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Gum disease is often characterised by bleeding from the gums, along with redness and occasionally swelling. The disease process is initiated in response to certain bacteria (plaque) that have been allowed to accumulate around the teeth and gums. The presence of this bacteria leads to an inflammatory response and, if left untreated, this response can spread below the gums and along the root of the tooth, causing destruction of the supporting bone and ligaments. This can often lead to loosening of the tooth and eventual tooth loss in advanced stages.
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In our mouth, we have over 700 different species of bacteria, most of which are completely harmless. However, when teeth cleaning is not adequate, the bacterial deposits build up next to the gums, forming plaque, and the conditions now become more suitable for the more dangerous bacteria to flourish. These harmful bacteria can overcome the natural defences of our body, and multiply in numbers.
If the soft plaque isn’t removed from our mouths through toothbrushing and flossing, it hardens and becomes calculus (also known as tartar). This leads to further growth of the bacteria, and a deeper spread of inflammation, resulting in the breakdown of supporting bone and ligaments.
There are certain risk factors can increase the likelihood and severity of gum disease:
Smoking
Diabetes
Family history of gum disease
Pre-existing medical conditions
Drugs
Stress
Clenching and Grinding teeth
Poor Nutrition
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The most common signs and symptoms of gum disease are:
Bleeding gums
Bad breath
Red, puffy, inflamed gums
Shrinking gums (gum recession)
Swelling or abscesses of the gums
Looseness or changes in the position of teeth
It is important to remember, gum disease is often painless until the most advanced stages. In many cases, bleeding and swelling around the gums may not be noticeable, making it very difficult to detect.
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With careful assessment and treatment, it is usually possible to halt the progression of gum disease. The key to success is the removal of the bacterial plaque which is causing the disease, reducing the risk factors, and the establishing excellent oral hygiene practices.
Oral Hygiene Instructions and Advice:
Your periodontist and dentists will help you establish a regime to reduce the bacterial load in your mouth. You will be given individually tailored advice on how to use the most appropriate cleaning aids effectively in your mouth.
Non-surgical Periodontal treatment
Debridement: All soft and hard deposits of the bacterial plaque and calculus are removed, both above and below the gums. This may be carried out over 2 or 4 visits depending on the complexity of the condition, and is completed under a local anaesthesia.
Re-shaping of fillings: Some older fillings may be acting as bacterial traps, and these are often re-shaped to allow patients to clean these areas more effectively. In some cases, the fillings may need to be replaced, and patients will be referred back to their dentists for this.
Bite adjustments: If a particular tooth is found to be under greater load, small adjustments to the bite can be made to allow for a more even distribution of loading.
Antibiotics and antiseptics: In some situations, oral antibiotics and antiseptics may be helpful to further control bacterial growth.
Corrective Surgical treatment
Some areas around teeth are particularly difficult to access and clean sufficiently, and bacteria will often recolonise or persist in these areas. In these instances, a surgical procedure help remove and residual bacterial plaque underneath the gums. Visualising the area under the gums helps us to ensure that all bacterial deposits removed. At the time of surgery, the architecture of the gums and underlying bone can be improved to help reduce the chance of bacteria re-entering the area.
Periodontal regenerative procedures involve the application of biological agents that can, in some cases, allow for the re-establishment of the periodontal structures.
Periodontal disease, also known as gum disease, is an inflammatory condition of the gums and supporting structures of the teeth. It is one of the most common and widespread human diseases.
Periodontal disease
Dental implants are one of the most popular solutions to replace missing teeth. The loss of a tooth or multiple teeth can have a considerable negative impact on one’s life, leading to difficulties in eating and chewing, as well a loss of confidence in smiling, affecting self-esteem and overall quality of life. One of the most common frustrations with dentures is that they are removable and can become very uncomfortable. Utilising dental implants to replace your teeth provides you with a fixed option (non-removable) which can act and feel as natural teeth do.
Dental implants
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To put it simply, a dental implant is a titanium screw, placed into the jaw bone, with the aim of mimicking a tooth root, and providing an anchor for a single tooth or multiple teeth. Implants are manufactured from medical-grade titanium, a metal that is biocompatible with body tissues and able to bond with adjacent bone during healing. It is the same medical grade titanium used in hip and knee replacements, with a wealth of evidence demonstrating its ongoing safety.
After the implant is inserted into the bone, a healing period of 2-4 months will follow. During this time, the dental implant fuses with your surrounding natural bone in a process called osseointegration. After his process has been confirmed to be complete, the implant is now stable to support a new tooth or multiple teeth.
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Dental implants have a number of advantages over conventional crowns, bridges and dentures:
Implants look and feel like natural teeth.
Implants function in the same way as natural teeth and there are no difficulties with eating.
There is no impact on adjacent healthy teeth. Adjacent teeth do not have to be filed down to act as supports for the missing tooth or teeth, eliminating any impact or complications on healthy unaffected teeth.
Implants help to preserve, or restore, an aesthetic smile. Not only do they improve the appearance of the teeth, they can provide support for the lips and cheeks to restore facial soft tissue profile.
Improved Speech. Having replacement teeth which are fixed in place that feel and function like natural teeth, allows you to function and speak as your normally would.
Dental implants can be used to give removable dentures a firm grip - With dental implants, there is no need to use special glues to hold the false teeth in place, as there is with some dentures.
