Local Dental Care - Swollen Gums During Pregnancy

Dental Disease And Ridge Augmentation

Whether a tooth has been lost to periodontal disease, tooth decay, or trauma, one may be left with a cleft, an indentation, or uneven gum margins. This happens because after a tooth is removed, the bone that was encasing it disintegrates and the gum around it collapses. If this occurs in the front of the mouth, it can result in an esthetic problem. No matter how well designed the replacement teeth are, they may appear to be too long and unattractive. To have a pleasing smile, the shape, color, and texture of the gums is just as important as that of the teeth they frame.

Ridge augmentation is a cosmetic periodontal procedure that may include gum and/or bone grafting. A dentist will determine which option is better suited to a patient's esthetic needs. Regardless of what treatment method a dentist chooses, ridge augmentation is a very predictable procedure with long-lasting results.

What to Expect from Periodontal Ridge Augmentation

Ridge augmentation is a surgical procedure that is done in the dentist's office with local anesthesia (lidocaine). Stitches (sutures) are placed to aid in healing. Post-surgical discomfort can last a few days and is usually minimal. It can be easily managed with commonly available over-the-counter medications such as aspirin, acetaminophen, or ibuprofen. Patients can expect to follow their normal routine the day after oral surgery. The dentist will provide special instructions related to diet, exercise and medications.

To ensure more esthetic results, ridge augmentation procedures should always be done before new crowns are made. Although a temporary (provisional) tooth replacement can be made at the time of tooth loss, the final restoration should not be fabricated until after six to eight weeks of gum healing.

Alternatives periodontal treatments

It is possible to help prevent collapse of the gum tissue by doing a bone grafting procedure or by placing an implant at the time of extraction. Although sometimes it may still be necessary to do further periodontal plastic surgery procedures, these treatments can help maintain the space that was previously occupied by the tooth and prevent bone loss. If this was not feasible, ridge augmentation can be done to improve esthetics after tooth extraction.

Ridge augmentation should be considered as part of an individual's cosmetic dentistry options when there are uneven gum contours, clefts, or indentations on the gums. The most beautiful teeth will not look natural if the gum surrounding them is not cosmetically pleasing. Talk to a dentist about esthetic concerns and the possibility of incorporating cosmetic periodontal procedures as part of a "smile lift."

By Laura Minsk, DMD

Periodontal Disease Treatment Slows Periodontitis

One of the goals of periodontal disease treatment is to arrest and control the progression of the bacteria that cause gingivitis and periodontal disease. As the bacteria infect the gum tissues, they release toxic substances that trigger the breakdown of gum and bone. The gum then separates from the teeth, forming a gap that is called a periodontal pocket. These spaces are inaccessible to daily oral hygiene techniques. Bacteria settle in these pockets and continue to accumulate and reproduce, creating further gum and bone destruction.

Periodontal disease treatment such as scaling and root planing involve the removal of the irritants and bacterial deposits (plaque and tartar) that have accumulated above and below the gum line in the periodontal pockets. The root surfaces of the teeth are planed (smoothed) to promote healing and to help prevent future bacterial reattachment. At the same time, gingival (gum) curettage can be done to remove the infected soft tissues that line the periodontal pockets.

Most of the time, scaling and root planing is done in two to four visits. For patient comfort, the gums can be numbed by the periodontist using a local anesthetic. One-quarter of the mouth is usually treated at the time and treatment of each quarter can take 45 minutes to an hour (three to four hours for the entire mouth). Most patients report minimal discomfort during these periodontics treatments.

During scaling and root planing appointments, the dental care provider will review oral hygiene techniques that are aimed at improving the person's ability to control plaque and to help avoid bacteria from re-infecting the pockets. Patients also will receive advice on the modification of certain risk factors associated with periodontal disease.

In some circumstances, the dental care provider may recommend the use of adjunctive products for periodontal treatment. To be effective, antimicrobial products such as Chlorhexedine, PerioChip, and Atridox should be used in combination with scaling and root planing. Periostat is also a product that can be used as an adjunct to scaling and root planing in order to impede further tissue breakdown and promote healing.

Several weeks after completion of scaling and root planing, a periodontal re-evaluation should be completed. The purpose of this exam is to assess the response to treatment and determine if there is a need for further treatment.

The best way to stop the progression of periodontal disease is to mechanically remove the bacterial plaque and tartar that have accumulated in the periodontal pocket. Daily oral hygiene and supportive periodontal treatment (see article "Supportive Periodontal Treatment") is key to the success of scaling and root planing. Without treatment, the tartar and plaque buildup underneath the gums will continue to cause periodontal tissue breakdown, progression of periodontal disease, and eventually tooth loss and/or systemic (general) complications.

By Laura Minsk, DMD