Understanding Periodontology Part 2 - Interview on the Possibilities of Treating Moving Teeth and Bleeding Gums
Introduction: As we announced, we will continue our series of periodontal interviews with Dr. Annamária Nevelits. In the current discussion, we will touch on such varied and exciting topics as e.g. the "how to treat moving but healthy teeth", we hope more people will get answers to your questions! Let's get started!
First, let’s start with a looser but all the more joyful topic. You had your wedding last week, we wish you a lot of happiness again. Your husband is also a periodontist. How long does it take to brush your teeth and what toothbrush do you use?
For the first time in our lives, we both encountered the right dental care techniques in the university freshman camp, during which we were surprisingly enriched with significantly more new information. This means that the majority of the population is unfortunately unaware of how to select and use the right tools to not only say we have brushed our teeth today, but to actually have our teeth clean. We then underwent several further trainings during our undergraduate years and residency training to learn not only the right technique, but also how we can pass this knowledge on to our patients.
We also understand and try to make everyone understand that this is a learning process that requires practice and regular control until it goes well, and even beyond. We also regularly attend inspections. While in the beginning it took significantly more time to brush your teeth compared to the original time and equipment requirements, thanks to the practice it quickly became a daily routine consisting of simple, fast and logical steps. We both use a short, densely spaced, ultra-soft bristle, manual toothbrush, which is complemented more than once by the use of a single-knot toothbrush.
We don’t think the electric brush is real from the devil either, but it also has the exact indication of when it’s needed. What is most important, however, is the interdental brush, as cleaning the interdental spaces with a toothbrush is completely impossible and dental floss does not give satisfactory results either. Since 30% of the plaque is located in the interdental spaces, so without specific cleaning, even though we have the most perfect toothbrush use, plaque remains. It is no coincidence that most caries and periodontal processes start from the interdental spaces. This method takes about 3-4 minutes twice a day at most in our evening.
Because you would reassure a patient who is worried, feels, and sees that he or she is affected, e.g. bleeding gums when brushing teeth, but have not yet dared / wanted to go to the specialist.
Unfortunately, the general experience is that if someone delays regular dental check-ups and treatments as much as possible, whether for fear or for any other reason, they will have to spend more, more often, and more in the future.
Bleeding gums, if they are not accompanied by swelling and pain, can be easily treated with a little more thorough cleansing at home, however, if the inflammation of the gingival tissue is reduced, there is no guarantee that subguminal sacs or periodontal processes are not present. With intuitive treatment at home, erroneously spread antibiotic medication, the symptoms can be reduced to the maximum, in the medium term the symptom will definitely reappear, but the cause of the problem has never been treated and will be discovered even later.
Unfortunately, with regard to dental problems, it can be said in general that the initial, or even moderate-severe problems are not necessarily associated with symptoms (tenderness, pain), so the idea that we only go to the dentist once we have a complaint is out of place. van. In the case of acute complaints and pain, in many cases we are already facing a complex problem that cannot be solved by a simple, cost-effective method, and this is especially true for periodontal disease.
The vast majority of patients ’previous bad experiences, which later act as a deterrent, are also caused by the fact that they were already in an inflamed condition with a problem that was no longer sufficiently anesthetized due to the extent of the inflammation. Overall, it’s not worth waiting until we have a complaint.
What does a consultation look like for you, what to expect?
In all our dental treatments, we try to provide the most pleasant environment for our patients as much as possible, and the first consultation is no exception. Examination of the oral cavity, after X-ray diagnostics, checking the depths of the pouch with a probe, if the condition allows, we can register it immediately so that the healing process can be followed by everyone (periodontal status recording).
It is very important to me that my patients know exactly what processes are going on in their oral cavity and based on these, what treatment is needed step by step, what the purpose of each treatment is, why it is happening. I try to present this, either in a mirror, on my own X-ray or with the help of illustrative figures, and to explain it in a way that is understandable to the Patients, with appropriate parables.
Nightmare of moving but healthy teeth. What are the options for treating moving teeth?
Remaining teeth can move from several things, even without periodontal disease. It could be an advanced root apex inflammation, but it could also be a possible overload force from an unbalanced bite, a high filling on a tooth, which acts as if we are sticking a stick in the sand and constantly pushing it. Squeezing and gnashing of dentures can also cause unhealthy levels of movement, or abnormal levels of mobility may remain after orthodontic treatment. However, in most cases, it is caused by periodontal disease, which involves the destruction of bone, as the supporting structure of the teeth is constantly decreasing over time, so the mobility of the teeth is also increasing, but this is not legal either. Once the condition of the disease has reached a level around a particular tooth, there is no way to save it anymore so removal is the only solution.
However, moving teeth with a sure and questionable / uncertain prognosis can be well treated in most cases with periodontal and other adjunctive treatments. There are cases where the teeth can only be held during or after treatment by splitting the teeth together.
What does follow-up look like in such a case? How often should a patient with this involvement see a dentist?
Follow-up requires a maximum of 3 months of regular check-ups for periodontal patients, which can be extended for up to half a year after a certain period of time in the case of stable condition and oral hygiene. If splinting is required, it is a plaque retention-enhancing structure on the teeth, so to prevent plaque buildup and deterioration, these patients are equally subject to regular professional cleaning (e.g.: GBT) and inspection for up to 3 months, even more often, but we always try to come up with a viable solution.
Thanks for the interview, I feel like we got a lot of useful information!
In Part 3 of the series, we discuss sublingual calculus, and the doctor also reports on what depends on whether someone is expected to be involved in periodontal disease, what the aggravating circumstances are, and how gingival retractions can be treated with modern therapeutic procedures.
An earlier interview, where we also discussed Guided Biofilm Therapy ™ and the prominent role of tartar removal in periodontology, can be found at the link below.