Articles on scaling and root planing

Importance of Flossing.

Dr. Ragini Parmar, Dentist
“Be true to your teeth and they won’t be false to you”- Soupy SalesAlright, I shall agree with you - flossing isn’t the most fun thing to do. Thing is, it’s one of those things that just have to be done. General dentists in Colaba recommend flossing as a great way to maintain oral hygiene.So you ask, why is flossing such a necessity? Here are a couple of reasons it would be a good idea to dedicate a few minutes a day to your dental care.Plaque DestroyerFlossing has the ability to get into those difficult tight spaces between teeth and under the gums where a toothbrush fails to reach. It not only cleans out food particles but also the plaque that live in these dark corners of your mouth.Gum ProtectionFlossing is most important where the gums meet the teeth. If the plaque here is not cleaned regularly, it hardens and forms tartar. A significant build up of tartar can lead to gingivitis – a gum disease characterized by red swollen gums. If the tartar and plaque spread lower into the gums, it can cause periodontitis - a severe gum disease that results in tooth and bone loss.Penny Wise Pound FoolishRegular oral hygiene works out to be cheaper than having to rush to the dentist for an expensive emergency procedure to rectify a severe problem with your teeth or gums. Flossing is an inexpensive way to maintain oral health. Pick a time in the day that works for you and dedicate it to your oral hygiene.Far Reaching EffectsWe don’t realize the effects of oral hygiene; we limit it to the mouth. The bacteria from a dirty mouth can cause diabetes, heart problems, and respiratory illnesses. Look at flossing as a small step towards long term health.It may not be evident at first, but flossing plays a very important role in the overall physical health and sense of well-being of an individual.  It catches tartar and plaque while they are manageable and prevents systemic diseases that affect the whole body. Kids should start flossing as soon as they have two teeth that touch each other. The sooner it becomes a way of life the easier the habit will be to maintain.   Flossing is the economic prevention-before-the-cure strategy that everyone should adopt as a way of life.Floss, floss, floss away…by DR RAGINI PARMAR

Flossing: To Do or Not to Do

Dr. Parag Shah, Dentist
Flossing these days is all over the news with a major US news paper saying it is not necessary to floss.Everyone all over the world is so happy to read this article.But hey hey hold on, yes you will have to floss. Agreed, there are very few studies proving the benefits of flossing, but the risks of not flossing outweigh the benefits it provides. So now go on, get your floss and start flossing.Why floss?There is no way a toothbrush is going between your teethA major number of cavities seen at a dentist is proximal (between 2 teeth)how do you think these surfaces will be cleaned.flossing not only prevents cavities it also protects the gums from getting infected.it saves you money, with healthcare costs rising its better to practice prevention rather than suffering later. links have been shown between gum disease and other systemic diseases like heart conditions.Flossing prevents bad breath.flossing prevents build up of plaque and tartar, hence saving you from gum disease & also a visit to a dentist :).How often should you floss?You can floss as  often as you like, but once a day should be enough.We ask our patients to floss at least once before going to bed, followed by brushing.However some patients find it difficult to hold the floss and reach the back teeth, for them we advice the use of floss sticks or other flossing aids. here s a pic of one such flossing aid:-Conclusion:We would like to conclude by saying that everyone needs to brush twice floss at least once use a mouthwash visit a dentist every 6 months for a regular check

Oral Health Complications During Pregnancy

Dr. B.N. Prasad, Dentist
Recent findings have reported that oral bacteria and their by-products can possibly pass the placental barrier keeping oral health at prime importance during pregnancy. An awareness related to oral health during pregnancy cannot be neglected or avoided in order to minimize the complications.This article focuses on few points related to the necessity of oral health during pregnancy. Pregnancy comes with many responsibilities making expecting mothers more concerned about their health. However, many pregnant women may not be aware of oral health and its effect on the developing child.  Negligence of oral health is quite common during pregnancy due to lack of alertness of oral hygiene and its effect on systemic health.Moreover, pregnancy discomforts like frequent bouts of nausea, increased physical demands, weight gain or certain dental problems like pregnancy gingivitis or inflammation of gums may be dangerous to developing fetus.  Risk of oral problems during pregnancy:-Few common oral problems associated with pregnancy are as follows. Pregnancy Gingivitis: Hormonal changes during pregnancy leads to pregnancy gingivitis. It is a condition of bleeding gums, redness. Moreover inflammation, swelling and tenderness are also observed. Ignorance of such problems may lead to serious gum disease.  Frequent cleaning can avoid such dental issues. Progesterone levels are elevated during pregnancy which stimulates the production of prostaglandins and leads to inflammation of blood vessels in gums.Tooth Decay:Diet during pregnancy is of high importance. It is designed to nourish both mother and unborn baby. Diet rich in carbohydrates actually increases the risk of tooth decay. The morning sickness increases acid secretion in the mouth which is harmful to enamel. Pregnancy tumors: Overgrowth of tissue on gums in pregnant women are called as pregnancy tumors. They are noncancerous and generally observed in the second trimester of the gestation period. It is nothing but swollen gums between teeth. The bleeding and reddening of gums observed in such conditions.  Periodontal disease and preterm birth:untreated gum disease or periodontal problems can development periodontitis characterized by inflammation and infection of the gums and supporting structures of the teeth. This ultimately leads to loss of supporting material and finally the teeth themselves. A study result has revealed that there is a relation between preterm birth and presence of gum diseases in the pregnant women. The reason is not yet known. However, research study findings have evidence that oral bacteria or their byproducts can pass placental barrier. This initiate inflammatory response leading to preterm birth. Another correlation exists between the gum disease and the increased rate of pre-eclampsia, a condition of high blood pressure during pregnancy. The positive correlation suggests that gum disease may cause stress to the blood vessels of the mother, placenta and the fetus.The basic periodontal therapies like oral hygiene instructions, scaling, root planing and prophylaxis can substantially decrease the level of prostaglandin responsible for inflammatory response. The regular treatment and follow-up in pregnant women can maintain good oral health and minimize the risk of preterm birth. Dental treatment during pregnancy: The dental procedures mostly include the use of X-rays and use of anesthesia. In the case of pregnancy, these procedures can be used with precaution. Therefore, before sitting on dental chair patient should declare her pregnancy to the physician. Untreated dental infections can harm fetus as well as the mother. The emergency situations request use of dental radiographs which can’t wait. The radiation of dental x-ray is generally very low and precaution is always taken for lowest radiation exposure. A leaded apron including collar, shields can be used to prevent abdominal exposure to the x-ray radiation. Use of dental X-ray is not at all contraindicated in pregnancy when used with precaution. The use of local anesthesia is also not contraindicated in the pregnancy. A clinical trial result showed that there is no harm in the use of local anesthetics during pregnancy. It is not linked with increased risk for major medical problems like cerebral palsy, cleft lip and heart defect in newborns. The medication prescribed during dental treatment mainly includes local anesthetics, analgesics, and antibiotics. Most of them can be used with safety precautions. Each drug has its own pregnancy category which should be considered during its use. The antibiotic like tetracycline can permanently cause discoloration of developing teeth.  Prevention: Dentists can educate patients with following points to avoid problems associated with oral hygiene. The patient should declare the pregnancy to  the Dentist Follow routine oral checkup. Undergo all elective and emergency procedures. Follow good oral hygiene practice ask for a better toothpaste.In the case of morning sickness avoid sweets and snacks which increase the risk of tooth decay. Have healthy and balanced diet. Awareness of oral health during pregnancy is a must to avoid complications.

