PERIODONTOLOGY

Supragingival scaling is the removal of hard dental deposits (tartar) that accumulate on the surface of the crown of the teeth, with the use of ultrasonic devices called scalers. The latest generation scalers used in our Clinic enable fast and effective cleaning of the tooth surface and are completely safe for the patient. The procedure is carried out in a water environment to protect dental tissues from damage.

In case of tartar deposits located below the gumline, subgingival scaling is applied.Scaling is usually a painless procedure. However, pain may occur in case of an inflammation of tissues surrounding the tooth. In such cases, local anaesthetic is applied.

Each scaling procedure is completed with the polishing of all tooth surfaces, which prevents further build-up of dental plaque and gives the patient a pleasant sensation of smooth teeth.After professional teeth cleaning fluoride varnish is recommended in order to:

• protect teeth against dental caries;
• prevent teeth hypersensitivity of the necks of the teeth.

Closed curettage is applied in case of deep periodontal pockets (spaces between gums and a tooth, which become deeper due to the development of periodontitis). During the procedure of closed curettage, the flap of the gum is pulled aside, which makes it possible to clean the periodontal pocket, freeing it from deposits that cause the inflammation, e.g. remains of tartar colonised by bacteria. The inflammation can thus be eliminated and the wound can heal.

Afterwards root planing is performed in order to scale the top surface of the root, which may be affected by bacteria.

The advantage of closed curettage is fast healing of the post-surgical wound, minimal discomfort to the patient and good aesthetic effect.

In case of significant bone and clinical attachment loss,and when tartar is located deep under the gum, open curettage is required. The procedure involves dissecting the gum in order to make the root visible and remove (using special curettes) tartar and other deposits created as a result of an inflammation. After this stage, rootplaning is performed in order to scale the top surface of the root, which may be affected by bacteria. The flap of the gum is sewed back in place. Naturally, this procedure is carried out under local anaesthesia. It saves the tissues surrounding the tooth and does not affect the overall condition of the patient.

Flap procedures are applied in case of advanced periodontitis, when extensive damage to the bone tissue covering the roots of the teeth occurs asa result of the progression of the disease. Flap surgery allows for

Periodontal diseases often cause loose teeth. When the comfort of chewing is clearly limited, the procedure of teeth splinting is applied, which connects single teeth together, forming a block that supports wobbly teeth, as well as prevents them from breaking down, pulling out or shifting. Teeth can be splinted for a certain period of time, e.g. after a surgical procedure, or permanently.

The following solutions are applied:

• splinting systems (Splint-Lock, Fiber-Splint, Fiber-Cor, Ever-Stick),
• glass fibre + composite material,
• combined prosthetic crowns or bridges.

Gingival recession is the exposure of the fragments of the roots of the teeth, which often increases teeth sensitivity to thermal and chemical stimuli, makes it difficult to maintain oral hygiene in the area of recession, and above all, creates a significant aesthetic defect related to the so-calledhigh smile line and exposed gums while smiling.

Frequent causes of gum recession include:

• improper brushing,
• using hard toothbrushes ,
• bruxism (grinding teeth and clenching the jaw),
• occlusal abnormalities (orthodontic treatment required – see -> orthodontics),
• improper oral hygiene.

The following surgical procedures eliminate gum recession:

• lateral pedicle graft,
• palatal mucosal graft,
• guided tissue regeneration.

An appropriate technique is selected for each patient individually.

Periodontal diseases lead to irreparable loss of tissues surrounding the teeth, and even with no symptoms of acute gingivitis (redness, bleeding, swelling of gums) lesions in the form of bone defects around the roots, which may even lead to tooth loss. The only solution for such teeth is the method of guided regeneration of tissues and bones. These techniques, successfully applied in our Clinic, allow for effective regeneration of lost or damaged tissues thanks to the use of state-of-the-art achievements of material engineering: barrier membranes and materials supporting bone tissue regeneration (Emdogein, biomaterials – Bio-Oss, BioGranCerasorb, Nano Bone).

Lip frenulum and tongue frenulum are folds of tissue that connect the lip or the tongue with the alveolar process. There are common abnormalities associated with the frenula, such as:

• frenulum located too close to the teeth,
• frenulum too short or too thick,
• abnormalities that negatively affect the periodontium, the aesthetics of the teeth, teeth alignment, the stability of removable dentures;
• speech impediments;
• feeding disorders.

