Prophylaxis Cleaning – Gingivitis – Periodontitis

1. Prophylaxis Cleaning (simple cleaning): During a simple dental cleaning, tartar (calculus) is removed from the dental surfaces. It is performed with an ultrasonic handpiece and with special tools (scrapers) that remove the tartar from places where the ultrasound may not have access. 
Depending on the degree of risk of developing gingivitis or periodontitis, the dentist recommends the interval between cleanings (usually 3 to 6 months, depending on the case – Recall). 
At the same appointment, pigments are removed with a special paste or Air Flow Powder and the patient is being advised on the proper way of applying oral hygiene (brushing, flossing, interdental brushes).
During cleaning appointments, the dentist will also identify possible cavities or other damage at an early stage, before they become a serious problem.

2. Gingivitis: Gingivitis is an inflammatory disease of the periodontal tissues. The gums appear red and slightly swollen and blood is often seen when brushing. The intensity of the symptoms depends on the severity of the inflammation and the patient rarely experiences pain. 
Gingivitis is caused mainly due to poor oral hygiene which allows billions of microbes, which are naturally present in the oral cavity, to expand and form plaque and tartar. As a consequence they attack and destroy the gums through the inflammation they cause in the area. 
Apart from gingivitis of microbial etiology, there are other causes of gingivitis. These are: smoking, heredity, hormonal imbalances, poor dental work (fillings, crowns that no longer fit well) and taking certain medications.
The treatment for gingivitis is dental cleaning. It usually requires 2 appointments but also regular re-examinations determined by the dentist. The patient’s most important weapon, however, is the implementation of good oral hygiene through which to maintain periodontal health as best as possible.

3. Periodontitis: If gingivitis is not treated on time, it is very likely to develop into periodontitis. Periodontitis, however, is not limited to the gum area but extends deeper by affecting and disintegrating the underlying bone. This can lead to reduced bone support of the teeth, teeth mobility and eventually their loss. 
The causes of periodontitis are similar to those of gingivitis. In some cases the extension of the disease can be very rapid even in young patients. This also suggests the heterogeneity of the disease from patient to patient. Depending on the extent of the damage there are two main treatment methods:

1. Conservative treatment: It is done in 2 to 4 appointments. The procedure involves local anaesthesia, measuring of the pockets (i.e. the empty space between the gum and the tooth) and cleaning them as deeply as possible. The goal is to eliminate inflammation and restore periodontal health. In the periodontitis stage, unfortunately, tissue loss is NOT reversible. We can only stop the progression of inflammation and not fully restore the periodontium.
Throughout the treatment, emphasis is placed on teaching the patient  good oral hygiene and making sure of its implementation, as this is the cornerstone for maintaining any result. 
Approximately 1 month after treatment a Recall appointment is made at which the pockets are measured again and the effectiveness of the treatment is assessed.

2. Surgical treatment of periodontitis: Surgical treatment of periodontitis enables the periodontist to access very deep sites or areas where the root morphology does not allow for proper treatment with the conservative method.
The surgery is performed under local anaesthesia and the surgeon is able to completely remove the inflammatory elements, tartar and plaque from the most difficult areas. Finally, he can reshape the gum shape as he deems necessary. The surgery is completed by suturing the area. The stitches are removed in 2-3 weeks and then the result of the treatment is assessed.

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