Gingivitis and Periodontitis

Causes of Gingivitis and Periodontitis
Plaque
The main cause of the disease, plaque is caused by the buildup of bacteria on the tooth surface and along the gumline, both above and below the gums. If not removed regularly, it triggers inflammation of the periodontal tissue.
Calculus (Tartar)
A contributing cause of gum disease, calculus forms when minerals in saliva combine with plaque and harden. It can build up both above and below the gumline, making it difficult to clean.

Additional risk factors that increase the likelihood or severity of the disease include:
– Smoking
– Diabetes
– Hormonal changes, such as during pregnancy or menopause
– Stress
– Genetics (family history of the disease)
– Certain medications, such as birth control pills, anticonvulsants, and blood pressure medication
– Inadequate oral hygiene

Warning Signs of Gingivitis and Periodontitis
• Swollen, red gums that bleed easily, especially when brushing or flossing
• Pus discharge from the gum margin
• Chronic bad breath
• Loose or shifting teeth
• Periodontal pockets detected during a dental examination
• Gum recession exposing the tooth root

Treatment Approach for Gingivitis and Periodontitis
1. Gingivitis Stage
• Scaling, root planing, and polishing to remove plaque and calculus, both above and below the gumline
• Guidance on proper oral hygiene, such as correct brushing techniques and the use of interdental cleaning tools like floss or interdental brushes
• Follow-up appointments to assess the response to treatment
2. Periodontitis Stage
• Deep scaling and root planing to remove plaque and calculus from deep below the gumline
• Consideration of antimicrobial agents in the gum pocket or antibiotics as appropriate
• In severe cases, periodontal surgery may be required to eliminate infection and repair periodontal tissue, such as bone grafting or Guided Tissue Regeneration (GTR)

Self-Care and Prevention of Gum Disease and Periodontitis
• Brush your teeth at least twice a day using the correct technique
• Floss or use an interdental brush daily to remove food debris and plaque between teeth
• Use mouthwash as recommended by your dentist to help reduce oral bacteria
• Avoid smoking and keep underlying conditions such as diabetes well controlled
• See your dentist regularly for oral examinations and professional scaling/root planing (every 6 months, or more often if you have risk factors or gum problems)

Gingival (Gum) Surgery
Gingival surgery is an oral surgical procedure aimed at reshaping or correcting abnormalities of the gum tissue, such as thickened, swollen gums, gums that cover too much of the tooth, or an uneven gumline — conditions that can affect both gum health and the appearance of the smile.

Gum contouring can help:
Improve gum health and reduce inflammation in cases that cannot be treated with standard methods
Create a more balanced gumline for a more esthetic appearance
Prepare the gums for dental treatment, such as crowns or dentures, to achieve the best possible results
Types of procedures may include:
Removal of excess gum tissue
Gum grafting in cases of gum recession
Adjusting the gumline to balance with the teeth and facial structure

Main Types of Gum Surgery (classified by purpose)
1. Esthetic or Cosmetic Gingival Surgery
Focuses on reshaping the gums for a more balanced, attractive appearance
Gingivectomy / Gingivoplasty – removing and reshaping excess or misshapen gum tissue
Crown Lengthening – lengthening the visible tooth to correct a gummy smile
Gingival Grafting – grafting gum tissue in cases of gum recession

2. Therapeutic Periodontal Surgery
Focuses on eliminating inflammation and controlling periodontal disease
Pocket Reduction Surgery – reducing the depth of infected gum pockets
Flap Surgery (Open Flap Debridement) – opening the gum tissue to clean deep areas below the gumline
Bone Grafting – rebuilding bone lost to periodontal disease
Guided Tissue Regeneration (GTR) – regenerating periodontal tissue using a biological membrane

3. Preprosthetic or Restorative Surgery
Such as Crown Lengthening to prepare space for a crown or denture
Ridge Augmentation to support a dental implant or denture

Reasons for Gum Contouring Surgery
Oral Health Issues
Swollen gums caused by gingivitis or periodontitis
Deep gum pockets that are difficult to clean and increase the risk of infection

Esthetic Concerns
Uneven gum levels or uneven gum thickness across teeth
Excessive gum display when smiling (Gummy Smile)
Gum recession exposing the tooth root, affecting appearance and causing sensitivity

Other Dental Treatment Needs
Gum tissue needs to be opened for restorative work, such as placing a crown
Preparing the gums before veneers or orthodontic treatment

Steps in Gum Contouring Surgery
1. Assessment and Treatment Planning
A thorough examination of the gums and teeth by the dentist
X-rays to assess the bone structure around the teeth
Planning the gum contouring procedure to suit each patient’s specific needs

2. Pre-Surgical Preparation
Cleaning the mouth and scaling before surgery
Disclosing any drug allergies, underlying conditions, or current medications

3. The Surgical Procedure
Local anesthesia is administered to numb the treatment area
The gum tissue is trimmed or reshaped using surgical instruments or a laser, according to the treatment plan
The area is cleaned and, if necessary, sutured

4. Post-Surgical Care
Apply a cold compress to the surgical area for the first 24 hours to reduce swelling
Take pain medication and antibiotics as prescribed by your dentist
Avoid chewing hard or very hot food near the surgical site
Avoid brushing directly on the wound for the first 1–2 weeks
Attend follow-up appointments and have stitches removed as scheduled (if sutures were placed)

Possible Risks and Complications
Swelling and pain after surgery
Minor bleeding during the first 1–2 days
Infection at the surgical site
Irregular gum shape if aftercare is not followed properly

Benefits of Gum Contouring Surgery
Improves the appearance of the smile for a more natural, attractive look
Boosts confidence when smiling and speaking
Reduces the risk of gum disease and periodontitis
Facilitates other dental procedures, such as veneers or crowns

Gum contouring surgery offers both health and esthetic benefits — enhancing appearance and confidence while helping to extend the life of your teeth and support long-term oral health.

Crown Lengthening
What is crown lengthening?
Crown lengthening is an oral surgical procedure aimed at increasing the visible portion of a tooth by removing a small amount of gum tissue and/or bone around the tooth root, allowing more of the tooth previously covered by gum or bone to be exposed.
This procedure is often used to prepare a tooth for a crown, or in cases where decay extends too deep to be treated with a standard filling.
Reasons for crown lengthening
To prepare a tooth for a crown or filling
Exposing more of the tooth structure allows for a properly fitted crown or filling
To treat teeth with deep decay
Allows access to the decayed area for proper treatment
To improve the shape of the gumline
For patients whose gums cover too much of the tooth, or who have a gummy smile
To access the tooth root for treatment
Such as in cases of infection or root fracture
Steps in crown lengthening
Assessment and treatment planning
The dentist examines the teeth and gums, takes X-rays, and plans the surgery to suit each patient
The surgery
Local anesthesia is administered, then surgical instruments or a laser are used to remove gum tissue and/or bone
Suturing and wound care
The dentist sutures the area and may apply a dressing to prevent infection
Benefits of crown lengthening
Creates more space for treatment, such as a crown or filling
Creates a more balanced smile with teeth that appear longer
Treats teeth with deep decay below the gumline
Prevents long-term bacterial buildup below the gumline
Post-surgical care
Take pain medication as prescribed by your dentist
Avoid hard, very hot, or very cold foods
Do not brush directly on the wound
Attend follow-up appointments and have stitches removed if necessary
Avoid strenuous activity that could affect the surgical site