factors

There is a proven correlation between periodontitis and systemic diseases such as diabetes mellitus, heart disease and HIV, leaving this infection unchecked increases your risk of more serious infections.

Environmental factors such as smoking, emotional stress, age, lack of proper oral hygiene and genetics will all increase your risk of periodontal infection.

▸ Treatment Options

In Office Treatment

  • Once any necessary active therapy is complete and your periodontitis is stable, your condition is kept in check through Phase IV therapy, which includes regular periodontal maintenance sessions with oral examinations.

  • Your gingival condition, mobility, occlusion, and any presence of caries will be thoroughly assessed at each 3-month visit.

  • Since periodontitis is a condition that cannot be cured, it must be controlled by these visits for the remainder of the patient’s life.

At Home Treatment

BRUSH twice a day for a minimum of 2 minutes with fluoride toothpaste that contains an antibacterial and anti-inflammatory ingredient.

Brush with a soft-bristled toothbrush held at a 45° angle to the line where your teeth and gums meet.

Move the brush in small circular movements along the gum line and chewing surfaces of your teeth.

A power toothbrush may make brushing easier and more efficient.

 

FLOSS daily.

Hold the floss tight.

Gently bring it down between the teeth.

Do not pop the floss against the gum.

Curve the floss around the tooth and gently rub up and down.

Adjust the floss so you use a fresh section for each tooth, including the back side of the last teeth.

Alternate flossing methods are available for patients who have difficulty flossing or who cannot floss.

 

RINSE with an antiplaque, anti-gingivitis mouthwash that contains either cetylpyridinium chloride or essential oils.

Listerine and Colgate Advanced Proshield are popular brands of antiseptic rinses.

 

VISIT our team of highly trained dentists and hygienists at Bathurst College Dentistry ® every 3 to 6 months, depending on the severity of the gingivitis. We will help you manage gingivitis by reviewing your risk factors and oral hygiene habits to create a home-care regimen that works for you. We can get to areas in your mouth that you are not able to properly access at home even with good home care.

Treatment Goals

  • Prevent the new occurrence of active infection.

  • Control bacterial plaque to prevent worsening of a stable condition.

  • Long-term outcomes depend on the patient’s compliance with home care and periodontal maintenance.

HEALTHY GUMS

WHAT MAKES GUM TISSUE HEALTHY?

Pink, firm, stippled gum tissue completely filling spaces between the teeth.

It has probing depths generally no more than 3mm and is without bleeding or pain.

Symptoms

  • Healthy tissues should not be red, puffy, sensitive, or bleed.

PERIODONTAL TREATMENTS

▸ WHAT IS PERIODONTICS?

• It is a specialty in the dental field that treats the supporting tissues of your teeth, i.e. the gums and bone.

• Early stages of periodontal disease in these tissues can often be treated by our hygienists using a procedure called scaling and root planing, but for more advanced infections / complex conditions, a surgical option may be necessary.

▸ TREATMENTS

GUM TISSUE GRAFTING

While this procedure can be performed cosmetically, most often we see connective tissue grafting performed to address significant gum recession.

The goal here is to increase the amount of attached, hard (keratinized) gum tissue that supports the tooth or teeth in question.

• Two main types of grafting:

Subepithelial Connective Tissue Graft

A small piece of tissue is borrowed from your maxillary palate (roof of your mouth) and then secured to the area that lacks adequate tissue by tucking it underneath the existing gum.

The palatal donor site is then closed using medical grade super glue or resorbable stitches.

Donor tissue can also be used here, especially if the area requiring surgery is larger than what is available from the palate.

This is used often for root coverage and almost always in cosmetic cases as it is difficult to distinguish the graft from the surrounding area.

 

Free Gingival Graft

This procedure also involves using tissue from your maxillary palate, but in this case the surface tissue is taken instead of the tissue underneath.

A free gingival graft will often be used on the lower jaw if there is a shallow attachment between your cheek and your gum tissue, the goals are not cosmetic, or if keratinized tissue and not root coverage is the main objective.

BONE GRAFTING

• If a patient’s periodontal disease progresses far enough, it can result in bone loss so significant that regeneration may be necessary to support the remaining teeth or, more commonly, place an implant in an edentulous space.

• In these cases, bone grafting will be performed, usually in conjunction with the extraction of an infected tooth.

• To perform a bone graft, bone material from a donor (allograft) is placed in the area where support is required and allowed to heal / integrate with the surrounding bone.

• Osseointegration usually takes several months to achieve, after which the space can be restored with a dental implant.

SINUS LIFTS

• When you lose a permanent tooth from your upper arch, the alveolar bone that supports it begins to resorb and the socket that held the tooth begins to collapse.

• This bone loss can happen rapidly or slowly, but it is usually progressive over time.

• As the bone loss occurs, the maxillary sinus expands, moving into the newly created space.

• To restore the upper arch with dental implants after this occurs, you may require a sinus lift (also known as a sinus augmentation), where the sinus floor is carefully elevated and bone graft material is pushed into the edentulous space.

• This bone can heal and integrate with the existing sinus floor for several months before implants are placed.

To get a comprehensive assessment of what periodontal treatments are best for you, call us and schedule an appointment today:

Call – 416 925–0154 | Email – info@bcddental.com

Visit our team of highly trained dentists and hygienists at Bathurst College Dentistry ®

474 College Street, Suite 103 Toronto, Ontario M6G 1A4

BATHURST COLLEGE DENTISTRY

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