Dr ANURAG KASHYAP Aesthetic and implant dentist - 098155 28949



Periodontology is the specialty of dentistry that studies supporting structures of teeth, as well as diseases and conditions that affect them. The supporting tissues are known as the periodontium, which includes the gingiva (gums), alveolar bone, cementum, and the periodontal ligament.

1. Alveolar bone -The alveolar process is the thickened ridge of bone that contains the tooth sockets (dental alveoli) on bones that hold teeth. .The alveolar bone has a supporting role In case of inflammation the bone is destroyed (resorbed). The teeth may become loose and have to be removed. 

2 . Cement - hard mineralized tissue which covers the root .Cement anchors the periodontal fibers . 

3 . Periodontal - connective tissue made of fibers mainly collagen, cells and intercellular substance whose primary role is to connect the cement with the alveolar bone . 

4 . Gums- it covers the alveolar bone and part of the tooth . It is composed of epithelial cells and different types of fibers .

What is gingivitis ? 
Gingivitis is an inflammation of gums. It is reversible and does not lead to loss of tissues. Gingivitis is characterized by swelling , bleeding and sometimes gingival recession . The most common form is plaque - associated infection with polymicrobial origin. Inflammation is painless ( except for a progressive form of the disease- acute necrotizing ulcerative gingivitis ) . 
It occurs at any age .

Etiology of the disease is the accumulation of plaque and the release of toxins which provoke an immune response . If the plaque is not removed , it is mineralized to calculus ( tartar ), and has a destructive effect on the connective tissue . Another cause is smoking , incorrect dental prostheses, mouth breathing , local trauma (including the technique of brushing ) , vitamin deficiencies ( especially vitaminC ) . Gingivitis can occur during pregnancy because of the increased levels of progesterone during puberty , menopause, by oral contraceptives, leukemia , type 1 and type 2 diabetes , Down syndrome , HIV medications (nifedipine , cyclosporine , phenytoin ) make patients more susceptible to disease. 

Brushing : 
Brushing at least twice a day 
Use brush of medium hardness of fibers(medium), hard is not recommended 
Avoid horizontal movement during brushing , there is a risk of systemic bacteremia
Avoid excessive pressure during brushing , there is a risk of abrasion and gingival recession 
Electric toothbrush removes a larger amount of plaque than manual toothbrush. 
Toothbrushes should be changed every month to remove accumulated bacteria. 
Toothpaste should contain fluoride because fluoride reduces the risk of tooth decay. 
Toothpastes should not contain abrasives, bleaching agents ( for example peroxide).

Dental floss : 
Daily use 
Wax or unwax flosses are equally effective 
Mouthwashes : 
Antiseptic mouthwash can be used to reduce the amount of bacteria 
Regular visits : 
Regular visits for your professional oral hygiene including scaling-removal of calculus. Frequency of visits is determined by the severity of the gingivitis. Usually every 6 months

What is periodontitis ? 
Periodontitis is a bacterial infection that affects the surrounding tissues of the tooth - gingiva , periodontium and bone. Without treatment ,there will be a progressive bone loss.The teeth become loosed. Periodontitis occurs in approximately 80% of the population on the age over 35 years. 

Factors that may increase the risk of disease are: 
Tartar - calculus deposition, which is formed on the surfaces of the teeth and gingival margin . Supra gingival tartar is build up around the exit of the salivary glands, lingual surfaces of the lower front teeth ,on the outer ( buccal ) surfaces of the upper first and second molars and to the distal surface of the last molars. Subgingival tartar is deposited under the gingival margin .Tartar is mineralized dental plaque. 
1. Lack of proper oral hygiene 
2 . Fillings , bridges and dentures with incorrect edges and irregular contours 
3 . Smoking 
4 . Diabetes 
5 . Reduced immune defense 
6 . Genetics 
7 . Parafunctions – bruxism and bruxomania 
8 . Fractures 

In many cases, periodontitis develops as a result of untreated gingivitis . It can develop around one or group of teeth . Periodontitis occurs in both children and adults . 

- Red, swollen and sensitive gingiva ( gums) 
- Presence of periodontal pockets 
Bone loss 
Bleeding - brushing of the teeth, using a floss,during eating 
- Recession of the gingiva , makes the clinical crown longer 
- Bad Breath ( halitozis ) 
- Change in occlusion and change in position of the prosthesis 

Mechanism- initially appears the gingivitis , an inflammation of the gums which is characterized by redness and bleeding during brushing. Gingivitis is due to the accumulation of dental plaque and calculus .If you do not take any care on this stage of the disease, the calculus will grow apically and will accumulate between the tooth root and gum .It leads to periodontal pocket formation .The bottom of the pocket is impossible to clean, the infection persists deeper ..Without treatment of the periodontitis,will appear recessions, mobility of the teeth, spaces between teeth, diastemas . This make the course of the disease worse , and leads to tooth loss . The bone loss can be two types - horizontal or vertical resorption .The horizontal affects more teeth while the vertical affects single tooth. Vertical can be restored by bone substitute material. 

Treatment requires several steps and a cooperation by the patient. With a proper treatment , the process can be stationed and further bone loss can be stopped. 
The goal of treatment is to cure the infection and to reduce the risk factors. The damaged tissues can be repaired only by bone substitute materials. Gums can be reconstructed only by grafts. 
Steps in the treatment of periodontal diseases are: 
Diagnosis of the disease 
Proper techniques of oral hygiene 
Removal of plaque retentives factors ( defective fillings , extractions of teeth with poor prognosis, roots , etc. . ) 
Removal of supragingival plaque and tartar ( ultrasonic or mechanical curettage ) ; 
Polishing teeth with Airflow or toothbrush and toothpaste ; 
SRP – scaling and root planing- scaling in quadrants , this procedure creates a smooth, clean and solid root surface. The procedure is performed under anesthesia ( local) and is completely painless. There are two types curettage – open and closed curettage .

Bone substitute procedures 
Regular visits after treatment – it is important for your periodontal therapy 
Regular examinations are very important to assess the stage of periodontitis progression in the time. The diary of your visits is determined by how advanced is the periodontitis. The progress of periodontitis really depends on many factors as: general health , severity of bone loss , risk factors such as smoking and genetic factors. If you have a mild periodontitis we recommended you a visit in every six months. If you have a severe periodontitis you have to go on visit every 3 months. 

The success in the treatment depends not only on your dents but on you. Patients should maintain adequate oral hygiene , teeth without plaque. 

Scaling is a manipulation that removal the plaque and calculus from the teeth. The aid of the procedure is cleaning and polishing the tooth surfaces.If they are cleaned enough the bacteria can not accumulate on them. 
Ultrasonic instruments: 
The ultrasonic instrument's vibration destruct the adhesion between the large deposit of calculus and tooth surface. 
Hand Tools: 
Polishing:the polishing is made by Air flow or polishing toothpaste with special dental brush. 
We make Air flow polishing procedure with special apparatus that sprays high pressure water mixed with soda on the surface of the teeth.