These abnormalities can be corrected through procedures performed on the frenula: frenulectomy and frenulotomy.

Frenulectomy is a simple incision of a too tight frenulum that is too tight, causing restrictions in movement of a tongue or lips. The procedure is performed under local anaesthesia.

Frenulotomy consists in removing a too thick or abnormally located frenulum, usually of the upper lip, and sewing it in the proper place. In case of a hypertrophic lingual frenulum, very often functionality is impaired, leading to speech disorders or difficulties in taking in food.

The procedures are carried out under local anaesthesia, with the use of special scissors or an electric knife, which eliminate the necessity of putting on sutures.

Routine head and neck examination should be carried out by a dentist at least once a year in every patient. It is always a visual and tactile examination.

This is not enough to diagnose cancer at its early stage.

Oral cavity cancer is ranked 5th among gastrointestinal cancers and 8th among all types of cancer. 70% of malignant cancers is diagnosed too late, at the 3rd or 4thstage.

In order to enable the earliest possible opportunity to detect a pathology, we use a ViziLite Plus test, which allows for the identification of lesions which are neither visible nor palpable. In case of visible disease focus, the test allows for its preliminary classification and monitoring.

The examination is completely non-invasive.

VECTOR PARO – it is a non-invasive, very effective and extremely comfortable for the patient treatment method in periodontal prevention.Directly combats the causes of periodontitis, effectively removes plaque, bacteria and tartar – without performing an invasive surgical procedure.This method is completely painless and is particularly recommended for patients with a low pain threshold.Villa Nova Dental Clinic uses the latest Vector Paro system to prevent and treat gum diseases and periodontitis.

This method allows not only to effectively remove deposits from teeth but also from root cement, prosthetic restorations and implants – thanks to the safety and precision of this method, they are not damaged. The treatment is carried out with a suspension of polishing fluid strengthened by hydroxyapatite, thanks to which it is possible to remove the entire harmful bacterial flora, which is the basic cause of periodontal disease and its recurrence. Small fluid particles are completely safe for the tooth or implant surface. The length of the visit is about 1-1.5 hours. After the procedure, the patient can return to his daily duties. The doctor conducting the individual determines the frequency of treatments.

1. What is periodontosis?

Periodontosis is a widespread disease of the tissues adjacent to the teeth, the periodontium, which consists of the loss of tissues fixing the tooth to the bone, which leads to loosening of the teeth, their migration and protrusion, exposure of tooth roots, and eventually spontaneous tooth loss. The principal cause of periodontosis is the dental plaque, being a reservoir of bacteria attacking the periodontium; however, there are several factors influencing the development and course of the disease, such as:

• genetic factor;
• older age;
• smoking;
• stress;
• diabetes;
• osteoporosis;
• other systemic diseases.

Periodontosis is a curable disease, but combating it requires patience and the commitment of both the patient and dentist (perfect oral hygiene, self-descipline, regular attendance at check-up visits and observation of the dentist’s recommendations).

2. What is the difference between dental plaque and dental calculus (tartar)?

Dental plaque is a strongly adherent, soft, white to yellowish deposit that occurs on the surface of the teeth, gums and prosthetic appliances. It comprises various organic material (elements of saliva, food debris, dead cells) and a wide range of bacteria. Tartar is a further stage in the development of plaque – mineralised dental plaque, which is formed due to its saturation with minerals contained in the saliva.

3. Have smoking and stress any effect on the development of periodontal diseases?

Numerous studies have undoubtedly confirmed the effect of smoking and stress on the development of periodontal diseases. Smoking increases the build-up of dental deposit, reduces immunity of the body and promotes the growth of harmful bacteria. The effect of stress may consists of hygiene negligence, improper nutrition, frequent smoking and decreased immunity, which are commonly associated with stress.

4. What complications may occur after professional tooth cleaning?

In general, the only complication that may occur after tooth cleaning with a toothbrush, as well as by means of scaling or sandblasting, is hypersensitivity of the teeth to temperature changes. An excellent remedy for the problem is the application of a fluoride varnish, which relieves it instantly and permanently.

5. Is tooth elongation always a symptom of disease?

Tooth “elongation” may not necessarily indicate disease, as there is a phenomenon called senile atrophy of the periodontium. The process begins at 25-30 years of age and develops up to the end of life. It consists of a slow migration of the connection between the tooth and adjacent tissues in the direction of the end of the tooth root. The tooth crown elongates with associated lowering of the gum level. The process is in general painless, but unavoidable.

