Quality & Affordable Dentistry in Malaysia

Periodontal Dentistry , Gum Disease in Malaysia

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illustration between healthy gum , gingivitis and periodontitis

Periodontal Dentistry in Selangor, Malaysia

Periodontal dentistry, or periodontics, is the study of the periodontium, including the gums, underlying bone supporting the teeth, and other supporting tissues, namely, the periodontal ligament. It has been documented, over the years, that most teeth lost after the age of 35 is from periodontal disease. This disease can be almost entirely avoided if one is aware of its causes and then practices the preventative techniques necessary to avoid it. This disease is also responsible for most of the population’s bad breath problems.

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A healthy periodontium should not bleed when it’s probed or touched. There are many degrees of periodontal disease and the range is from gingivitis to advanced periodontitis. This disease has been classified by Roman numerals I through IV and by various names. Here, I will describe it by its sensitivity and appearance and by names that seem somewhat logical.

Before we do this, however, we would like to remind you that its prevention can be almost completely affected. If controlled and treated and hopefully cured, a patient would have to follow these instructions to the letter in order to prevent a recurrence. So why not start now and never have to go through this intermediary step of contracting the disease in the first place?

Since this disease is progressive, we will explain it in a continuum from the least severe to the most severe. We will start with the onset of gingivitis or a swelling of the gingiva. The root word itis means inflammation, thus gingivitis is the inflammation of the gingiva or swelling of the gums. In this disease, soft plaque builds up around the necks of the teeth next to the gums and usually extends one or two millimetres under the visible gum line. This soft plaque is made up of a matrix of bacteria, sticky foods, and toxins given off from the bacteria.

Those bacteria are organised into colonies and thus are pathogenic. The word pathos means disease and the word genic means the formation of something, thus pathogenic equals disease formation or producing. With these substances in close proximity to the gingiva, swelling occurs. This inflammation means larger more voluminus gums, which contain puss and which will bleed easily to the touch. The body temperature is elevated and a microscopic examination will reveal an increase in the white blood cells, which are there to fight infection. At this early stage, an invasion into the underlying bone and periodontal ligament has probably not begun, but danger lurks. An attack is imminent. If stopped in its tracks, at this point, treatment is relatively simple and quick. Your dentist might find it advantageous to start you on a regiment of antibiotics, possibly aeuromycin. He will most certainly clean your teeth, probably starting with pumice on a cup to loosen and destroy the bacterial colonies. He will instruct you on the proper methods of brushing and flossing and insist that you maintain this regiment several times a day. 

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dental scaling has to be done at least once a year to prevent gum problems
dental scaling has to be done at least once a year to prevent gum problems

After a few days or a week, he will have you return to the office to remove any and all hard plaque (also called “calculus” or “tarter”). Then, upon completion of this task, another pumice polishing will be accomplished.

Pumice is a gritty substance like a fine sand. It is usually held together with glycerin and flavoured with spearmint, peppermint, or other fruit flavour.

Other extenuating circumstances can contribute to gingivitis, such as puberty or pregnancy hormone changes. So, too, can certain medications, such as anti convulsive drugs used to control epilepsy and other conditions. Still, with fastidious cleaning regiments, patients can control the bacteria in their mouths, thus contributing quite significantly to minimising gingivitis brought on by these conditions.

The next progressive event in uncontrolled gingivitis is early periodontitis. With this disease, gingivitis has prevailed long enough for there to be an early onslaught of bacteria into the underling bone and periodontal ligament. No treatment has been instituted yet and the gingivitis with its millions of bacteria have invaded the bone supporting the teeth. With early periodontal disease, bone destruction is slight; but the process has begun and, if left uncontrolled and untreated, will eventually progress to the next phase of disease, moderate periodontitis. With early periodontitis, we will find many of these same conditions as with gingivitis. While the gingiva itself may not be in quite as an active inflammatory stage as with gingivitis, it is, nevertheless, swollen, and now we find the addition of tarter which has hardened from the earlier soft plaque. This tarter will be found visibly above the gum line as well as subgingivaly or under the gum line. The same toxins prevail; but now, they are beginning to infect the bone too. The depth of the periodontal pockets may reach four, five, or more millimetres and radiographs will show this denser outside bone, covering the inner bone, starting to lose some of its density. This outer bone is known as cortical bone and it may begin to look more like the inner spongy bone. (Spongy is the name given to this bone mass.)

