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Periodontology (Gingiva Diseases)

What is Periodontology?

It is the branch of dentistry that deals with the diagnosis and treatment of gingival, alveolar bone (the bone around the tooth), cement (the layer covering the tooth root) and periodontal ligament (the soft tissue, connective tissue that connects the tooth root and the bone), which are the tissues surrounding and supporting the tooth.

Who is a Periodontology Specialist?

Physicians are trained for a long time for the expertise of this branch, which deals with the diagnosis, treatment and surgery of gingival diseases. In addition to their 5-year education, dentists receive the title of periodontology specialist (periodontologist) after 4-5 years of doctorate or at least 3 years of specialization training. Periodontology specialist receives training on dental implant surgery along with gingival surgery.

What is Periodontal Disease?

Due to gingival diseases, resorption (melting, loss) in the bone surrounding the tooth and gingival recession occur. As a result of the reduction in the bone and gingiva surrounding the tooth, the teeth begin to wobble and eventually the teeth may be lost due to decay.


Gingival diseases usually progress painlessly and insidiously. Patients usually apply to the dentist with complaints such as bad breath, gingival bleeding, and pain in the teeth. If there is pain in the teeth due to gingival diseases, a gingival abscess has probably occurred, and this often occurs in the last stage of the disease which is the extraction phase of the tooth. For this reason, it is important for patients to consult a dentist at the initial stage, that is, before advanced bone loss occurs. Because with the gingival treatment it is aimed to preserve the lost bone and gingiva rather than restoring it. The earlier the gingival disease is diagnosed and treated, the longer the life of the teeth.


The patient’s gingiva bleed while brushing, eating or spontaneously (Photo 1). The patient’s gingiva appears red and shiny (Photo 1). The patient’s gingiva is edematous, mobile and loosely attached to the tooth (Photo 1). Healthy gingiva does not bleed, is in pale pink color and has a firm consistency (Photo 2).

Why Does Gingiva Disease Occur?

The cause of gingiva disease is usually incomplete hygiene, that is, incomplete tooth cleaning. Bacteria that adhere to the teeth and multiply due to lack of hygiene form a layer called dental plaque, which plays the most important role in the formation of gingiva disease. The main cause of advanced gingival diseases occurring at a young age is genetic predisposition. Gingival disease, inherited from parents or genetically a generation ago, should be treated urgently because it can cause advanced bone and gingival destruction in a short time. No matter how hereditary the gingival disease is, the progression of the disease can be slowed down or even stopped with perfect hygiene (brushing with the right technique, use of dental floss and interface brush) after the treatment. Smoking is one of the most important risk factors for gingiva disease. Other risk factors are various systemic diseases such as diabetes, stress and malnutrition. Night clenching or grinding, bad teeth closing, crooked teeth, bad and old fillings or dentures can also cause gingiva disease.

How do I care for my teeth and gingiva?

Our patients often state that the disease occurs despite using the best toothpaste, mouthwash and the most expensive toothbrushes. The important thing is not to brush with the most expensive toothbrush, but to brush with the most accurate technique (moving from the gum to the tooth) and to brush all surfaces of each tooth, including the anterior-posterior-upper one. Even there is bleeding and pain, still cleaning must be done in a daily sense. On the other hand, the effect of toothpastes on gum disease is limited. Toothpaste is not a medicine. It is the biggest mistake to look for the treatment of the disease in the paste. The effect of different toothpastes on gum diseases is similar. In any case, dentists recommend using a paste as much as chickpeas or even lentils instead of toothpaste that is applied throughout the brush. Too much usage can harm your teeth. As a result, rather than using the most expensive paste and brush, the technique, duration (3 minutes), timing (morning, evening) and the interface care products (dental floss and / or interface brush) are effective in the prevention and severity of gingival diseases.

Is Just Brushing Teeth Enough?

The use of an interface brush or dental floss is very important in every area of dental treatments. We recommend to patients to use those materials in addition to normal brushing.  These tools should be used once a day and regularly after the treatment. It would be wrong to left those habits after regained gingiva health. A normal toothbrush cleans the front, back and top of the teeth when brushed with the right technique. However, it cannot clean the interfaces where most caries and bone loss occur. Dental floss or interdental brush should be used to clean these interdental surfaces. If the patient’s tooth interfaces are enlarged due to bone loss caused by gingival disease, use an interface brush of the size that the physician deems appropriate (there are various sizes such as 0.5 mm, 0.6 mm, etc.). In addition, if there is no loss and there are narrow interfaces, floss once a day. It should be used after brushing once with a normal toothbrush.

Should I Use Mouthwash?

