Periodontal (Gum) Disease

What is Gum Disease?

Gum disease is a widespread condition affecting a high percentage of the world's population, possibly as high as 75%.  It varies from a mild and easily reversible "gingivitis" to a more severe and sometimes irreversible "periodontitis".   It is an insidious condition that usually develops over long periods of time undermining the integrity of the bony support that holds teeth in place.  Generally speaking most people blame loss of their teeth upon age, this is only partly true.   In reality gum disease is the culprit which only becomes severe enough to be obvious after many years.

Most people do not realize they have gum disease.  This is because gum disease usually doesn't cause the sort of problems that people are concerned about.

Signs of early gum disease include:

  Redness of the gums

  Bleeding of the gums on tooth brushing.

Signs of established gum disease include:

  Red puffy gums

  Gum tenderness and intermittent pain

  Spontaneous bleeding with minimal brushing or flossing

  Bad breath or taste

  Alteration in the bite

  Loose teeth

  Pus discharge from the "pocket" around a tooth

  Gums separating from teeth

  Receding gums

Gum disease is initiated through the accumulation of plaque on surfaces of teeth.  In a matter of days undisturbed plaque calcifies, this is called calculus or tartar.  Tartar cannot be removed through tooth brushing.  Waste products of bacteria that live on the tartar seep into the gums and destroy the attachment of the gum to the tooth.  As this attachment is progressively destroyed a "pocket" of un attached gum is formed around the tooth.  Once plaque colonize the pocket, gum disease is established and can progress rapidly....and painlessly.  Generally speaking, the deeper the pocket, the more destructive the bacteria that reside in it.  Once the pockets reach about half the length of the teeth involved the tooth gets loose, may develop acute infections and require removal.  Treatment is based upon meticulous cleaning and measures to reduce pocket depth.

Assessment of Severity of Gum Disease

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The severity of gum disease is measured, using a special ball ended probe which painlessly measured the depth of the pockets.  The distance the probe passes into the pockets determines the severity of gum disease and indicates set levels of treatment as prescribed by the European Society of Periodontics. During your routine check the Periodontist calls out numbers which are recorded in your records - these numbers vary between zero and 4.  Zero is an indicator of excellent gum health and 4 indicates very poor gum health.  In this way is that we can monitor the progress of treatment and act accordingly.  We attempt to improve your own ability to manage gum disease through oral hygiene instruction, in conjunction with regular hygiene visits and use of antibiotic gels to reach the destructive bacteria at the base of the deepest pockets.  Severe cases are treated with guided tissue regeneration techniques

Guided Tissue Regeneration

Background: Conventional treatment of destructive periodontal (gum) disease arrests the disease but does not regain the bone supporting the tooth or connective tissue lost in the disease process.

Guided tissue regeneration (GTR) is a surgical procedure that aims to regenerate the periodontal tissues when the disease is advanced and could overcome some of the limitations of conventional therapy. The technique involves regeneration of bone with graft material, and the use of membranes which act as a barrier for to ingrowth of unwanted soft tissue into the area.

Guided Tissue Regeneration: The Technique

A flap of gum is raised under local anaesthesia and the bony pocket is illustrated between the teeth (A). This is thoroughly cleaned, and filled up with a commercially available graft material which turns into bone.

The area is covered by a membrane which prevents ejection of the graft and regrowth of soft tissue into the pocket.

Careful patient selection is required; the technique works best with cases of irregular bone loss rather than with uniform horizontal bone loss. Research has shown that improvement in gum disease is possible with this technique.

Guided tissue regeneration techniques may also be used to make the jaw wide enough to receive dental implants. In these cases the graft material is held in place by a membrane secured by titanium tacks. Implants are placed 3 months following the procedure






Benefits of Periodontal Treatment

  Keeping your teeth for the rest of your life

  No need for dentures

  Potential complications

Sometimes teeth are slightly sensitive after being cleaned with a dental scaling device - this is partly because they are cleaned and hence not insulated with a layer of plaque.  The teeth will adapt quickly and de-sensitizing agents can be used if necessary. Despite gum disease being successfully treated it can subsequently recur.  This poses a specific problem: damage caused by a previous episode of gum disease facilitates further episodes of gum disease. This is because the initial episode may have resulted in physical damage which reduces the natural "self cleansing" ability of an intact and healthy set of teeth and gums.  Hence specific and personal oral hygiene may be required.

Oral Hygiene Measures

Prevention and treatment of gum disease is the most important cosmetic dental consideration.  It is very common for patients to fail to appreciate how important it is to put time, effort and money into management of gum disease - often because the symptoms are not severe or obvious.
The Sonicare toothbrush http://sonicare.com/default.asp is an excellent aid in the management of gum disease in conjunction with dental flossing and other oral hygiene measures.