Gum Disease: Causes, Symptoms And Cure

Dr. M. R. Pujari, Dentist
What Is Gum Disease?Gum disease is an inflammation of the gums that can progress to affect the bone that surrounds and supports your teeth. It is caused by the bacteria in plaque, a sticky, colorless film that constantly forms on your teeth. If not removed through daily brushing and flossing, plaque can build up and the bacteria infect not only your gums and teeth, but eventually the gum tissue and bone that support the teeth. This can cause them to become loose, fall out or have to be removed by a dentist.There are three stages of gum disease:Gingivitis : This is the earliest stage of gum disease, an inflammation of the gums caused by plaque buildup at the gumline. If daily brushing and flossing do not remove the plaque, it produces toxins (poisons) that can irritate the gum tissue, causing gingivitis. You may notice some bleeding during brushing and flossing. At this early stage in gum disease, damage can be reversed, since the bone and connective tissue that hold the teeth in place are not yet affected.Periodontitis: At this stage, the supporting bone and fibers that hold your teeth in place are irreversibly damaged. Your gums may begin to form a pocket below the gumline, which traps food and plaque. Proper dental treatment and improved home care can usually help prevent further damage.Advanced Periodontitis: In this final stage of gum disease, the fibers and bone supporting your teeth are destroyed, which can cause your teeth to shift or loosen. This can affect your bite and, if aggressive treatment can't save them, teeth may need to be removed.How Do I Know if I Have Gum Disease?Gum disease can occur at any age, but it is most common among adults. If detected in its early stages, gum disease can be reversed so see your dentist if you notice any of the following symptoms:Gums that are red, puffy or swollen, or tenderGums that bleed during brushing or flossingTeeth that look longer because your gums have recededGums that have separated, or pulled away, from your teeth, creating a pocketChanges in the way your teeth fit together when you bitePus coming from between your teeth and gumsConstant bad breath or a bad taste in your mouthHow is Gum Disease Treated?The early stages of gum disease can often be reversed with proper brushing and flossing. Good oral health will help keep plaque from building up.A professional cleaning by your dentist or hygienist is the only way to remove plaque that has built up and hardened into tartar. Your dentist or hygienist will clean or "scale" your teeth to remove the tartar above and below the gumline. If your condition is more severe, a root planing procedure may be performed. Root planing helps to smooth irregularities on the roots of the teeth making it more difficult for plaque to deposit there.By scheduling regular checkups, early stage gum disease can be treated before it leads to a much more serious condition. If your condition is more advanced, treatment in the dental office will be required.