6. What type of toothbrush should I choose?

The selection of an appropriate toothbrush is of significant importance to oral hygiene. As there is a huge diversity of toothbrushes available, you may have some problem in choosing the most suitable. The most important is that the size and bristle hardness of the toothbrush is matched individually to the patient’s needs. The toothbrush should not be too big and should have a long thin neck, allowing access to molar teeth. Usually medium or medium-hard toothbrushes with multiple bunches, made of synthetic bristle of gently polished and rounded tips, are recommended. In the case of any periodontal disease, a soft toothbrush with a flexible neck that reduces pressure on the gums should be used. There are various versions of bristle pattern. The bristle may be of various lengths or serrated to improve cleansing of dental gaps (longer tips easily penetrate between the teeth) and to massage the gums.

7. How frequently should I replace my toothbrush?

In general your toothbrush should be replaced every two months. After that period the bristles stiffen and irritate gums. Some toothbrushes have a wear indicator in the form of a bristle bunch in a different colour, which discolours as the toothbrush wears. To function properly, the toothbrush needs to be taken care of. After brushing your teeth, the toothbrush should be thoroughly rinsed and stored in a place where it can dry. You should also pay attention to whether the bristle in your toothbrush is crushed, if it is, this indicates that you press your toothbrush against your teeth too firmly.

8. How should I brush my teeth?

In general, each method of brushing the teeth is good provided that it is efficient and not harmful to teeth and gums. Ideally, the tooth brushing technique should be chosen individually by a dentist or hygienist depending on the patient’s needs, the condition of his or her dentition and gums and dexterity. Regular tooth brushing should last at least three minutes. The minimum frequency of the procedure should be twice a day: in the morning after breakfast and in the evening after the last meal. However, in some circumstances, e.g. in patients wearing permanent braces, teeth should be brushed after each meal.

9. Is a toothbrush alone sufficient?

Efficient tooth care requires that all their surfaces (facial, lingual, masticatory and interproximal ones) be cleaned. However, only the first three of them are accessible to a toothbrush; thus, a toothbrush alone is not sufficient for maintaining appropriate oral hygiene. You should use additional tools:

• Dental floss – a bunch of waxed silk threads formed into a band, used for cleaning interdental spaces where teeth are close together;
• Dental toothpicks made of soft, non-splintering wood and saturated with fluorine compound are designed for people with spaced or missed teeth;
• Interdental toothbrush – a bristle spiral used similarly to a toothpick, and also for maintaining oral hygiene in people with permanent braces;
• irygator – urz?dzenie dzia?aj?ce na zasadzie bicza wodnego, strumie? p?ynu oczyszcza przestrzenie mi?dzyz?bowe i kieszonki dzi?s?owe, masuje dzi?s?a;
• Dental irrigator – a device producing a water stream that cleans interdental spaces and gingival pouches, as well as massaging gums.

A single bunch toothbrush used for cleaning difficult to reach back teeth.

10. What toothpaste should I choose?

The selection of toothpaste is not as important as the selection of the toothbrush; however, the use of an appropriate toothpaste may improve the efficiency of brushing. Most of the toothpastes marketed conform to basic requirements and contain clinically proven substances, such as polishing agents (help in the removal of dental plaque and deposit), foaming agents, fluorine compounds (sodium fluoride, calcium fluoride or amine fluorides). In particular circumstances you may choose a toothpaste containing appropriate additional ingredients:

• protective toothpastes containing fluorine;
• herbal toothpastes containing herbal extracts that relieve the gums;
• whitening toothpastes that remove food-related discolorations (caused by tea, coffee, smoking and red wine);
• multi-action toothpastes, that include the above-mentioned properties.

11. How can dental plaque be combated, apart from cleaning the teeth?

A very efficient method of combating dental plaque, which assists but does not replace mechanical tooth cleaning, is the use of a disinfecting mouthwash. In particular, chlorhexidine-based mouthwashes (Corsodyl, Eludril) are recommended, as the substance efficiently inhibits the build-up of the plaque and kills bacteria. However, note that the period of use of such mouthwashes should be limited up to two weeks, to prevent a side effect, i.e. discoloration of the teeth, dental fillings and tongue. Other recommended products are fluorine mouthwashes.