The mouthwashes that our patients can reach in our country; chlorhexidine mouthwashes, mouthwashes containing essential oils, and mouthwashes containing disinfectant chemicals such as triclosan. Chlorhexidine mouthwashes, that is, mouthwashes that are given by prescription and only available in pharmacies, are mostly used after oral surgeries or in serious mouth infections. They are the gold standard material and the best mouthwash for plaque prevention. However, they are not suitable for long-term use. It prevents the salty taste of the food and creates discoloration on the tongue and teeth. Mouthwashes containing essential oils are represented on the market and can now be found even in supermarkets. These mouthwashes also have antiplaque properties and more suitable for long-term use than chlorhexidine. Although they can cause discoloration on the teeth, they do not cause staining as much as mouthwashes containing chlorhexidine. However, it does not need to be used by people who do very good tooth brushing and interface cleaning. Individuals with insufficient hand manipulation (ability) and individuals with hard-to-reach areas in their mouths (incompatible fillings and prostheses) can use these mouthwashes in addition to daily brush and interface cleaning (not an alternative). Mouthwashes, help prevent caries and hygiene with their fluorine and triclosan content however, their effectiveness is limited. Various issues regarding the formation of a carcinogenic substance by evaporation of the triclosan substance in these mouthwashes when combined with tap water have been discussed in the United States in the past years. It cannot be said that it is harmful for our patients to use chemicals such as mouthwash and paste, but the main problem is that the disease is expected to be treated with these agents. Above all, please be aware that the most important cleaning is mechanical cleaning which is cleaning with a toothbrush and dental floss. Pastes and mouthwashes only help this cleaning.

Should I Use Antibiotics?

Antibiotics and various other drugs are agents that are used for the treatment of the disease. Antibiotics are only used as adjuncts in the treatment of dental infections. In order for the infection to be completely cleared, it must first be treated. Along with the treatment, if the physician deems it necessary, antibiotics should be used as told by the physician.


Using antibiotics only because of bleeding in the gingiva and bad breath may relieve the patient for 1-2 weeks however the disease may return more severely because the bacteria, that cause infection are still around the tooth. The reason for this is that bacteria gain resistance to the antibiotic used over time. In the right cases, any medicine that is not used with the right indication will not only be wasted but also harm the body. After the bacteria gain resistance due to wasted antibiotics, the antibiotic will have a lower effect when used. For this reason, our patients should definitely not use antibiotics at their own discretion without the advice of a doctor.

What is Flap Operation?

The aim here is to stop the bone destruction around the tooth by cleaning the inflamed tissues.

In which situations does this operation performed?

It is performed in cases of advanced gingiva disease and loss of bone which supports the teeth.

What is the Treatment Content?

Regional anesthesia is applied to the area where the surgical procedure will be performed. An incision is made on the gingiva with a scalpel and the gingiva is lifted. Inflammatory granulation tissues around the roots are cleared. The root surface is leveled with hand tools, and if necessary, bone correction is made and the gingiva is shaped in accordance with the bone and sutured. Antibiotic therapy can be given if necessary. After 7-10 days, the stitches are removed.

What are the Benefits?

After the procedure, the destruction of the bone supporting the tooth stops. Even some new bone may form if good hygiene is maintained. Bad breath caused by gum disease is eliminated. The gingiva changes from dark red to pink, which creates an aesthetic appearance. Gingival bleeding is minimized or completely eliminated. Fatigue and low resistance that may occur due to inflammation in the mouth are also eliminated.

Attention to these!

After the flap operation, it is normal to increase some hot, cold, sour and sweet sensitivity in the teeth. In order to eliminate this situation, it is appropriate for our patients to use desensitizing paste. Some gingival recession can occur after the operation. The reason for this is that the gingiva is edematous due to inflammation before the surgery. The gingival level formed after the surgery is actually at the level that it should be and hygiene can be provided. The mobility of the teeth may increase slightly after the surgery. It should be noted that this situation will reverse in the long term and the teeth will become less mobile than before the surgery.

What is Deep Gingival Abortion?

The aim here is to stop the bone destruction around the tooth by cleaning the inflamed tissues.

In which situations does Gingival Abortion performed?

In the flap operation, the surgical removal of the inflammation by opening the gingiva is performed closed (without stitches and without surgery). However, this process can be done up to a certain level of the disease. While flap operation completely eliminates the disease in people with advanced gingival disease, deep gingival curettage only reduces the severity of the disease. Here, the radiographic and clinical examination performed by the physician is decisive in the treatment to be planned.

What is the Treatment content?

After regional anesthesia, the inflammation under the gingiva is curetted with hand tools. Root surfaces are flattened. In control sessions, the process is repeated if necessary. Some sensitivity after the procedure considered as normal.

What is Free Gingival Graft?

The aim here is to prevent bone destruction and tooth loss by transplanting healthy gums from the palate to areas where there is no healthy gum due to gingival recession. Aesthetically, it is to cover the open root surfaces a little.

What is the Treatment Content?

The procedure begins with the application of regional anesthesia to the area where the gingiva will be placed and to the palate. In the area where the gingiva will be placed, an incision is made with a scalpel and the gum is removed from the palate. A piece of tissue about 1-1.5 mm thick is taken from the palate. The removed piece is placed on the previously prepared and non-gingival area and sutured. A paste is placed on both the recipient and donor areas to protect the operation areas. After 1 week, the pat is removed. It takes at least 4-6 weeks for a full recovery.

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