Diabetes and Oral Health

Dr. Anuradha Mallya, Dentist
Diabetes Mellitus is a type of chronic disease which causes a rise in the levels of glucose in the blood. The body utilises glucose, or sugar, as its main source of energy. This glucose is derived from the food we eat. The pancreas, an organ that lies near the stomach, makes a hormone called insulin to help glucose get into the cells of our bodies. In diabetics, the body either does not produce enough insulin or is unable to use its own insulin effectively. This is what causes the blood sugar levels to go up. This high blood sugar can cause damage to many parts of the body like heart, kidneys, eyes, blood vessels and even your teeth and gums.WHAT SHOULD YOU DO EVERYDAY TO STAY HEALTHY WITH DIABETESFollow the healthy eating plan that you and your doctor or dietician have worked out. Be active a total of 30 minutes most days. Ask your doctor what activities are best for you. Take your medicines as directed. Check your blood glucose every day. Each time you check your blood glucose, write the number in your record book. Check your feet every day for cuts, blisters, sores, swelling, redness, or sore toenails. Brush and floss your teeth every day. Control your blood pressure and cholesterol. Don’t smoke.HOW CAN DIABETES AFFECT YOUR TEETH AND GUMS?Tooth decay and gum diseases are caused by ‘dental plaque’ which is a film of bacteria found in the mouth. Thus anyone can suffer from these diseases. But the high blood sugar in diabetics helps the growth of these bacteria. This causes red, sore and swollen gums which bleed while you brush. In its more serious form, called periodontitis, the gums can pull away from the tooth resulting in an elongated appearance of teeth, bone can be lost, and the teeth may loosen or even fall out. Emerging research also suggests that the relationship between serious gum disease and diabetes is two-way. Not only are people with diabetes more susceptible to serious gum disease, but serious gum disease may have the potential to affect blood glucose control and contribute to the progression of diabetes. HOW DO YOU KNOW IF YOU HAVE ORAL PROBLEMS?If you have one or more of these problems, you may have tooth and gum damage from diabetes: red, sore, swollen gums •bleeding gums gums pulling away from your teeth so your teeth look long loose or sensitive teeth increased spaces between teethbad breath a bite that feels different dentures—false teeth—that do not fit wellHOW CAN GUM DISEASES BE TREATED?Gingivitis can be controlled and treated with good oral hygiene and regular professional cleaning. More severe forms of periodontal disease can also be treated successfully but may require more extensive treatment. Such treatment might include deep cleaning of the tooth root surfaces below the gums, medications prescribed to take by mouth or placed directly under the gums, and sometimes corrective surgery. WHAT CAN YOU DO TO KEEP YOUR TEETH AND GUMS HEALTHY?To help prevent damage to your teeth and gums, take diabetes and dental care seriously:Make a commitment to managing your diabetes. Monitor your blood sugar level, and follow your doctor's instructions for keeping your blood sugar level within your target range. The better you control your blood sugar level, the less likely you are to develop gingivitis and other dental problems.Brush your teeth at least twice a day. Brush in the morning, at night and, ideally, after meals and snacks. Use a soft-bristled toothbrush and toothpaste that contains fluoride. Avoid vigorous or harsh scrubbing, which can irritate your gums. Consider using an electric toothbrush, especially if you have arthritis or other problems that make it difficult to brush well. If you wear false teeth, keep them clean.Floss your teeth at least once a day. Flossing helps remove plaque between your teeth and under your gumline. If it's hard to manipulate the floss, use a floss holder.Schedule regular dental visits.Regular dental checkups and periodontal screenings are important for evaluating overall dental health and for treating dental problems in their initial stages. Your dentist may recommend more frequent evaluations and preventive procedures, such as teeth cleaning, to maintain good oral health.Make sure your dentist knows you have diabetes. Every time you visit your dentist, remind him or her that you have diabetes. Make sure your dentist has contact information for your doctor who helps you manage your diabetes.Look for early signs of gum disease. Report any signs of gum disease — including redness, swelling and bleeding gums — to your dentist. Also mention any other signs and symptoms, such as dry mouth, loose teeth or mouth pain.Don't smoke. Smoking increases the risk of serious diabetes complications, including gum disease. If you smoke, ask your doctor about options to help you quit.ROLE OF A PERIODONTISTA Periodontist is a dental surgeon who specialises in gum diseases and their treatments. There are large numbers of undiagnosed individuals with diabetes. The oral signs and symptoms of the diabetic patient can be important indicators of the risk of both periodontal disease and future diabetic complications. The present concept is that periodontal treatment can have a positive effect on sugar control in diabetic patients. Patients should be informed that periodontal infection may make it more difficult to control diabetes and conversely, poor diabetic control may increase susceptibility to periodontal infection. Initiating periodontal care for the diabetic patient should be a foremost concern of physicians as it may make their task easier and reduce insulin requirements. Every diabetic patient should undergo oral examination at least once in 6 months. Periodontal intervention is as important as diabetic medication in the management of diabetic patients. A close cooperation between the Endocrinologist and the Periodontist is vital in the management. 

Are Your Gums Keeping Your Smile From Looking Its Best?

Dr. N Srinivas, Dentist
Gums around your teeth can make or break your smile.You can have very attractive natural teeth,bonding,veneers or crowns,but if your gum tissue is red,puffy,or bleeding,then the result is an unattractive smile.Also if your gum tissue shrinks away from your beautiful restorations,leaving a black triangle where the gum used to be,you are left with an older-looking and unaesthetic smile.What is gum disease?Gum disease also called periodontal disease is caused by excessive bacteria building up in the mouth.In early stages,gum may bleed easily and appear red,tender,spongy,and slightly swollen.Eventually,the disease may lead to recession of the gums,destruction of the underlying bone,loosening of the teeth,and ultimately tooth loss.In addition,periodontal disease present a major health risk.Research has shown that it has a strong connection with heart disease,lung disease,diabetes,and other systemic illnesses.Gum disease treatment:Plaque removal accomplished through diligent home care(brushing,flossing)and regular visit to the dentist for professional cleanings,often prevents gum disease or stops it in its early stages.If gum disease is more advanced ,professional root planing and curettage may be required.Root planing is the removal of plaque and calculus from the  tooth crowns  and root surfaces.Curettage is the removal of the diseased gum tissue.These procedures combined with meticulous home care may be sufficient to control the disease,depending on its severity.In later stages of the disease,surgery is often required.The dentist surgically fits sections of gum tissue,removes plaque and calculus,and corrects bone defects.The tissue is then positioned to allow more efficient cleaning.The procedure usually requires only a local anesthetic.If surgery reveals extreme bone loss,then bone grafting or guided bone regeneration (GBR) is sometimes required.These procedures are typically performed over the course of several appointments but in some cases may be done all at once with the use of conscious sedation.Prevention is best!Regular brushing,flossing,rinsing,gum massage.keep your mouth as clean as possible. 