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Dental implants are suitable for almost anyone who has lost one or more teeth and would like to restore their appearance and chewing ability. However, as it is important that the patient’s bone tissue is fully developed, they are not generally used in people younger than 18 years of age.
To be considered for dental implants, your mouth must be in a healthy condition, with no untreated tooth decay or active periodontal (gum) disease, and good oral hygiene. If implants are fitted in the presence of active gum disease, there is an increased risk for infection around an implant, which can lead to its failure and loss.
The general health of individuals is also important and, in some instances, can affect the overall success of dental implants. Uncontrolled medical conditions such as diabetes and clotting or bone disorders can increase the risk of infection, poor healing, and ultimately the failure of a dental implant.
Smoking is also an important consideration. Smokers tend to heal more slowly than non-smokers, and research has shown a higher incidence of complications and loosening of implants in smokers. Quitting smoking will increase your chances of a successful outcome.
During your first consultation, we will assess your suitability for dental implant therapy and the various treatment options that are available. This will depend on many factors individual to you, such as your general health, the number and position of missing teeth, and the quantity and quality of your bone and soft tissues. Should there be any concerns, we will help you navigate through these and liaise with your treating medical practitioners as required to achieve a successful outcome.
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Unlike a filling, replacing a missing tooth with a dental implant isn’t an instant procedure. There are two phases of treatment, the surgical phase which involves the placement of the implant, and the restorative phase where the tooth or prosthesis is fabricated. Careful planning and assessment is carried out, so that the whole process runs smoothly from the start to finish. The steps involved can be summaries below:
Consultation and Planning
Everyone situation is unique. At the initial consultation, we will discuss the potential options available to you. This often involves a thorough examination of your mouth and a 3D X-ray. This will allow us to assess the shape and condition of your bone tissue and locate the positions of any important structures, such as nerves and sinuses, which may be close to the intended implant site. This will allow us to plan exactly how and where the implants will be placed. It is at this point we formulate a detailed treatment plan outlining the number of visits and costs involved.
2. Insertion of Dental implant
A small incision is made in the gum to expose the bone. The bone is prepared in a shape to accommodate the implant, and the implant is then carefully inserted into the bone. before the gum is repositioned around the implant.
In some situations, there may be insufficient native bone for implant placement. If this is the case, a bone graft may be required to either simultaneously, or as a prior procedure. This will be assessed in the detailed consultation in the planning phase.
Implants are left to heal for at least 3 months for the bone to secure the implant. The exact time frame will be determined after the surgical placement of the implant and may vary depending on each individual situation.
3. Confirmation of healing
After a healing phase, the implant will be reviewed to confirm that it has fused with the bone. Occasionally, modifications to the gum around the implant can be carried out at this stage to improve the strength, appearance and contour of the gums.
This is often the conclusion of the surgical phase. We will commonly refer you back to your dentist for fabrication of the final tooth
4. Impression
Following confirmation of the implants healing, and a successful surgery, the tooth can now be fabricated. Your dentist will take a customised impression of your implant and its relationship to the adjacent teeth. A laboratory will fabricate a custom made tooth for you to be inserted onto the implant. This typically takes between 2 – 3 weeks, depending on the complexity of the case.
5. Fitting of final tooth/prosthesis
Once the tooth or prosthesis is ready, your dentist will then insert this on the implant(s). It is at this appointment that the fit, appearance, bite and comfort of the tooth is assessed. If any modifications are required, this can often be carried out at this visit.
6. Maintenance
This is without doubt the key to the success of your implant. Once your dentist has placed the tooth on the implant, we will often review each individual to discuss the care for their implant at home. Depending on the individual, we will also review all implants every 12-24 months. This will often professional cleaning of the implant site, assessment of the surrounding implant tissues including the bone, and review of your bite. The research is clear that that impeccable at-home and professional care is critical to ensure the long-term health and success of your dental implant.
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Our patients are always surprised at how little pain and discomfort they have after implant surgery. The majority of our surgeries are carried out under local anaesthesia, similar to other dental procedures. However, depending on the case and the individual, various sedation options are available. These include oral sedation (tablets, e.g. Valium®), intravenous sedation with a medical anaesthetist, or a general anaesthetic in hospital.
Following surgery, written care instruction will be provided to you on how to best look after your mouth, and yourself for the next 7-14 days.
Gum grafts are common technique to address the issue of receding gums. Receding gums results in exposure of the root surface of a tooth. This can be an aesthetic concern, with the appearance of excessively long teeth. It can also result in temperature sensitivity. At worst, there is potential for tooth loss. Once gum recession begins, the gum becomes prone to further recession, exposing the root surface of the tooth which is particular soft and prone to trauma and decay.
Gum grafts
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Malpositioned teeth
Abhorrent muscle/frenum position
Lip and tongue piercings
Occlusal/bite trauma
Over-Aggressive tooth brushing
Gum disease
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In some situations, receding gums can be improved or corrected through the use of a gum graft. In this technique a small piece of soft tissue is taken from underneath the gums on the roof of your mouth and carefully transplanted to the site of the receding gums, in order to cover the exposed portion of the tooth root.
In many cases, complete root coverage can be achieved. In some very advanced situations, this may not be possible, but a significant improve can still be achieved through increasing the thickness and strength of the gum.