Periodontic Dentists:
Editor-in-Chief, Judy J. Johnson, DDS
Wednesday, June 17, 2009 - 07:01 PM
Aesthetic Considerations in Periodontics
Periodontics, also referred to as Periodontology, is the study of the structure of the teeth along with the diseases and conditions that affect them. Periodontal disease, more commonly known as gum disease, can be caused by a series of events within the mouth, all of which lead to periodontal disease.
The Problem is Gum Disease
Gum disease is typically caused by bacterial infection of the soft tissues and bone which support the teeth. Eventually, the disease will cause the bone and teeth to be destroyed. When destruction occurs, the individual will experience tooth loss.
No matter which stage of periodontal disease the patient is in, treatment will improve the individual’s gums and making them healthier. The type of treatment an individual receives varies according to the stage of gum disease they are in.
Treatment to Conquer Gum Disease
Typically, the goal of periodontal treatment is to eliminate any bacterial infections that the patient may be experiencing, which may be causing gum disease. Treatment also controls the inflammatory process destroying the tissues that anchor the teeth to the jawbone. It also creates a healthy periodontal environment, making it easy for the patient and the dentist to maintain.
Damage Done
Gingivitis is the earliest stage of gum disease and if interrupted, it can be stopped without permanent damage to the tissue or bone. A dentist with no special or additional training should be able to effectively treat gingivitis in the office. If gingivitis develops into a more advanced stage of gum disease, damage can occur. The patient’s structures, which anchor the teeth into the jawbone, are in jeopardy of becoming damaged. A very advanced stage is referred to as periodontitis. This stage requires very aggressive treatment and the patient will likely be referred to a periodontist, who is a specially trained gum specialist.
Esthetics Affected
In periodontic treatment, there are many different aesthetics to be considered. Even if there is no bacterial infection, gums may recede or shrink. Improper brushing is probably the main cause of gum recession. Individuals who use a hard or medium bristled brush may be wearing away their gums. Using too much force during brushing may also wear the gums away with time.
Receding Gums
When an individual’s gums recede, the roots of the teeth will eventually be exposed. When this happens, the outcome is that the individual’s teeth will become sensitive to hot and cold temperatures. Individuals who experience significant amounts of gum recession are at a higher risk for developing root cavities.
Gummy Smile
For patients who have what is referred to as a “gummy smile”, their teeth may look very small in comparison to their gums, which will have the appearance of being too big for their mouth. Some medicines may cause overgrowth of gum tissues (such as phenytoin, cyclosporine and nifedipine). A periodontist can remove excess gum tissue with a procedure that’s called gingivectomy.
Crown Lengthening
When bone tissue or gum is removed, the procedure is referred to as crown lengthening. This procedure is necessary when a tooth needs to be fixed. Sometimes, not enough of the tooth will stick out above the gum to support a filling or a crown. This procedure is necessary when a tooth breaks off at the gum line or when a crown or filling falls out.
Grafts
Soft-tissue grafts can also be very beneficial to the aesthetic look of an individual. Periodontal disease, physical mouth trauma, such as brushing too hard or too often with a firm bristled brush. The position of the tooth or gum tissue that is too thin may benefit from a soft-tissue graft.
Some of the tooth will be exposed when gums recess severely. Again, this will cause the tooth to become extremely sensitive to hot and cold temperatures and these teeth are more prone to tooth decay. Often times, people do not like the way their mouths look when this happens.
A soft-tissue graft is used to add more tissue and can help to prevent further recession, to cover the exposed root, stop the tooth sensitivity and to improve the overall look of the teeth. For individuals who have naturally thin gums, they are more likely to have a problem with gum recession at some point in their life and may need a soft-tissue graft to remedy the situation.
There are three different types of soft-tissue grafts: free gingival grafts, connective-tissue grafts and pedicle grafts. A free gingival graft is typically used for people who naturally have too little gum tissue around their teeth and need to have their gums enlarged.
A connective-tissue graft is most commonly used for treating root exposure. A pedicle graft can be done in certain cases, but not all cases. There must be a tooth next to the tooth which is being treated, which has enough gum tissue to “share”. A pedicle graft uses the flap of tissue from the gum of one tooth to fix a tooth next to it that is experiencing recession.
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