Your First Visit to a Periodontist

Dr. Parag M. Khatri, Dentist
If you are referred to a Periodontist, your first visit will be for an evaluation. This typically involves a review of your dental, medical and social histories. If you have any medical problems, it is crucial that you describe them to the Periodontist because so many systemic diseases can affect your mouth and the health of your gums. He or she also will want to know about any medications you are taking, since these also can affect your gums.If you smoke, your Periodontist will ask you to make an earnest effort to quit whatever the condition of your gums. This is especially important before a surgical procedure. Smoking increases the risk of periodontal disease, makes the disease worse once you have it, and decreases the effectiveness of periodontal treatment by affecting your body's ability to heal properly.The first visit always includes an examination of your head, neck and jaw joints (temporomandibular joints, or TMJs); a general oral examination of all of the structures in your mouth and throat (tongue, tonsils, cheeks, etc.); evaluation of your teeth; and a full examination of the health of your gums, called a periodontal examination.In addition to the examination, your Periodontist also will need X-rays of your teeth. A type of X-ray called a periapical X-ray helps the dentist or Periodontist determine the extent and pattern of bone loss around each tooth. These X-rays show the entire tooth from the crown (top) to the end of the root, which anchors the tooth in your jaw. You also may need an X-ray of your entire mouth,known as a panoramic radiograph (OPG). This type of picture provides information about other important structures in your skull, such as the maxillary sinuses and jaw joints.Once the examination is done, your Periodontist will develop a plan to treat your periodontal problems. Since people have different wants and needs, there is no single treatment that is best.In addition, you may find that Periodontist differ in their treatment philosophies. Some Periodontist believe in attacking the disease aggressively with surgical treatment, while others believe in more conservative, nonsurgical approaches. It's important that you understand why your Periodontist is recommending a particular form of therapy and that you feel comfortable with the proposed treatment plan.Regardless of the specific type of treatment, all patients will be placed in a maintenance program in which they will be asked to come in for regular follow-up examinations and cleanings. These cleanings and checkups are critical to maintain the health of your mouth and gums, and to help to prevent the disease from worsening again in the future. For someone who has gingivitis and no other problems, most Periodontist will recommend twice-yearly visits. For people with more significant periodontal problems, the schedule might be once every three months.Here's what your dentist will evaluate during a periodontal examination and what to expect:In addition to the periodontal examination, you also may need X-rays of your teeth. A type of X-ray called a periapical X-ray helps the dentist or Periodontist determine the extent and pattern of bone loss around each tooth. These X-rays show the entire tooth from the crown (top) to the end of the root, which anchors the tooth in your jaw. You also may need an X-ray of your entire head, known as a panoramic radiograph. This type of picture provides information about other important structures in your skull, such as the maxillary sinuses and jaw joints (temporomandibular joints or TMJs).Many dentists check all of these factors at every dental visit, but don't write down the results unless something has changed from the previous visit. Repeating these measurements helps your dentist track the progress of treatment. For example, if you need scaling and root planing, your dentist will chart these measurements before the treatment and again several weeks or months later to see if the treatment was effective.Each dentist has his or her own method for keeping track of periodontal measurements, although most charting methods probably look similar. Many offices today use computers to keep track of the measurements.Goals of periodontal treatmentTreatment of Gum DiseaseGum (or periodontal) disease includes a number of conditions caused by bacterial infections of the soft tissue and bone that supports the teeth within the jawbones.The disease can cause tissue and bone to be destroyed, and can lead to tooth loss.Acombination of professional treatment and your efforts can stop the progressionof gum disease and prevent further tissue destruction. Depending on the stageof gum disease, treatment ranges from a thorough cleaning to sophisticatedtypes of periodontal surgery.Treatment at any stage of periodontal disease can make your gums healthier. Some people assume that losing teeth is a natural part of aging, but if you work with your dental professional to keep your gums healthy, you should be able to keep your teeth for a lifetime.The main goals of periodontal treatment are to:The earliest stage of gum disease, gingivitis,usually can be stopped before it causes significant destruction of soft tissue or bone. Your general dentist or dental hygienist can treat most cases of gingivitis with a combination of in-office cleanings and instruction in good oral hygiene.In some people, gingivitis will progress to the more advanced stages of gum disease that involve loss of the structures that anchor the teeth to the jawbones. These more advanced stages are known as periodontitis and usually require more aggressive forms of treatment than gingivitis. In this case, it is likely that your dentist will refer you to a Periodontist (a gum specialist) for treatment.Treatment of Gum RecessionGums can recede,or shrink, even if there's no bacterial infection. One of the main causes of gum recession is improper brushing. Using a hard- or medium-bristled tooth brush can cause gums to wear away. Using too much force can also cause gums to recede over time. As the gums recede, the roots of the teeth are exposed. This may cause the teeth to become sensitive to hot and cold temperatures. In addition,teeth with significant amounts of gum recession are more prone to developing root cavities. Periodontist can treat recession by taking gum tissue from onepart of your mouth and moving it to the area where the gums have receded. This is known as a soft tissue graft.Treatment of Gum OvergrowthFor some people, the problem isn't too little gum tissue, but too much. Some people have what is known as a "gummy smile," in which the teeth look very small and the gums seem very large. Also, some medications, such as phenytoin (Dilantin and other brand names), cyclosporine (Neoral, Sandimmune) and nifedipine (Adalat,Cardizem), can cause an overgrowth of gum tissue. Periodontists can remove excess gum tissue through a procedure known as Gingivectomy.Scaling and root planingWhat Is It?Scaling androot planing is the most common and conservative form of treatment forperiodontal (gum) disease. Scaling is the removal of calculus (commonly calledtartar) and plaque that attach to the tooth surfaces, especially below the gumline along the root surface. Because plaque is more likely to stick to roughsurfaces, the root surface is smoothed down in a process called root planing.Root planing removes any remaining calculus and smoothes root-surfaceirregularities.Plaqueis a sticky substance, full of bacteria, that usually forms on your teeth. Whenplaque hardens over time, it is called calculus.What It's Used ForScaling and root planing are done to remove the irritants (plaque and calculus) that can cause periodontal disease. For early stages of the disease, especially gingivitis,this treatment may be all that is needed to get the condition under control.With more advanced gum disease, this may be the first step before moving on to surgical treatment.PreparationFor somepatients, scaling and root planing can cause discomfort. A local anesthetic maybe used to numb the portion of your mouth that is being worked on.How It's DoneScaling and root planing are done with a combination of ultrasonic scalers and hand instruments. Ultrasonic instruments are electric or air-powered devices that have two components: a relatively dull metal tip that vibrates at a very high frequency and "knocks" plaque and calculus off the tooth, and a water irrigation system that cools the tip and helps to flush out debris from around the teeth. Hand instruments are not powered. They have cutting edges and are pressed against your teeth by your dentist or hygienist. These instruments come in various shapes and sizes. Different instruments are used for different teeth, and even for different surfaces of the same tooth.Typically, ultrasonic instruments are used first to remove large deposits of plaque and calculus from the crowns and roots of the teeth. Hand instruments called scalers and curettes then are used to remove any remaining material and make sure that the tooth surface is clean and smooth. When working under the gumline, your dentist or hygienist cannot see the plaque or calculus, so he or she will rely on the sense of touch to feel for roughness on the root surface.If you have gingivitis (the earliest