Patients in their daily lives do experience symptoms like bleeding gums while brushing teeth, swollen red gums, bad breath, loose teeth, itchy gums, food lodgement into spaces between teeth, salty discharge from certain areas, etc.
These are actually the manifestation of periodontal diseases like gingivitis and periodontitis. Pyorrhoea is the layman term rather known to the general Nepalese population which is actually periodontitis.
Gingival and periodontal diseases initiate due to the accumulation of plaque which are the accumulation of bacteria aided by salivary pellicle. It takes a day to call it a fully developed plaque and is visible on tooth surface after 4 days.
Usually, plaque initiate from necks of teeth and interdental areas where they are accumulated most commonly, and then grow towards crowns of teeth. Rough surfaces like crown margins, denture bases, implant abutments, etc., retain more plaque than clean and polished surfaces. Plaque also forms more in the lower jaw, molar areas, interdental areas and buccal areas of teeth than lingual or palatal areas.
But surprisingly plaque growth decreases at night by 50% due to decrease in salivary flow because the plaque formation requires nutrients from saliva. It is also to be taken into account that the plaque doesn’t get spontaneously removed during eating fibrous foods since they are firmly attached to tooth surface.
Plaque when left undisturbed can lead to its calcification within 4-8 hours to form calculus. These hard deposits serve as a fixed nidus for the continued accumulation of plaque and retains it in close proximity with ginigiva.
Although, the main etiology behind gingival and periodontal diseases is bacterial plaque, the removal of plaque and calculus remain the cornerstone of periodontal treatment. Other factors that can predispose to plaque and calculus formation are crowded teeth, tobacco products, orthodontic therapy, mal adjusted dentures, ill-fitting restorations, etc.
Some systemic diseases like diabetes mellitus can also predispose to periodontal disease. Gingval overgrowth can be seen in patients taking medications like phenytoin (for epilepsy), amlodipine(for hypertension)and cyclosporine (as immunosuppressant). Physician consultation is necessary in these conditions.
The most common periodontal diseases are gingivitis and periodontitis
Gingivitisis simply the inflammation of gums which presents as redness in gums and bleeding while brushing without bone loss. Periodontitis (Pyorrhoea) is the inflammation of supporting tissues of teeth (which are present around the root of teeth) which also show bone loss.
Bleeding while brushing or eating has to be the 1stself-reported sign of disease occurrence which is accompanied by itchy gums, food impaction between teeth, black triangles between teeth, sensitivity due to lowering of gingival position (gingival recession), loose tooth, or even tooth loss in advanced disease.
Prevention of the periodontal disease requires meticulousoral hygiene maintenance which is daily brushing, flossing, rinsing with mouthwashes, visiting a dentist regularly and refraining from adverse habits like tobacco chewing. Modified Bass method
using a medium or soft bristled tooth brush having a fluoridated tooth paste is the best brushing technique. Hard brush can lead to abrasion of teeth which can cause dental sensitivity.
Powdered form of toothpaste contains maximum abrasives; so should not be used. Gel and paste forms are indicated. Brushing has to be practiced twice daily; once in the morning and another at bedtime to remove maximum plaque. More than twice daily brushing is not beneficial. 2-3 minutes brushing time is adequate.
Powered or electronic toothbrushes are also available which can be beneficial for child or elderly people or physically disabled patients or orthodontic patients. Dental floss help to remove plaque from interdental regions where brush can’t reach .
Dental floss with handles are also available which are easy to work with. Rinsing after meals help to remove the sticky foods from the occlusal and interdental areas. Tongue brushing is also recommended with soft bristled tooth brush.
The brush can be changed after the bristles of the brush fray or usually in a 2-3 month period. In this COVID-19 lockdown time, these home hygiene measures are to be followed to prevent the onset of periodontal diseases.
Treatment of periodontal disease include non-surgical and surgical intervention. Non-surgical includes scaling which is simply the removal of plaque and calculus using ultrasonic machines. Scaling can be done once in a 6-month period if required.
Scaling can be performed by a registered dental hygienist or dental surgeon or periodontist. It takes at least 1 month for the gingival conditions to be normal after scaling. Patients after scaling can experience sensitivity problems for 1-2 weeks which is normal and can be reduced by maintaining oral hygiene.
Desensitizing agents (like Sensodyne, thermoseal paste) can be prescribed for those who experience prolonged sensitivity. These agents have to be used for at least 4 weeks to exert its effect and should not be used for more than 2 months. If sensitivity problem persists even after these measures, dental or periodontal consultation is necessary.
Surgical measures include flap surgeries, grafts, root coverage
procedures and furcation debridement. These measures are done in case of advanced periodontal diseases. Chemical mouth washes like chlorhexidine which is the Gold Standard in plaque control can be given to those patients who can’t maintain proper oral hygiene and after surgical procedures but for a limited time period. Alternatively, Listerine can be given on a long-term basis.
Always visit a NMC registered dentist or Periodontist for gingival and periodontal problems once in a 6-month period.