What is Gum Disease?
Periodontal diseases are inflammatory diseases that affect the gums and bone tissue that support the teeth. Diseases involving the gums and jawbone are responsible for 70% of tooth loss in adults. Periodontal diseases respond easily and successfully to treatment when diagnosed early on. Primary gum diseases are:

Gingivitis: This period is the beginning of gum disease. Symptoms; Gums are bleeding, red and enlarged in volume. Gingivitis may not cause much discomfort. Gums that bleed while brushing are usually sensitive. If left untreated, the disease progresses to periodontitis, which is an advanced stage, causing damage to the gums and the bone that supports the teeth.

Periodontitis: It is a more advanced stage of gum disease. Damage occurs in the alveolar bone along with other tissues that support the teeth. A ‘periodontal pocket’ is formed between the tooth and the gums. Bacteria begin to multiply rapidly in this pocket because it’s a small area that can’t be cleaned. As the disease progresses, the teeth begin to wobble and may even go into extraction. Gums can easily separate and slip away from the teeth. Inflammatory pus between the teeth and gums. Teeth may be wobbly. In fact, the patient may see that their teeth gradually move away from each other. Because there is destruction at the cellular level in the alveolar bone, there is mobility. There is also constant halitosis.
That said, periodontal diseases can sometimes reach advanced stages without any symptoms. For this reason, it’s extremely important to go to the dentist at regular intervals and have panoramic x-rays taken.

Gum diseases also occur in children. Bleeding, swelling and redness of the gums may occur. This is often caused by insufficient brushing or the inability to clean crooked teeth. These findings are seen in incurable cavities and overflow fillings.

Why Does Gum Disease Occur?
When teeth aren’t cleaned properly, food residue that accumulates on and between them produce bacteria. Called bacterial plaque, these structures are responsible for dental cavities and gingivitis, and over time, they form dental calculus with the effect of saliva. If plaque isn’t removed from the teeth effectively, it turns into a hard structure called tartar. Bacteria in plaque and tartar causes destruction in the gums. If the disease is left untreated, eventually the teeth will become loose and may even need to be extracted.

How to Prevent Gum Disease?

• Efficient, ideal brushing.

• You should definitely use dental floss before brushing your teeth in the evening (or interface brush).
• Dentist check-up every six months.

How is Gum Disease Treated?
Even if you take the ideal care of your teeth, sometimes you may have hereditary gum disease. In the treatment, it can be completely healed by a good dental calculus cleaning by the first step dentist and paying attention to the patient’s oral hygiene. In slightly more advanced cases, curettage includes removing the attachments (plaque and tartar) on the teeth and providing a smooth root surface. Along with curettage, bacteria and irritants that cause inflammation in the gums are removed. Usually, this treatment is sufficient for the gums to adapt to the tooth again or to shrink the gums and destroy the pocket containing bacteria. In the majority of cases in the early stages of gum disease, daily effective oral care is sufficient for successful treatment, following tartar removal, removal of plaque and ensuring a smooth root surface.
Surgical treatment includes flap operations for more advanced cases. Bone grafts can also be imbedded if the fused bone needs to be supported in the flap operation, or if bone is to be formed in that area. Thus, new bone formation can be achieved. However, the bone formation never regains its former level. Flap operations are sutured operations.

Gum Aesthetics (Gingivoplasty)
In periodontology, some interventions can be made on the gums, both in terms of gum tissue and aesthetics. Healthy gums have a light pink, orange peel appearance, slightly rough and non-bleeding. Smile line adjustments are not merely a matter that can be solved with changes to the teeth. Gum aesthetics also play a big role here.

Conditions Requiring Gum Aesthetics

• In cases where the gums appear excessively while smiling (Gummy Smile),
• If the level of the gums is in a different position than it should be,
• In gum recessions,
• In gum discoloration,
• In cases related to gum diseases (Gum growth due to medication use, etc.)
• In gum level disorders due to crowding,
• In some situations where the length of the teeth is very short, gum aesthetics are needed for crown lengthening procedures.

Gingivectomy and Gingivoplasty: Operations called gingivectomy are performed in aesthetic dentistry, especially if the gums are very visible while smiling. Or, if the gums don’t appear symmetrical, gingivectomy is performed if one tooth is above and the other is below the gum level, and then laminates are performed if planned.

In some cases, inflammatory, pharmaceutical-induced or hereditary gum enlargements may occur. If there’s no bone resorption in these gum enlargements, if there shall be no operation that requires bone formation, the enlarged gums are destroyed by gingivectomy. On the other hand, gingivoplasty is generally applied after gingivectomy to correct the gums with surgical methods in order to restore its normal physiognomy, that is, its shape. Gingivoplasty can also be conducted alone.

Crown Lengthening Operation: It’s a procedure performed to lengthen the visible parts of the teeth, called crowns, which are above the gum level. In some cases, the fracture line or decay progresses below the gum level. In such cases, it’s necessary to extend the gum level towards the root part for gum health or for the retention of crown-bridge treatments.

Soft tissue grafts to create gums: There are several reasons for gum recession. Let’s list the principal ones:

Age: In elderly individuals, there’ll be a withdrawal that we call physiological withdrawal and isn’t considered a disease. This is a natural condition and no treatment is required.

Improper toothbrush usage: Caused by excessively harsh and prolonged brushing. The oral hygiene of these people is extremely good. There’s no inflammatory disease in the gums. The gums were destroyed by the pressure of brushing.

Due to anatomical structures: Some teeth are located outside the teeth row. The gums on the lip and cheek surfaces of these teeth are candidates for recession. Pulling down on your lower lip with your hand, you’ll see the thin muscle structures that go towards the gums. With this muscle bond called frenilum, there may be recessions, especially on the cheek surfaces of the teeth.

Gum disease: With the formation of bacterial plaque, recessions are observed in the gums.

The formation of excessive forces in the teeth: Gum recession is observed in teeth exposed to excessive forces and in people who clench and/or gnash their teeth at night.

Soft tissues taken from a different part of the mouth (usually the palate or the gum area where there is no recession) are used to close gum recessions. It is usually carried out for aesthetic or preventive purposes to hinder the progression of gum disease.

As a result of gum recession, some teeth may appear too long, and the root surfaces of these teeth are exposed. In such a case, the aesthetically exposed root surfaces are closed with soft tissue grafts.

Bone Tissue Grafts Used in Flap Operations
During flap operations, bone formation is stimulated by artificial- or natural-sourced bone powder applications in areas where bone loss is advanced. Your doctor will decide whether bone grafts will be needed or not.

The gums shrink a bit as a natural result of gum healing after flap operations. That’s why sometimes teeth look like they’re getting longer. The more advanced the disease before treatment, the greater the amount of recession. There may be recessions in the form of exposed roots and may bother the patient. There may also be hot-cold sensitivity. Sensitivity can be reduced by using high fluoride toothpastes and desensitizing products. After flap operations, the teeth may wobble more than before, but this may disappear completely within 4-5 months or decrease even more than before.

No matter what type of treatment is applied by the dentist, the patient must maintain good oral hygiene at all times. After the flap operation, the patient should pay extreme attention to oral hygiene. Otherwise, all the improvements will quickly reverse. One of the most frequently asked questions by patients is whether their gum disease can be cured by using medication. There is no such gum medication. After the operations, the doctor prescribes antibiotics and some painkillers to the patient.