stage of gum disease) or localized periodontitis (more advanced gum disease located in only one part of your mouth), scaling and root planing usually can be completed in one visit.However, if you have periodontitis throughout your mouth, your Periodontist typically will do a quarter of your mouth (a quadrant) at a time. This means that four visits will be necessary to complete the scaling and root planing.Follow-UpFor two to three days after the treatment, you may have some soreness and sensitivity to hot and cold temperatures. Over-the-counter pain relievers can relieve this discomfort.You may be asked to use an antiseptic mouth rinse after scaling and root planing,especially when soreness of the gums prevents effective oral hygiene measures. However, brushing and flossing should be continued as usual. Some minor bleeding can be expected the first days after scaling and root planing, but this usually stops within a week.RisksTreating periodontitis decreases gum inflammation and also eliminates periodontal pockets,which can trap plaque. Therefore, if treatment is successful, your gums will shrink or recede. The extent of shrinkage depends on the initial depth of the pocket and the severity of periodontitis. The more severe the disease, the larger the recession of the gums after successful therapy. As a result, some part of the root is exposed, making the tooth look longer and making it more sensitive to hot and cold temperatures. To prevent root cavities, your dentist may prescribe a fluoride-containing gel, and will emphasize the importance of good plaque control.Ifyour medical doctor has told you that you need to take antibiotics beforecertain dental procedures, you should inform your dentist or hygienist aboutthis before you undergo scaling and root planing.Soft-tissue graftsWhat It InvolvesThere are three different types of soft-tissue grafts: free gingival graftsconnective-tissue grafts pedicle grafts.In a free gingival graft, a small strip of flesh is removed from the roof of the mouth. The tissue, called the "graft," is then stitched to the existing gum tissue in the area being treated. This is often used for people who naturally have minimal amounts of gum tissue around their teeth and need to have them enlarged.In a connective-tissue graft, a flap is cut in the roof of the mouth, forming a"trap door." The tissue under the flap is removed. The flap is then stitched over the area. The tissue that was removed, known as sub epithelial connective tissue, is then slipped under the gum tissue surrounding an exposed root surface and anchored in place with sutures. This is the most commonly used procedure for treating root exposure.In a pedicle graft, a flap of tissue from around an adjacent tooth is partially cut away with one edge still attached. The flap, also called a pedicle, is then slid sideways to cover the exposed root, and is stitched in place. A pedicle graft can be more successful than a free gingival graft because at least some of the blood vessels that feed the grafted section remain in place. However, a pedicle graft can be done only if an adjacent tooth has enough gum tissue to"share" with the tooth being treated.Withall of these procedures, many Periodontist will use periodontal packing tocover and protect the grafted tissue for the first week or two of healing.Discomfort FactorWith free grafts and connective-tissue grafts, you will have two wounds, near the tooth and on the roof of your mouth, where the graft tissue was removed. The wound on the palate is often described as feeling like a significant pizza burn. Prescription pain medication can help control discomfort after surgery.AftercareKeeping the mouthclean is important, so unaffected teeth will have to be brushed and flossed asusual. Mouth rinses that contain chlorhexidine usually are prescribed to assistin plaque control during the healing period. Antibiotics may be prescribed, butusually are not.Side Effects of TreatmentTypically, there are no long-term side effects aftersoft-tissue grafting. In some cases, the new gum tissue may need some reshapingusing a procedure called gingivoplastyto make the gum look as natural as possible.Crown lengtheningWhat Is It?This common procedure involves the removal of gum tissue, bone or both to expose more of a tooth's structure.What It's Used ForCrown lengthening is done when a tooth needs to berestored, but there is not enough tooth structure above the gum line to supporta fillingor a crown.This can happen when a tooth breaks off at the gum line, or a crown or filling falls out of a tooth that has extensive decay underneath. If your dentist wants to repair the tooth using a crown or a large filling, he or she may need to expose more of the tooth by removing some soft tissue or bone.In rare cases, a condition called gummy smile — when an unusually large amount of gum tissue shows around the upper teeth — can be treated using crown lengthening.PreparationYou will visit a Periodontist for a consultation before the procedure. During the consultation, the specialist will review your medical history and your X-rays,and set a date for the surgery.Your Periodontist will instruct you on how to keep the area clean after the surgery. You may receive a tooth cleaning before the procedure.If the tooth needs a crown, your Periodontist may have a temporary crown put on the tooth to protect it. This also makes the crown-lengthening procedure easier because the tooth is already prepared for the crown, and the Periodontist can see precisely how much soft tissue or bone will need to be removed.Oncethe area has healed completely — in about three months — your dentist willprepare the tooth again, and make a new temporary crown before making the finalcrown.How It's DoneThis procedure is done under local anesthesia. The amount of time it takes varies depending on the number of teeth that requires treatment. Although your problem may involve only one tooth, crown-lengthening surgery typically includes neighboring teeth so that the tissues can be reshaped gradually. If only soft tissue is removed, the procedure probably will take less time than if both soft tissue and bone are removed.The Periodontist will make incisions to "flap" the gums away from the teeth. This provides access to the roots of the teeth and the surrounding bone.In some cases, by simply removing a little gum tissue when the incisions aremade, enough tooth structure will be exposed for your dentist to place a crownof filling. However, in most situations it will also be necessary for the Periodontist to remove some bone from around the roots of the teeth. The bone is removed using a combination of hand instruments (resembling chisels) and rotary instruments (similar to the drill and burs used to treat cavities).Oncethe Periodontist is satisfied that enough tooth structure is exposed, thesurgical area will be washed with sterile salt water and the flaps will bestitched together. At this point, your teeth will look longer because the gumsare now sitting at a lower level then before the surgery. Some dentists use aperiodontal dressing — called an intraoral bandage — to cover the surgicalsite.Any temporary crowns will be removed before the procedure begins and replaced afterward.The Periodontist will make incisions to remove the soft tissue and to provide access to the tooth roots and the underlying bone. Bone removal allows more of the tooth structure to be exposed. If this is necessary, the bone is removed using a combination of hand instruments (like small chisels) and rotary instruments (similar to the drill used to treat cavities).After the soft tissue and bone have been removed, the incisions are sutured. This will cause more of the tooth or teeth to be exposed. Some dentists use a periodontal dressing to cover the incisions.You will be given prescriptions for pain medication and a chlorhexidine mouthrinse. Your dentist will review oral-hygiene instructions, and ask you to follow a somewhat soft diet. You can brush the teeth in the area that was worked on, but you should avoid the gums. You can remove food particles around the affected teeth with a toothpick or a water irrigator.Follow-UpFor the first day, use ice on your face to keep swelling down.After the procedure, you will return to the Periodontist in 7 to 10 days to have the sutures removed, and then return again 4 to 6 weeks later for a follow-up visit.Your gums should heal for at least three months before the tooth is prepared for the final crown. If you don't wait this long, the gums may shrink as they heal and the margins of the crown could show, or other problems could develop. You will visit your regular dentist to have the crown or filling placed, and then again for a follow-up visit.RisksAs with all surgical procedures, there is a risk of prolonged bleeding during crown lengthening, as well as a risk of developing an infection after the procedure.Additionally, many patients will experience sensitivity to hot and cold because the roots of the teeth are now exposed. This will go away when the roots are covered with new temporary crowns.Becauseof the tissue and bone removal, the affected tooth may look longer thanadjacent teeth. However, this is only a cosmetic consideration.Removing bone from around a tooth can loosen it. In addition, if the tooth is ever lost,the