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Treatment has now become more involved and will probably require a comprehensive soft tissue management program. This is accomplished by, first, performing a complete probing and charting to establish exactly what degree of periodontal pocket damage exists. Then a general debridement (called a “gross scaling”) will be done. After a few days, a more comprehensive root planing procedure will be begun. This is the procedure that the dentist or dental hygienist will perform one quadrant at a time. Your mouth is divided into four quadrants: the upper right, upper left, lower left, and lower right. This root planing is done with small, sharp, hand instruments which are designed with the proper angles to reach all surfaces of the teeth roots. The goal is to rid the root surfaces of all tarter and to make them smooth so that bacteria cannot harbor there anymore. This sometimes requires local anaesthesia, but many people need only a topical anaesthetic or even none at all. The quadrants are usually treated one or two at each dental visit. Upon completion, a week or two interval is allowed and then the final appointment consists of a re-evaluation and fine polish. In most cases, if the patient maintains compliance at home with his personal oral hygiene care and keeps his every three- to six-month recall appointments, his periodontal problems will be over and he should be able to maintain a high level of periodontal health.

Moderate periodontitis is another matter. The term “periodontitis” applied to the last three conditions means inflammation of the periodontium. Remember gingivitis and how that means inflammation of the gingiva. Well, the same thing applies here except it is more involved.

Now, not only do we have a beginning invasion into the bone, but we have a destruction of the bone easily visible on the radiographs. The pocket measurements will be greater than with early periodontitis and some of the teeth may be loose. Now, treatment becomes much more complex as some of the teeth may be beyond saving and need to be extracted. Furthermore, although soft tissue management will again be instituted, some surgery may be indicated. Surgery in such cases involves peeling the gingiva away from the bone, contouring away the diseased bone with a dental handpiece and special bone burs, trimming away a portion of the diseased and excess gum, and then suturing the gum back over the bone. We used to place a special medicated periodontal packing over the surgery site, but this is being done less and less today. After 10 days or so, the sutures are removed and close monitoring by the dentist ensues. The same rules apply for the success of this treatment as for the most previous condition: And, if any teeth were lost due to this overall treatment plan, they must be replaced after healing and stabilisation occur. 

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The last condition to be discussed here is advanced periodontitis. This, obviously, is the most serious and often times most hopeless of all periodontal problems. Bone loss is nearly everywhere, quite often one-half or more of the supporting bone is gone, and teeth are loose all over the place. The severity of the problem might dictate full-mouth extractions and subsequent full dentures. If it is deemed advisable and a good risk, the hopeless teeth will be removed and periodontal surgery will be performed on the rest. This scenario will probably require removable partial dentures because to place fixed bridges on these already badly compromised remaining teeth would introduce the additional risk of additional stress on the remaining teeth due to the occlusal (biting) forces of normal function. Normal function means chewing your food, swallowing, and speaking.

So, there you have it. The world of periodontics is filled with both wonders and perils. But do not ignore it if you have it, because it will only get worse and worse and the more bone you lose, the less you will have left for any necessary dental reconstruction.

There are some systemic diseases that contribute significantly to the development of periodontal disease. If this is the case, you will need to coordinate all your efforts with both your physician and periodontist (periodontal specialist) or general dentist. These cases are fairly rare, but they do occur.

Today, dentists can perform near miracles. Soft tissues grafts are now commonplace. These are accomplished by moving gum tissues from healthy areas to areas that need bolstering. Also, artificial bone can be used to supplement areas that have lost significant amounts of bone, but still have a good chance of responding positively to this procedure. In still other instances, bone is taken from other parts of a patient’s body and transplanted into the bone-supporting area of the teeth needing reinforcement. Finally, periodontists can aid a great deal in cosmetic dentistry by performing the appropriate surgery to help too gummy smiles show less gums and the opposite by showing just enough when the gums do not show. As in all of the specialties of dentistry, periodontics offers many interesting challenges and provides some of the most important services needed. Many of these are quite comprehensive and complicated, but today’s periodontists are extremely well trained and up for the task. 

Healthy periodontium.
Healthy periodontium.
Early periodontal disease.
Early periodontal disease.
Early periodontal disease.
Early periodontal disease.
Advanced periodontal disease.
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