Cosmetic Periodontal (Gum) Plastic Surgery

This section deals with periodontal (gum) surgery. Gum surgery may be needed in conjunction with another procedure, or may be used on its own to correct a problem and improve the patient's appearance.

What is cosmetic gum surgery?

Your gum tissue is like a frame that provides form and shape to the top of your tooth. A less than attractive smile results when the integrity of the gum is compromised or the actual gum between your teeth becomes weak. Loss of gum tissue is usually associated with poor dental hygiene techniques.

Cosmetic dentistry provides many cosmetic solutions such as composite resin bonding, crowns, and veneers to create a great smile. These solutions are usually part of an overall strategy which may involve cosmetic gum surgery.

Cosmetic gum surgery is the process of surgically trimming the gums to enhance cosmesis (e.g. to correct a gummy smile). Your teeth then appear to be longer and much less gum is seen when you smile.

The "Long in the Tooth" Smile - Cosmetic Gum Surgery, or Periodontal Plastic Surgery, can correct almost any deformity or gingival problems preventing you from a beautiful smile. As we age, our gums may shrink and recede which makes our teeth look longer. While this is often age-related, it can also occur due to a bad bite. A Cosmetic Dental Surgeon or a Periodontist can correct this to such an extent, that you'll have a very youthful appearing smile.

Who is a candidate for cosmetic gum surgery?

You should consult your Cosmetic Dental Surgeon about cosmetic gum surgery if you believe you have

  Gummy Smile ( i.e. small crown length)

  Gum recession (i.e. teeth appear to be long)

  An uneven gum line due to "short teeth"

  Gum loss or gums which appear to be collapsing (from missing teeth)

  Dark / black areas between bridges, implants, crowns or teeth

  Tooth sensitivity from receding gums.

Cosmetic Gum Surgery Procedures

There are two primary procedures for cosmetic gum surgery, depending on your current smile.

"Gummy Smile" (Excessive Gingival Display)

A "Gummy Smile" can occur due to wear of teeth from teeth grinding, a short upper lip, or having a longer than usual upper jawbone. The condition can also occur in those patients taking medication (phenytoin) for epilepsy and in some patients taking immunosuppressive drugs following transplant surgery. This smile is when your teeth appear too small and your gums appear too large.

To Correct a "Gummy Smile"

Cosmetic gum surgery can be done to reduce the excess gum and bone. The removal of these tissues allows for normal sized teeth and for a normal gum line appearance by using an instrument, usually a laser, to remove the undesirable tissue. Typically your Cosmetic Dental Surgeon will prescribe an antibacterial mouth rinse to be used twice a day for a two-week period following your surgery.

To Correct a "Long Tooth Smile"

As your gums recede, your teeth look much "longer" than normal. Such gum recession exposes your sensitive root surface which often makes hot or cold foods and drinks a painful experience. Teeth can become loose as your gum recedes. The cosmetic gum surgery solution is basically when a cosmetic dentist or Periodontist removes tissue from the roof of your mouth and then grafts it onto your gum line. This tissue then reinforces thin gums or fills in areas where your gums have receded. Typically your Cosmetic Dental Surgeon will prescribe an antibacterial mouth rinse to be used twice a day for a two-week period following your surgery.

How much does cosmetic gum surgery cost?

The costs involved in cosmetic gum surgery vary extensively based upon how much of your mouth is undergoing a procedure, which corrective procedure is being used, and which other cosmetic dentistry procedures will be needed to provide you with that perfect smile. It is common for other cosmetic dentistry procedures, such as crowns or veneers, to be recommended by your dentist as part of the overall strategy to cosmetically correct your gums. The overall strategy should be extensively discussed and well understood by you prior to undergoing these procedures.

Pros and Cons of Cosmetic Gum Surgery

Advantages: Healing is usually quick and your more youthful and beautiful smile is obvious early on. It has been reported that cosmetic gum surgery additionally improves the health of your gums. The procedure to correct receding gums may even reduce your tooth sensitivity to cold or hot foods or beverages while protecting your roots from decay and lessening further gum shrinkage.

Disadvantages: Cosmetic gum surgery is of course, surgery. Surgery is often performed in segments under a local anaesthetic - unless your entire mouth is undergoing this procedure at once, then a general anaesthesia is typically used.

Before & After Photos: Cosmetic Gum Surgery

Gummy Smile Before Long Tooth Smile Before
Gummy Smile After Long Tooth Smile After