removal of bone could reduce the chances of successfully placing a dental implant in that area. Your Periodontist will consider these details during your consultation.Maintenance TherapyPeriodontal disease is a chronic (long-lasting) problem and can return without regular dental care and careful attention to oral hygiene at home. Therefore, one ofthe keys to successful nonsurgical or surgical treatment for periodontal disease is regular follow-up care.Maintenance therapy appointments are usually one-visit sessions with your dentist or periodontist or their hygienists. These visits can be scheduled between two and four times a year depending on the severity of your periodontal condition,whether you have a history of recurrent periodontal disease, and whether you demonstrate an increased susceptibility to the disease. You also may need more frequent visits if you smoke or have another disease that increases your risk of periodontal disease.A typical maintenance visit will include:If you have teeth that are very sensitive, your dental professional may need to apply a dental anesthetic in order to clean them. Either a topical or an injectable anesthetic can be used.If your dentist or Periodontist determines during your maintenance appointment that your periodontal disease continues to return, he or she will discuss appropriate treatment with you. Proper follow-up care should minimize the likelihood of the disease returning. Also, if your disease does return, it tends to be rather localized and more easily treated than in people who forgo maintenance care for long periods of time.Antimicrobial therapyWhat Is It?Antimicrobialtherapy refers to the use of chemical agents that either kill or inhibit thegrowth of bacteria that cause periodontal(gum) disease. The two most common forms of antimicrobial therapyare antiseptics and antibiotics. Products containing antiseptics are usuallyused to help prevent periodontal disease, while antibiotics are used to treatperiodontal disease. Antiseptics are found in oral rinses. This articlepresents information on antibiotics that are placed under the gums or given aspills, typically in conjunction with a procedure called scaling androot planing.What It's Used ForBecause periodontal diseases are caused by bacteria, dentists and Periodontist (who specialize in treating gum disease) may use antibiotics to help treat them. In dentistry, antibiotics are commonly prescribed for the treatment of an acute (sudden and short-term) infection in the gums called an abscess. Antibiotics are also used to treat other conditions.Antibiotics usually are given to supplement the beneficial effects of scaling and root planing, a common treatment for periodontal disease. Although many forms of periodontal disease are successfully treated using this combined approach, other situations may require additional treatment, including periodontal surgery.Because periodontal diseases are caused by bacteria, you may be wondering why antibiotics aren't considered a routine part of periodontal therapy. In today's world, health professionals are extremely concerned about bacteria becoming resistant to the effects of antibiotics. This can happen when antibiotics are overused or when prescriptions are not taken exactly as instructed by your dentist or physician. Therefore, because most forms of gingivitis and periodontitis can be successfully treated without antibiotics, these drugs are avoided unless absolutely necessary.PreparationOnce yourdentist has decided on an antibiotic, you will have scaling and root planing.This procedure removes plaque and calculus (tartar) from under your gum lineand smoothes any bumps or irregular areas on your tooth roots, where plaque canaccumulate easily.Becausescaling and root planing, as well as local delivery of antibiotics, can besomewhat uncomfortable, these procedures usually are done under localanesthesia. You will be given an injection to numb the area.How It's DoneAntimicrobialtherapy for periodontal disease can be given in pill form or applied directly.If you are given antibiotics in pill form, you will take them for 7 to 10 days.Localtherapy is given in the dentist's chair and involves placing the antibioticdirectly into the affected parts of your mouth. There are several types oflocal therapy, including:Follow-upIt is extremely importan tthat you practice ideal oral hygiene. Brush at least twice a day for at leasttwo minutes per session, and floss at least once a day.Take your medication exactly as directed for the full amount of time prescribed.This reduces the risk that surviving bacteria will become resistant to themedication, and helps to make sure that the medication works as intended.Local antibiotic therapyAfter the placement of local antibiotics, you may feel something under your gums, but it shouldn't be uncomfortable. Avoid flossing the treated teeth so you do not dislodge the medication. Sometimes the dentist will place a covering called a periodontal pack around the gums. If you receive a periodontal pack, do not disturb it.Your Periodontist will want to examine you again in 7 to 10 days to remove the periodontal pack and/or the remnants of the antibiotic. After this, you can resume your standard brushing and flossing routine.Both types of antimicrobial therapyYour dentist will check you again after two or three months to see if the therapy is helping. If your disease does not respond to antibiotics, the next step will depend on several factors, including the severity of your disease. Your dentist can prescribe a different antibiotic or schedule periodontal surgery. Some people may receive several rounds of antibiotics before their disease responds.Once you have had successful treatment for periodontal disease, it's important to help keep the disease under control. Maintenance therapy involves regular visits to your dentist or Periodontist,which can include:RisksThe major risk of antibiotic therapy is an allergic reaction to the medication. If you know you are allergic to certain antibiotics, it is important that you tell your dentist. If you are not aware of an allergy and experience any adverse reaction (such as rash, hives or stomach upset) after you have taken an antibiotic, stop taking the drug and contact your dentist. You may need to switch to another antibiotic.Inappropriate use of antibiotics can lead to the bacteria becoming resistant to the antibiotics' effects. Therefore, it is up to your dental professional to use antibiotics appropriately. It also is important for you to follow instructions for taking the medication and take all of the medication prescribed.GingivectomyWhat Is It?Gingivectomy refers to the surgical removal of gum tissue (gingiva). Gingivoplasty is the surgical reshaping of gum tissue around teeth with healthy gums. Both procedures typically are performed by Periodontist, dentists who specialize in treating gums and the other supporting structures of your teeth.What It's Used ForGingivectomy originally was developed to treat periodontal disease. Today, Gingivectomy is more commonly used as a cosmetic technique. Gum tissue may need to be removed for two reasons:Reshaping the gums through gingivoplasty can help gums look more natural. This procedure can be used to correct malformed or asymmetrical gums caused by genetics,disease or trauma, and might be done solely for cosmetic purposes.Gingivoplasty often is done alone, but can be done during or after a Gingivectomy or a gum graft (which adds tissue to the gum line).PreparationBefore eitherprocedure, your Periodontist will talk to you about oral hygiene after theprocedure and any other instructions you will need to follow. Before a Gingivectomyor gingivoplasty, you should receive a thorough cleaning and, possibly, root planing,to remove tartar (calculus) from existing pockets.How It's DoneGingivectomyand gingivoplasty usually are done with scalpels, but also are done with electrosurgery units, lasers and/or diamond dental burs. Your Periodontist also mightuse specialized instruments that were designed for Gingivectomy, with angledblades to help them get around teeth.Beforeeither procedure, you will receive a localanesthetic by injection to numb your gums. A Gingivectomy can takefrom a few minutes to more than an hour, depending on how much tissue is beingremoved. Gingivoplasty typically are done in a couple of minutes.Follow-UpAfter a Gingivectomyor gingivoplasty, a type of bandage called a periodontal dressing will beplaced on your gums. This usually is left in place for a week to 10 days,during which you will need to follow a somewhat soft diet and avoid spicy andcrunchy foods. Your dentist might give you prescriptions for pain medicationand a chlorhexidine mouthwash.Itis very important to keep your mouth clean during the healing period. You willbe advised not to brush your teeth in the surgical area while the pack is inplace. You will be able to brush and floss the rest of your mouth normally.When the pack comes off, you can brush and floss your teeth normally, butgently. It is not uncommon for the healing tissues to bleed when you floss orbrush immediately after the dressing is removed.After7 to 10 days, you will return to your Periodontist to have the pack removed.Your gums will begin to look normal in three to four weeks, but it can take twoto three months for