Periodontics

When a new tooth erupts, a colourless film forms on its surface from saliva. Bacteria in the oral cavity accumulate on this film and plaque begins to form. If you do not clean your teeth and between your teeth thoroughly, a sticky layer remains on them. If you do not clean this plaque for a long time, it mineralises and tartar forms under or above the gums. If left untreated, tartar can cause inflammation and disease in the gums and surrounding bone.

Possible causes of plaque formation:

• The amount and types of bacteria present in the oral cavity.
• The roughness of the tooth surface.
• The affinity of bacteria, tendency to bond.
• Oral hygiene.
• The composition of saliva (hardened plaque usually forms where the salivary glands open).
• Your drinking water (water hardness and the minerals in it determine the composition of your saliva).
• Eating habits (soft food, insufficient chewing, irregular bite).
• Diseases (tartar forms more in patients with kidney disease, asthma or cystic fibrosis).
• Smoking.

Dental plaque usually occurs if you do not brush your teeth at all, forget to brush them regularly (in the morning and at night), brush incorrectly, or use a low-quality toothbrush or toothpaste. Tartar also forms when you only chew on one side of your jaw (left or right) or have an irregular bite.

Eating crunchy foods such as fruit and vegetables cleans your teeth naturally. Unfortunately, in schools today, children often choose crisps, biscuits and buns instead of fruit and vegetables. Eating soft food does not clean the teeth naturally, and over time, the minerals from the saliva are absorbed into the soft plaque in the mouth, which hardens. This is how tartar is formed. A soft plaque accumulates on its surface again, which hardens and the tartar grows.

The composition of tartar varies – it depends on the age, hardness and place of origin of the tartar. A regular toothbrush and toothpaste cannot remove tartar, so be sure to visit your dental hygienist regularly.

Albeit, there are people who never have tartar. But they account for only 5% of the population. We advise everyone else to come in for oral hygiene twice a year. There are also people for whom tartar forms faster than usual. If you are one of them, visit your dental hygienist more frequently. People like this also account for about 5% of the population. Interestingly, tartar forms more often in men, and men have more of it than women.

We often see a periodontist when it is too late and the disease is already advanced and causing serious discomfort – when the teeth have already started to move and chewing is becoming difficult. It is therefore important to know how to recognise the symptoms of periodontal diseases.

The main symptom that suggests inflammation is bleeding gums. First you will notice this when brushing your teeth, and then when you eat. As the disease progresses, the gums often bleed for no reason.

You should be concerned if you notice that the gums have changed (become enlarged, swollen, more sensitive, a different colour). When the inflammation reaches the bone, you will start to notice pus coming from the gums and persistent bad breath.

If you have symptoms like this or are in doubt – come in for a consultation. We will examine and assess your current situation and prescribe treatment if necessary. The most important thing is not to wait too long.

Gingivitis, which is defined as an inflammation of the gums, is the earliest stage of periodontal disease, when it affects only the soft tissues (gums). Left untreated, gingivitis can develop into more serious diseases, but if you notice the first signs of inflammation and see a periodontist in time, you can avoid complications and recover completely.

Gingivitis is usually caused by bacteria in the soft dental plaque. If your immune system is weakened, even a small accumulation of bacterial plaque can cause inflammation of the gums.

However, gingivitis can also be of non-bacterial origin. It can be caused by medications, hormonal changes (pregnancy, puberty), eating disorders or an incomplete diet, or diabetes and other diseases. Then we select an individual treatment.

The main risk factors leading to the occurrence of gingivitis are:

• Inadequate personal oral hygiene.
• Not seeing a dental hygienist regularly.
• Caries.
• Smoking.
• Food debris trapped between the teeth.
• Low-quality dental crowns, prostheses or fillings.
• Mouth breathing in children.
• A weakened immune system.

The main symptom of gingivitis is bleeding gums. At first, you will only notice bleeding when brushing your teeth, and later – when eating as well. As gingivitis progresses, the gums will also bleed for no reason. These symptoms are often accompanied by gum pain, bad breath, and discolouration and swelling of the gums. At first, the gums are barely red, and later they become bright red or even dark blue. Bleeding indicates that the immune system has “turned on”, and, by releasing certain substances, is now destroying the bacteria present in oral plaque and neutralising their toxins. Antibacterial substances of the immune system enter the mouth through the walls of the blood vessels, which become rarer in the presence of inflammation; therefore, the gums being to bleed from the slightest touch of hard food or a toothbrush.

Local inflammation of the gums (one to three teeth) can also occur due to edges of dental fillings that are insufficiently polished or chipped, low-quality dental prostheses or irregular tooth position. Then pain can be felt in the gums, which only bleed in the affected area.

People often complain of sensitive gums and use very soft toothbrushes for this reason, and start brushing their teeth for a shorter period of time, less often or not at all, thinking that it is the brushing that is damaging the gums. Actually, the opposite is true. If you notice the first signs of gingivitis in time and start brushing your teeth more carefully and prioritising oral hygiene, you can avoid complications that lead to a more serious disease – periodontitis.

When treating gingivitis, we first eliminate the causes of gingivitis – accumulated tartar and soft plaque. For this, we perform professional teeth cleaning. Afterwards, you must take extra care of your teeth, brushing them at least twice daily (in the morning and at night), removing food debris stuck between the teeth with floss or an interdental pick, rinsing with anti-inflammatory, therapeutic and preventive mouthwashes, and coming in three to four times a year for professional teeth cleaning.

If the inflammation of the gums is local, we treat it by polishing or replacing the old fillings and dental crowns and removing the accumulated plaque.

