Definitions and Descriptions

The presence of plaque and calculus on the teeth is a source of continuous release of irritating bacterial substances, harmful for the mouth's tissues. Of course the gums also have the possibility of defending themselves: they are irrorated by capillary vessels that carry the immunity system cells. But a physical anatomical problem does exist: plaque and calculus are actually pathological structures which are external to the gum and cannot be reached by our defensive cells. This is, in the end, the reason why plaque cannot be spontaneusly removed by the organism.

The prolonged presence of plaque and calculus over and beneath the gingiva has the gum's disease as a consequence.

a) Gengivitis

Gingiva shows itself in a continuosly, more or less irritated status. According to patient's age, plaque quality, better or weaker capillary blood irroration of the tissue, it may show different intensity.

The gum is recognizable because of its diffused reddening, a certain sensation of burning and dolency, from the (very frequent) presence of bleeding. Of course in some subjects, a lower quantity of plaque is enough to cause the disease, while in others, a bigger amount is necessary.

b) Periodontithis

This is often an evolution of gengivitis. The organic defenses of the tissues (bone and gingiva) begin to give in, and the bacterial plaque opens itself a road downwards, pacing the tooth's root. The gingiva detatches itself from the tooth's neck and leaves plaque in contact with the underlying bone. At this point, the very sustaining tissue of the tooth is attacked, so that it begins to recede downwards (to the root's apex), reabsorbing itself.

The gum may also hold its position, so that to an external view, what is happening underneath may not be detected. This way a dental pocket is created: a situation in which bacterial palque keeps sneaking under the gingiva and consumes the bone.

Symptoms and signs of this pathology are extremely variable. In particularly resisting subjects, the pockets can be even asymptomatic, but generally a diffused bleeding is expected, a certain quota of pain (even acute), a heavy reddening, bad smell, outcome of pus, and sometimes the forming of abscesses.

Not all these symptoms are present at the same time, but they outline an actual disease. When the consumed bone amount reaches a sufficient level, the tooth has lost so much support that it shows instability and begins to oscillate. At this point situation can degenerate to the total loss of the sustaining bone, leading to the loss of the tooth.

c) Gingival recession

It's the spontaneous retreat of the gingival neck along the dental root. It's not necessarily a disease: within certain limits it can be considered phisiological coming with age, something like the graying hair or some sight problems. Usually it alarms the patient more than a gingivitis, because it happens mostly on teeth that have an aesthetic meaning and therefore jumps into evidence for its effect of elongation of the visible crown.

Patients as an average don't have a continuous vision of their denture and, beginning with the moment they discover a recession, they begin to worry much, thinking it happened very quickly. Of course the process is much slower and lasts years. It is favoured by less resistant and thin gums, wrong and too aggressive teeth brushing, traumatic occlusion, presence of frenums (fibrous chords similar to tendons situated in the mucosa and that act with a "traction" on the gingival neck).

The direct consequence on the tooth is that the root is being uncovered so that the increase of thermal or mechanical sensitivity is to be expected, or even the appearance of abrasions on the root itself, having the looks of an "axe chopping": these problems can be solved with desensitizing substances or with the filling of the neck abrasion.

In all cases in which the situation is judged to be dangerous, it is possible to stop the process or at least to slow it strongly down with a gingival graft surgery, with palatal drawing (or from other areas where rigid gingiva can be fetched). According to some operators it is also possible to cover the root thus regaining the lost gum: in this case though, the graft is sticked on the bare root, without the possibility of regenerating bone too, so that the final result has a more delicate stability in time.

a) Hygenic or maintainance therapy

During the early degrees of periodontal diseases, it's possible to control the situation simply by a very careful level of oral hygene, coadiuvated by professional hygene sessions. Within certain boundaries, it is even possible to stabilize pockets having a significative depth by means of repeated dental hygene sessions, under the condition the patient is perfectly instructed in the maintainance and follows a rigid hygenical protocol.

b) Guided Tissue Regeneration (GTR)

When the pocket reaches non maintainable depth levels, periodontal surgery is called into action.There are various kinds of gingival intervention and they differ mostly on the base of the anatomy of the damaged site and the peculiar intervention characteristics. In general we can state that we wish we could "open" the gum, clean the bacterial invasion and have the lost bone regrow: this is the Guided Tissue Regeneration (GTR), which can be applied in many cases, but not always. The so called bone graft has more or less predictable and stable results according to the material being used to fill the defect, to the form of the defect, to the means of covering the graft (with or without membrane). In all cases where this technique is applyable, it gives a complete (or almost complete) restoring of the original situation.

c) Resective Surgery

In all those cases where regenerative surgery cannot be applied, the bone level reached is taken for definitive and the gum is lowered instead, with the aim of preserving the tooth and its residual sustaining tissues. This more traditional technique has a better result rate, but has the uncovering of the tooth's root as a price to pay, thus making the tooth itself "longer", even while recovering in health and stability.