the tissue to heal completely.RisksThere are no major risks to either procedure. Infection is very rare. Bleeding is a possibility, but also is rare. The affected area might ooze blood for the first 24 to 48 hours, but after that, it should not bleed much, if at all.Osseous surgeryWhat Is It?Osseous surgery is a procedure that reshapes the bone that holds a tooth or teeth in place.What It's Used ForOsseous surgery is a treatment for the gum disease called periodontitis.People with periodontitis develop holes called defects in the bone surrounding their teeth. Osseous surgery reshapes the bone to get rid of the defects. This procedure is often used to treat bone loss around multiple teeth.PreparationYou need toundergo initial periodontal therapy (scaling and root planing) before yoursurgical appointment. You also must have a good level of oral hygiene. A localanesthetic is used to numb the area for surgery.How its DoneThe Periodontistwill separate the gums from your teeth to gain access to the roots andsurrounding bone. After the roots have been thoroughly cleaned, a drill(similar to the one used to treat dental decay) and sharp hand instruments areused to reshape the bone around the teeth. Bone is removed in certain areas torestore the normal rise and fall of the bony cup, but at a lower level. Imaginethat you have a scarf that has frayed along one edge and you decide to trim offthe frayed part. The damage is gone, but the scarf is shorter. The gums arethen placed back over the remaining bone and stitched in place.Follow-UpPain medications may be prescribed to ease discomfort after surgery.Itis very important for you to keep your mouth as clean as possible while the surgical site is healing. This means you should brush and floss the rest of your mouth normally. If the surgical site is not covered by a periodontal pack,you can use a toothbrush to gently remove plaque from the teeth. Antimicrobial mouth rinses containing chlorhexidine are commonly prescribed after periodontal surgery. Although these rinses do not remove plaque from the teeth, they kill bacteria and help your mouth heal.You may also have some swelling after surgery. This can be minimized by applying a nice pack to the outside of your face in the treated area. In some situations,antibiotics may be prescribed to prevent an infection and these should be taken as instructed. Your Periodontist will want to reexamine the area in 7 to 10days.RisksAfter the surgery, you may have some bleeding and swelling. There is a risk that you could develop an infection.Your gums in the area that was treated are more likely to recede over time. The teeth that were treated may become more sensitive to hot and cold and may develop cavities in the roots.Gingival flap surgeryWhat Is It?Gingival flap surgery is a procedure in which the gums are separated from the teeth and folded back temporarily to allow a dentist to reach the root of the tooth and the bone.What It's Used ForGingival flaps urgery is used to treat gum disease (periodontitis).It may be recommended for people with moderate or advanced periodontitis,especially if the initial, non-surgical treatment (scaling and root planing) has not eliminated the gum infection. It may also be done in conjunction with another procedure known as osseous(bone) surgery.PreparationYour periodontist or your dental hygienist will first remove all plaque and tartar (calculus)from around your teeth and make sure that your oral hygiene is good. Before flap surgery, your periodontist will determine whether your general health or your current medications allow for a surgical procedure to be carried out.How It's DoneAfter numbing the area with a local anesthetic, the Periodontist will use a scalpel to separate the gums from the teeth and then lift or fold them back in the form of a flap. This gives the Periodontist direct access to the roots and bone supporting the teeth. Inflamed tissue is removed from between the teeth and from any holes (defects) in the bone. The Periodontist will then do a procedure called scaling and root planing to clean plaque and tartar. If you have bone defects, your Periodontist may eliminate them with a procedure called osseous recontouring, which smoothes the edges of the bone using files or rotating burs.After these procedures are completed, the gums will be placed back against the teeth and anchored in place using stitches. Some Periodontist use stitches that dissolve on their own, while others use stitches that have to be removed a week to 10 days after the surgery. Your Periodontist may also cover the surgical site with an intraoral bandage known as a periodontal pack or dressing.Follow-Upyou will have mild to moderate discomfort after the procedure, but the Periodontist can prescribe pain medication to control it. Many people are comfortable with just an over-the-counter pain reliever.Itis very important for you to keep your mouth as clean as possible while the surgical site is healing. This means you should brush and floss the rest of your mouth normally. If the surgical site is not covered by a periodontal pack,you can use a toothbrush to gently remove plaque from the teeth. Anti microbial mouth rinses containing chlorhexidine are commonly prescribed following periodontal surgery. Although these rinses do not remove plaque from the teeth,they kill bacteria and help your mouth to heal.Youmay have some swelling, and this can be minimized by applying an ice pack to the outside of your face in the treated area. In some situations, antibiotics maybe prescribed to prevent an infection, and these should be taken as instructed.Your Periodontist will want to reexamine the area in 7 to 10 days.RisksAfter the surgery, you may have some bleeding and swelling. There is a risk that you could develop an infection.Your gums in the area that was treated are more likely to recede over time. The teeth that were treated may become more sensitive to hot and cold. The teeth also are more likely to develop cavities in the roots.Bone graft (regenerative surgery)What Is It?A bone graft(regenerative surgery) is a procedure that is used to recreate hard and soft supporting tissues lost due to gum disease.What It's Used ForRegenerative surgery is a treatment for the gum disease called periodontitis.People with periodontitis lose gum coverage and bone support around their teeth. Regenerative surgery regrows these lost tissues.PreparationYou need to undergo initial periodontal therapy (scaling and root planing) before your surgical appointment. You also must have a good level of oral hygiene. A local anesthetic is used to numb the area for surgery.How It's DoneThe goal of regenerative surgery is to coax the body into rebuilding the structures that attach a tooth to the jaw, including bone. The Periodontist will separate the gums from your teeth to gain access to the roots and surrounding bone. The roots will be thoroughly cleaned. The holes (defects) in the bone are filled in with a graft material and covered with a physical barrier.Bone grafting materials commonly used include bits of a patient's own bone, cadaver bone, cow bone and synthetic glasses. The patient's own bone is preferable. The barriers, used to prevent soft tissue from growing into the bony defect, are made from human skin, cow skin or synthetic materials.The gums are then repositioned over the treated site and secured in place with stitches. During the next six to nine months, your body fills in the periodontal defect with new hard and soft tissue, effectively reattaching the tooth to your jaw.Follow-UpPain medications may be prescribed to ease discomfort after surgery.Itis very important for you to keep your mouth as clean as possible while the surgical site is healing. This means you should brush and floss the rest of your mouth normally. If the surgical site is not covered by a periodontal pack,you can use a toothbrush to gently remove plaque from the teeth. Antimicrobial mouth rinses containing chlorhexidine are commonly prescribed after periodontal surgery. Although these rinses do not remove plaque from the teeth, they kill bacteria and help your mouth heal.You may also have some swelling after surgery. This can be minimized by applying a nice pack to the outside of your face in the treated area. Antibiotics usually are prescribed to prevent an infection and these should be taken as instructed.Your Periodontist will want to reexamine the area in 7 to 10 days.RisksAfter the surgery, you may have some bleeding and swelling. There is a risk that you could develop an infection.Your gums in the area that was treated are more likely to recede over time. The teeth that were treated may become more sensitive to hot and cold and may develop cavities in the rootsPeriodontal Examination and ProbingA periodontal examination and probing is one way your general dentist or dental specialist can evaluate the health of your gums and teeth. They help your dentist diagnose the gum diseases gingivitis and periodontitis and also check for receding gums, exposed roots, tooth grinding (bruxism),and other problems.Periodontal measurements can be taken by any dentist or dental specialist, as well as by dental hygienists. If you are referred to a Periodontist (gum-disease specialist) for evaluation, these measurements will be taken during your first visit.

