f) Periodontal abscess

Periodontal abscess always happen in people who have existing periodontitis that is advanced enough to have resulted in some loss of bone around the root of the tooth. While abscesses usually spontaneously occur in patients with untreated periodontitis, it is more common in periodontitis patients with a systemic disease such as diabetes. Sometimes, severe periodontal infection can spread under lower jaw and down into neck.

Signs and symptoms of periodontal abscess:

• smooth, shiny swelling of the gingiva
• pain
• area of swelling painful to touch
• loose teeth
• bad taste or smell
• pus coming out from gum
• deep pocketing
• poor oral hygiene

Treatment of periodontal abscess:

The gum area will be cleaned out a bit, debris removed and the pus is allowed to drain. Hot salt water or chlorrhexidine mouthwash can be used as an aid upon treatment. Antibiotic will be given to reduce swelling, kill or inhibit bacterial growth. However, antibiotics for gum diseases are unnecessary unless systemic upset is present. Underlying periodontal disease also treated.

General causes of gum disease

Periodontal disease is caused by bacteria in dental plaque. However, there would be some predisposing factors affecting the health of gums include:

• Diabetes
• Smoking
• Stress
• Medication
• Nutritional deficiencies
• Genetic Susceptibility (Hereditary Problem)

Diagnosis of gum disease

Metal probe is used to measure the depth of the gingival sulcus (the groove between gums and teeth). The probe is inserted beside tooth beneath the gum line, usually at several sites throughout mouth. Radiographic (x-ray) examination is needed to help in confirming the disease. Panoramic radiograph is taken to see the present of bone loss surrounding the tooth.

Treatment of gum disease

Since gingivitis is primarily plaque-induced, good oral hygiene, including regular brushing and flossing, is the best way to stop gum disease. Calculus deposits cannot be removed by brushing alone, however, but must be removed by a dentist or dental hygienist using ultrasonic scaler or hand instruments

Periodontitis  may involved more procedure of gum disease therapy than gingivitis. It can be divided into 3 phase:

• The initial phase- the aim is to control or eliminate and arrest further progression  of periodontal disease by the removal of plaque and other contributory factors.

• The corrective phase-the aim of corrective techniques such as scaling, root planning,periodontal surgery, restorative work, endodontics and occlusal adjustment is to eliminate periodontal pocket, arrest loss of bone and create free-plaque environment.

• The maintenance phase-the aim is to reinforce oral hygiene to prevent recurrence of disease.

Scaling is there removal of plaque and calculus from the tooth surface using hand instrument or ultrasonic scaler.

Most of the treatment to get rid of gum disease involves root planing and curettage (cleaning) under the gum margins. Root planing  smoothes the root surfaces, discouraging further accumulation of calculus.

In more advanced cases, the treatment may become more complex. If after removal of the deposits, fairly deep pockets remain, they can be eliminated by a minor surgical procedure called gingivectomy. This is done under local anesthesia.

A similar procedure, called gingivoplasty, is used to remove excessive gum tissue and to provide a new and healthier shape for the gums. In some cases, flap procedures are performed. Other technique may involve is guided tissue regeneration.

Antiseptic mouthwash for gum disease can be used to aid mechanical control of plaque. Chlorhexidine gluconate based mouthwash in combination with good care of oral hygiene may cure gingivitis, although they cannot reverse any attachment loss due to periodontitis. However, problems with their use include the unwanted side effects of such chemicals and development of resistance.

Prevention of gum disease

The key to prevention is regular and thorough plaque removal. Gingivitis can be prevented through regular oral hygiene that includes daily brushing .

Tooth brushing requires a brush, identically with a small head and even nylon bristles, which should be renewed at least once every 6 month. Brushing technique recommended is to use vertical movements, always from the gums at the edge of the tooth. However, other modified technique also can be used a long as it does not irritate gums. Teeth should be brush at least twice daily — in the morning and before going to bed.

Brushing alone is unlikely to clean the interdental spaces adequately. Flossing once a day helps to eliminate plaque on the proximal faces, these are the teeth’s sides that touch each other. Interdental toothbrushes also can be used for cleaning interproximally.

Mouthwash or Hydrogen Peroxide can be helpful, usually using peroxide or saline solutions (water and salt), alcohol or chlorhexidine. Vitamins for gum disease that can be taken include vitamin A, C and B complex.

Regular dental check-ups are important as well. This requires a full oral examination, including probing for pockets as part of routine examination.