Gum disease treatment

Gum disease is the inflammation of the gum margin that can progress to affect the bone that surrounds and supports your teeth. The three stages of gum disease — from least to most severe — are gingivitis, periodontitis and severe periodontitis.

https://www.mayoclinic.org/diseases-conditions/gingivitis/symptoms-causes/syc-20354453

https://www.mayoclinic.org/diseases-conditions/periodontitis/symptoms-causes/syc-20354473

Food and bacteria combine to form plaque, which causes inflammation of the gums and lead to gingivitis. However, plaque can also calcify to become tartar and the body will mount an immune response to the plaque or tartar. This inflammatory response can attack the surrounding bone and gums and a gum pocket can form. Tartar will then continue to form underneath the gums, creating a vicious cycle of destruction and deepening gum pockets. Eventually, if left untreated, the whole tooth can start to shake and fall out of the mouth. Yes, we all grow old and get “longer in the tooth”. but there are steps and treatments that slow down that process and keep those pearly whites in your mouth much longer! (And keep you looking fresh and young looking as well!)

Many people dislike going to the dentist as they find dental scaling and gum treatment very uncomfortable! Most patients don’t like the feel of the vibrations, the extreme tooth sensitivity when the teeth are cleaned, and the sound of the instruments against the teeth. Don’t worry though, we hear you and we got that covered!

At An Dental, you can request for the EMS AIRFLOW machine which makes the gum infection treatment process so much more comfortable. This machine cleans teeth with much-reduced teeth sensitivity because:

• the vibration is gentle and the noise level is very low
• it uses warm water that is soothing for the teeth
• the scaling tip moves in a very gentle up-down motion that does not hurt the teeth by knocking into it
• the AIR-FLOW® PLUS powder is the most finely grained cleaning particle in the world of dentistry. This type of powder efficiently removes plaque and stains whilst being very gentle on the teeth and gums

All these makes for a very comfortable, gentle gum treatment experience and is especially recommended for people with dental phobia.

In general, gum treatment is divided into non-surgical and surgical gum treatment.

Non-surgical gum treatment involves scaling and root planing and is usually the first line of treatment when we first see patients with gum disease. (Surely you would prefer conservative treatment as a first-line instead of surgery directly yah?)

Surgical gum treatment is usually only done when there are residual pockets that cannot heal from non-surgical gum treatment. This comprises pocket reduction surgery and regenerative surgery

What is scaling and root planing (deep cleaning)?

Scaling and root planing is the removal of tartar, bacteria and food from the gum pocket. We use ultrasonic or hand instruments to do that and to ensure that the root surfaces are fresh and clean for optimum healing. https://aap.onlinelibrary.wiley.com/doi/abs/10.1902/jop.1981.52.3.119

Who needs scaling and root planing?

People with gum disease, and who have tartar in their gum pockets need scaling and root planing.

Why do scaling and root planing?

Scaling and root planing is done to flick the nidus (which is tartar in this case) out from your gums. Without this “irritating” substance in your gums, your gums can attach back to your teeth and the pockets can heal. So this treatment initiates the healing process by reducing the amount of inflammation in the area.

How are scaling and root planing done?

We use an instrument to cleanse the area between the gums and the tooth. When someone has gum disease, this gum pocket traps a lot of black tartar. So we use a light vibratory ultrasonic tip to jiggle out the tartar. The tartar then pops out from your gum pockets like blackheads. (ever watched Dr Pimple Popper?) We also use hand instruments to smoothen the root surface and to remove super fine pieces of tartar. If the pockets are very deep, we give a topical and local anaesthetic to numb the area for a more comfortable experience!

Postoperative care

Most of the time, there is no downtime if no local anaesthetic is needed. Most people are able to go straight back to work or to their kids! If you opt to use local anaesthetic though, you will just need to wait for the effects of the local anaesthetic to wear out and your gums should feel normal. There are some people who experience some mild bleeding and mild discomfort post-procedure. If you do, please take some light painkillers like Panadol (assuming you are not allergic to it) and you will be fine!

What is pocket reduction surgery?

It is a surgery to reduce the depth of the gum pocket (ideally to reduce to 5mm and below) so less food and bacteria get trapped in the pocket. It changes the type of bacteria in the pocket to make it less toxic to the body. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-051X.1995.tb00261.x This is to make sure the gum condition will not worsen.

Who needs pocket reduction surgery?

People who have gone through scaling and root planing and yet still have deep gum pockets that measure 6mm and above.

Why do pocket reduction surgery?

Studies show that when the gum pocket depths remain at 6mm and above even after scaling and root planing treatment, periodontal conditions are not stable and can continue to worsen. https://www.ncbi.nlm.nih.gov/pubmed/18549447
It is likely because the toothbrush bristles can only extend to 5mm below the gum line into the pocket to clean it out! Anything deeper than that and the bristles are unable to fish the bacteria and food out.

How is pocket reduction surgery done?

