Does your gum bleed when you brush teeth? Are you prone to gum bleeding even when minimal irritation is applied (a strong bite, toothpick etc)? Do you feel a dull, vague pain around your teeth? Have your teeth shifted in the past few years, either towards the front or laterally, broadening the gap?
If your answer is YES to any one of these questions, it is necessary to contact your dentist because you may have a case of periodontal disease, popularly referred to as gum disease.
Gum disease is a chronic inflammatory condition affecting the supporting substance of teeth, the tissue surrounding teeth that provides strength and stability. It wreaks complete havoc within gum tissue, resulting in the loss of teeth. Periodontal disease may occur at any age. If it comes about in early childhood, it is called aggressive periodontitis, whereas if it happens during adulthood or later in life, it is called chronic gum disease. The latter is much more common, and it is characterized by a slow, gradual loss of gum tissue. The basic etiology factors of gum disease are microorganisms found along the gumline and their products. Aside from microorganisms, gum disease may be exacerbated by poor oral hygiene, smoking, inadequate dental restorations and fillings, and certain systemic diseases.
Gum disease stages
The first and the most common stage is gingivitis, or gum inflammation, which, if not treated, may lead to gum disease proper, infecting the bones around teeth, and later causing the teeth to shift, become loose, and eventually fall out. The main goal of gum disease treatment is to eliminate pathogenic microorganisms within the periodontal pockets by removing supragingival and subgingival plaque and calculus around teeth and in periodontal pockets. Mild forms of the disease, such as gingivitis, may be completely neutralized by removing plaque and calculus, combined with instruction of patients regarding oral hygiene, so that the inflammation does not come back.
If gum disease has gained momentum and there are periodontal pockets and the loss of bone tissue, which can be determined by an examination or a digital radiogram analysis, but is also commonly self-evident if there is acute gums inflammation and bleeding, it becomes necessary to introduce advanced treatment techniques. At this stage, plaque and calculus removal will not eliminate the bulk of harmful bacteria, since they have inhabited periodontal pockets and other deeper periodontal areas, e.g. root canal or periodontal pocket bed, and have become inaccessible using manual dental instruments (certain microorganisms may even occur in the radicular cementum or dentin tubules. Application of antibiotics as a form of chronic gum disease treatment, either local or systemic, has limited success because it may cause side effects, and it may even make bacteria more resilient in the long run.
Pros and cons of laser treatment
A fast-paced advancement of laser technology in the last two decades has lead to its routine usage in dentistry. Laser has found its application in gum disease, in the treatment of periodontal conditions, periodontal surgery, peri-implantitis treatment, endodontics, post tooth extraction treatment, root canal treatment and other treatments.
However, laser is not a one-stop tool for periodontal disease treatment, but is a very useful auxiliary device. One issue with the laser is that it destroys all microorganisms, including the ones which are beneficial to the body. Furthermore, although lasers eliminate periodontal pocket with great precision, its usage to cut tissue may cause certain adverse effects, despite the fact that there is no pain and no blood. Namely, it often becomes the case that the calculus deep inside the periodontal pocket, which is invisible to the naked eye, heats up producing high temperature because it absorbs laser energy. This may cause damage to and necrosis of tissue, which is the worst possible scenario for a patient.
Photodynamic laser therapy
This is precisely the reason why at Cvejanović Clinic we use exclusively use a special photodynamic laser therapy, which does not require antibiotics and provides a virtually painless way to eliminate harmful microorganisms, viruses and fungi found in periodontal pockets.
Photodynamic therapy is an oxygen-dependent reaction which combines short-pulse diode lasers (630 to 700 nm) and a photoactive material, or photosensitizer. The photosensitizer bonds to the target cells and colours them. Then, laser beams are projected and the photosensitizer is activated, rendering the target cell dead. By using this therapy, only target cells are destroyed, while the surrounding periodontal tissue is left intact.
Gum disease treatment using photodynamic laser therapy starts by manually cleaning periodontal pockets under local anesthetic, removing calculus and plaque. Then, a blue dye is applied which is in turn activated by the laser. This dye makes it possible to reach areas otherwise inaccessible using dental instruments. This technique is remarkably efficient, leading to a complete elimination of harmful bacteria or their reduction to such an insignificant number as to render them harmless to a patient for years to come.
Treatment of acute cases
When it comes to acute periodontitis, where major damage to bone tissue has occurred, there is a necessity, alongside laser therapy, to perform a surgical procedure to elevate the gumline and to implant artificial bones and cell growth stimulants (Emdogain®) into lacking areas, which all facilitates the process of bone and periodontal tissue regeneration.
Though all these techniques are successful and much practiced, the periodontopathic processes cannot be reversed. The progression of the disease may be halted, but the bone and gum tissue will never go back to its young and healthy state. The treatment may prevent periodontal disease to lead to the wobbling and eventual loss of teeth in the next 10, or even up to 20 years, which comes close to complete recuperation, but this positive outcome is possible only if after the treatment the patient abides by the doctor’s instructions and attends regular checkups.