Relationship between Gum Diseases & Heart Attacks

Dr. Swasti Jain, Dentist
The bacteria in gum disease can enter your bloodstream through damaged blood vessels which run through the gums. This can increase the toxins in your bloodstream According to a recent study  2 kinds of bacteria breeding in dental plaque around inflamed gums can bring about "blood clumping". This is technically speaking the first step towards forming a clot that can trigger a heart attack, it appears that we should add "periodontal disease" to the standard risk factors like high cholesterol, lack of exercise, poor diet, and being overweight.The most noteworthy finding was that gum disease and poor oral hygiene are stronger indicators of risk of total mortality than were coronary artery disease. Studies show that the oral bacteria, "Streptococcus sanguis" does cause the clumping of blood platelets. This clumping can be the first stage in the development of a blood clot -- the cause of a heart attack. The periodontal infection would reduce the health of the lining of the gum tissues which, in turn, can allow bacteria from the mouth to enter into the underlying tissues (5).Patients with periodontitis have significantly higher levels of inflammatory products (fibrinogen and white blood cells) which are well-known risk factors for acute heart attacks.Dental bacterial components affect the body's response to infection and can play a role in the development of atherosclerosis.New development in medical research is further raising concerns that bacteria can cause heart attacks. One bacteria, "Chlamydia pneumonia" has been found in the walls of the blood vessel of patients who have had heart attacks.You must practice proper oral hygiene to treat gingivitis. You should also cut back on any smoking and control your diabetes. Other treatments include deep cleaning your teeth, antibiotic medications, and surgery.There are several techniques that can be used to deep clean your teeth without surgery. They all remove plaque and tartar to prevent gum irritation.Scaling removes tartar from above and below the gum line.Root planing smoothes rough spots and removes infected tooth parts.Lasers may remove tartar with less pain and bleeding than scaling and root planing.