Local anaesthesia is given and we gently shift the gums away to expose the tartar on the tooth root. We then use an instrument to first thoroughly cleanse the area between the gums and the tooth. All the tartar is removed and the root surface is smoothened; the bone is also thoroughly cleaned and shaped to remove any infected material. Once the tooth root is clean, we trim away the excess gums and replace the gums in a new position so it can stick back to the tooth surface more easily and the deep pockets that trap bacteria are eliminated.

What is regenerative surgery?

Regenerative surgery is done to grow the bone and surrounding soft tissues back. Bone is lost in Periodontitis due to bacterial attack and the inflammatory process. Scaling and root planing usually arrests the gum disease, but now we are also able to grow the lost gum and bone back under certain conditions. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001724.pub2/abstract

Who needs regenerative surgery?

People who have lost bone in an angular/ cup shape defect due to gum disease. These cup-shaped defects are called infrabony defects. https://onlinelibrary.wiley.com/doi/abs/10.1034/j.1600-0757.2000.2220108.x Where is is a lot of bone loss around the teeth, some teeth may become shaky. Also, some pockets do not heal as the gum tissues is unable to stick back to the tooth.

Why do regenerative surgery?

Sometimes, even after the pocket heals, the tooth is still mobile. In some cases, we want to grow the bone back and reverse the gum disease process to allow the tooth to firm up. There are also individuals who have pockets that do not heal well from scaling and root planing because the pocket is too wide. So we may need to put in some wound healing and growth factors into the gum pocket and provide a scaffold for new gums and bone to grow. https://aap.onlinelibrary.wiley.com/doi/abs/10.1902/jop.1993.64.10.934

How is regenerative surgery done?

Local anaesthesia is given and we gently shift the gums away to expose the infected bone and tartar on the tooth with an infrabony defect. We then use an instrument to first thoroughly cleanse the area between the gums and the tooth. All the tartar is removed and the root surface is smoothened, the bone is also thoroughly cleaned to remove any infected material. Once the root surface and bone are clean, we check the shape and size of the bone defect.

Regenerative surgery can only be done if the residual bone defect is able to contain the bone graft or wound stimulating factors. Sometimes a dissolvable collagen membrane may also be placed to contain the bone graft and keep the new bone particles in. This point is to create a good blood clot to enhance the gum healing process and to grow new bone around the tooth!

Post-operative care

Activity: It is recommended that you restrict your activity on the day of and the day after surgery. Typically, patients return to work or school the following day. It is in your best interest not to participate in any physical activity for at least two days following surgery. Avoid sleeping on the side where surgery was done. Smoking is not advised 7 to 14 days after surgery.

Medications: You may experience some discomfort as the local anaesthetic wears off. If a medication is prescribed or recommended, you are advised to take it as directed, even if you initially do not have much discomfort – it is much easier to prevent discomfort than it is to treat it once it occurs.

Swelling: Some swelling is normal following surgery and should reach its peak by 48 hours. For the first 24 hours following surgery, apply an icepack on your face, outside the operation site, for 15 minutes on/15 minutes off. A reusable ice bag or a frozen vegetable bag, wrapped in a soft towel, may be used as an ice pack. After the first 24 hours, warm, moist heat may be applied to the area to break down the blood clot. You may get a towel and wet with some warm water from a bowl or tap. Wring dry then apply to your face. Keeping your head elevated above your heart will also help. Most swelling can occur in the morning and up to 3 days after surgery. Avoid sleeping / laying on the side that surgery was performed.

Bleeding: A small amount of oozing for the first 24 hours following surgery is normal. If slight bleeding is noted gently apply moderate pressure to the area with gauze for 20 minutes. If you run out of gauze, get a caffeinated tea bag and run it under distilled or clean water. Squeeze dry and place it with compression onto the area with bleeding. The caffeine will cause the blood vessels to constrict and reduce bleeding. Don’t rinse too hard or spit forcefully! If bleeding cannot be controlled, contact An Dental at Tel 85889868.

Mouth Care: Please refrain from pulling on your lips and keep your TONGUE and fingers away from the surgical site. Minimizing post-surgical movement and trauma will help the site to heal faster and more effectively. Sutures have been placed and will either be removed in 1-2 weeks or resorb away on their own. The sutures may also become loose as the surgical site heals. Please refrain from smoking during the healing phase.

Diet: Avoid hot, spicy, brittle, or abrasive foods following surgery. Often a soft diet is best for the first 24 hours. Minimize chewing on the side where surgery was performed. A balanced diet is important for optimal healing.

Oral Hygiene: Refrain from brushing the surgical area until instructed. You have been given a prescription for Chlorhexidine. Beginning 24 hours after surgery, begin rinsing your mouth twice a day for 30 seconds. Also, do not eat or drink anything for 30 minutes following rinsing. Side effects of this mouth rinse may include staining and taste alterations, which are reversible.

Follow-up appointments: You will be scheduled to return to our clinic for a follow-up appointment at 1-2 weeks. This is a short appointment (20 minutes) and is very important. At this time, sutures may be removed and additional oral hygiene instructions are given.