An important part of treating gingivitis is learning to take better, more thorough and responsible care of your oral hygiene. Our periodontist or dental hygienist will help you choose the right oral care products and teach you how to brush your teeth, floss and so on. They will also recommend dietary changes and measures to boost your immune system.

Cooperation between you and your doctor is important. Since gingivitis is a disease that is largely determined by the patient’s lifestyle and attention to oral hygiene, the treatment of gingivitis depends greatly on your motivation and desire to fix the problem. We can eliminate the cause of gingivitis and teach you how to take care of your teeth, but only you can prevent a recurrence of the disease and complications. If you do not practice proper oral hygiene, even surgical treatment of inflammation of the gums and its complications (periodontitis) will not produce the expected outcome. In other words, treating gingivitis is a joint effort. Working together, we can give you a healthy and beautiful smile!

Periodontitis occurs when untreated gum inflammation (gingivitis) progresses. Periodontitis is an inflammation of the surrounding tissue, which affects not only the gums, but also the alveolar bone.

The most common origin of periodontitis is bacterial. If gingivitis is not treated and the blood circulation of the gums is impaired, bacteria migrate to deeper tissues, the periodontal ligament begins to disintegrate, the bone surrounding the tooth dissolves, and the teeth become loose.

Periodontitis can occur as a result of personal oral hygiene, genetic predisposition (occurrence of this disease in relatives), medication being taken, hormonal changes (pregnancy) or various diseases (eating disorders, diabetes, etc.). Periodontal diseases can also occur as a result of other problems in the oral cavity, such as irregular position or arrangement of individual teeth or an irregular bite.

Symptoms of periodontitis:

• Bleeding gums.
• Suppuration (pus formation) in the gums.
• Discolouration of the gums.
• Bad breath.
• Loose, mobile or sensitive teeth.

The course of treatment is determined by a periodontist. Treatment consists of several stages. Team work between the patient, the dental hygienist and the periodontist is very important throughout the process of stabilising the disease.

• The cleaning stage 

This is two to three months of work with a dental hygienist. The goal of this stage is to maximally reduce gum inflammation and achieve quality gums of healthy consistency, without bleeding. Your appointments with the dental hygienist will involve oral hygiene training, increasing motivation, and the selection and application of personal oral care products for daily use. 

• Conservative (non-surgical) treatment

This treatment is performed by a periodontist over the course of one or two appointments, depending on the patient’s situation and ability to handle a long appointment. During this stage, the remaining periodontal pockets are disinfected, the biofilm is removed, and the root surface is levelled and polished. Local anaesthesia is used for the procedure.

• Surgical treatment of periodontitis

If, six to nine months after the beginning of periodontitis treatment, the periodontal pockets are still being probed and the patient’s individual oral care is good and no plaque is found, surgical treatment of periodontitis with periodontal regeneration is performed in the remaining areas. 

• Maintenance stage

Once active treatment is done and the periodontal condition is stabilised, the patient is left for periodontal maintenance therapy – appointments with a dental hygienist according to the frequency prescribed by the periodontist. Maintenance appointments are necessary every two to four months, depending on the patient’s individual hygiene skills, bad habits and degree of risk of disease progression.

IMPORTANT! Periodontitis is not a curable disease. The goal of all of the procedures is to stabilise bone dissolution and teach patients how to improve their personal hygiene habits. Stable, long-term results can only be achieved by following a prescribed schedule of oral hygiene, coming in for periodic check-ups with a periodontist, practising excellent personal oral hygiene, improving your diet, and giving up bad habits.

Gingival recession is the receding of the gums from the tooth, exposing the roots of the teeth. Patients usually come in to take care of unsightly tooth root exposure in the area of front teeth, and often complain of increased tooth sensitivity. 

The occurrence of gingival recession is due to multiple factors. Recession can occur due to anatomically thin bone that covers the root externally, thin gingival phenotype as a result of orthodontic treatment, poor brushing habits (using horizontal movements, brushing too aggressively, using the wrong type of toothbrush), gingivitis, or high frenal attachment due to a lack of attached gingiva. Without treatment, the progression of gingival recession can reach up to 85%. 

As the recession progresses, we use surgical treatment at the clinic and perform the following procedures:

Frenuloplasty. If, when moving the lips or cheeks, the high/low lower/upper lip (cheek) frenal attachment pulls the gums up or down, we perform a frenectomy under local anaesthesia.

Gum graft surgery. For aesthetic reasons as the recession progresses, or if cleaning the exposed root becomes more difficult and the tooth becomes sensitive, we perform gum graft surgery.

The surgery is done under partial anaesthesia. Before treating gingival recession, professional teeth cleaning is a must, since you need to remove soft plaque and tartar, which would otherwise slow down the healing of the gums after surgery.

There are many methods of surgical treatment, so our specialists will help you choose the right one for you, taking into account the individual characteristics of your oral cavity.

Postoperative oral care is very important, as the success and results of the treatment depend on it, so you must follow the doctor’s instructions and strictly adhere to postoperative regimen guidelines.

Gum height correction is gum contouring surgery that aims to even out the gum line. This type of surgery is needed after orthodontic treatment to address crowns in the front part of the upper jaw that are too short or excessive exposure of the gums. It is also done before prosthetic restoration with veneers or in planning cosmetic filling. Smile planning is done in a team with a restorative doctor and dental technician laboratory. After digitally planning the new smile line, we transfer the image to the patient’s mouth to “try it on”. Then we make a surgical guide in the dental laboratory that the periodontist uses to perform the gum contouring.

Monika Ambrasienė, a periodontist at our clinic, uses the advanced “flapless” technique for gum surgery. With this technique, healing is without discomfort and after a week you can already see the healed gums, and further restoration work can be done two months earlier than when extensions are performed in the usual way.