Periodontology

Oral hygiene should be maintained at least twice a day, once in the morning, after waking up and once in the evening, before going to bed for a minimum of two minutes. The correct technique of brushing your teeth and the correct choice of brush are also very important. The most appropriate technique that we recommend to you at 'Dentoria' is the so-called modified Bass technique, which requires the use of a brush with numerous and soft (soft) or ultra soft (ultra soft) bristles, which should be directed at an angle of 45° degrees in the gingival sulcus (the space between the tooth and the gingiva - the palate), and then with circular movements the brush moves from the last tooth on the left side to the last tooth on the right side.

In addition to mechanical brushing, there are also sonic and electric toothbrushes, which remove dental plaque much better than mechanical (manual) brushes. There are two types that Dr. Ertan recommends, one is Oral B or Philips toothbrushes. Ultrasonic Philips toothbrushes are better at removing dental plaque than classic toothbrushes. They produce 62,000 up-and-down, back-and-forth movements and cause a cavitation effect of bubbles, which allow for deep cleaning of interdental spaces. Sonic brushes remove plaque 20 times more than classic toothbrushes. There are different types of brush heads, according to the different needs of users, such as: removing surface stains, brushing sensitive gums or deep cleaning for users of bridges, crowns and implants.

These brushes can be used by different age groups, including children, for whom brushing becomes fun, which will then turn into a lasting healthy habit. These brushes also have a built-in timer, which helps to brush your teeth for as long as necessary. They also have a pressure sensor, which will warn you if you are brushing with too much pressure. They also improve your focus to brush even hard-to-reach places, which are often left unbrushed with classic toothbrushes. They also effectively whiten your teeth at home. In addition to toothbrushes, there are other means for maintaining oral hygiene, such as: toothpaste, mouthwashes, interdental brushes, interdental floss, oral irrigators and many others that will be recommended to you in our office, according to the current indication for their use.

Oral douche

Dr. Ertan recommends the Philips Sonicare Power Flosser, which is a replacement for dental floss, interdental brushes and sticks. The oral irrigator works on the principle of pulsed water waves. Depending on the purpose, it has two nozzles, an X-directional nozzle, which focuses the water into 4 wide jets, which remove plaque on the tooth surfaces themselves, and a directional nozzle, which removes plaque from the interdental spaces. It is suitable for use by patients wearing crowns, bridges or orthodontic fixed prostheses.

Cleaning dental plaque

Dental plaque (dental biofilm) is an acquired bacterial deposit on the surface of the teeth. It can be supragingival, that which is located on the teeth above the palate, and subgingival, that which is located in the space between the tooth and the palate. Subgingival plaque is the main cause of gingivitis, and then of periodontal pockets and periodontitis. Preferential places for plaque to form are the fissures (dents) and pits of the teeth and the interdental spaces. In order to accurately identify plaque, at 'Dentoria' we use plaque indicators, which discolor the plaque, making it visible, in order to see which places need more attention when brushing and thus make it easier to remove.

At Dentoria we use the KaVo PROPHYflex 4 sandblaster, which is a new generation of air polishing system. It produces a precise, thin and homogeneous jet of powder, which provides very good visibility of the working field, and the treatment for patients is very comfortable, thanks to the reduced irritation of the tissue. It is suitable for removing supragingival (above the gingiva - palate) and subgingival (below the gingiva - palate) dental plaque, for eliminating the contents of periodontal pockets and is especially recommended for patients who have dental bridges, crowns and dental implants.

Tartar removal

After a certain period of time of about 14 days, if the dental plaque is not removed, it mineralizes (hardens) and turns into tartar. Tartar is most often localized on the inner surfaces of the lower front teeth and the front surfaces of the upper lateral teeth, because the excretory ducts of the salivary glands are located near these places, so the saliva itself contains minerals that mineralize the plaque and it turns into tartar. Tartar is an additional factor that influences the occurrence of gingivitis and periodontitis. For these reasons, professional tartar cleaning is mandatory every 6 months.

At 'Dentoria', we most often remove tartar using ultrasound from the company EMS, which uses ultrasonic vibrations to destroy the structure of tartar and allow for its removal.

Note: This causes hypersensitivity (hypersensitivity), as the tooth roots are exposed. At Dentoria, we treat hypersensitivity with topical fluoride application or special toothpastes for hypersensitivity. Sodium fluoride (NaF) varnish is applied topically to the hypersensitive surfaces of the exposed tooth root. We also recommend the professional GC Tooth mousse paste in different flavors. GC Tooth mousse paste:

• inhibits enamel demineralization and induces remineralization

  reduces hypersensitivity by sealing open dentinal tubules

  prevents the formation of incipient caries thanks to its anti-cariogenic properties

  restores initial demineralization lesions (white spots)

Delicious flavors stimulate saliva flow for increased effectiveness of CPP-ACP.

Gingivitis

• Gingivitis is an inflammation of the gums around the teeth, which is most often caused by bacteria from plaque that accumulates on the teeth. If left untreated, it can eventually progress to periodontal disease. There are several types of gingivitis, such as:

• Catarrhal, which is caused by bacteria in dental plaque and is characterized by redness and bleeding of the gums, discomfort when chewing food, a foreign body sensation and burning

• Desquamative, which is most often within the framework of bullous autoimmune diseases and is characterized by the appearance of larger bubbles filled with liquid content on the palate, which later burst, creating painful wounds

• Ulceronecrotic, occurs in patients with impaired immunity for various reasons and poor oral hygiene. It is accompanied by a large number of ulcers on the palate, which are very painful and with an unpleasant odor from the oral cavity

• Proliferative gingivitis/gingival enlargement occurs most often during therapy with certain medications such as: immunosuppressants, anticonvulsants or antihypertensives. It is characterized by spherical enlargements of the palate. It can also be part of some general diseases or in gingival tumors.

At 'Dentoria' we successfully treat all these gingivitis by first removing dental plaque and local medication therapy for catarrhal gingivitis, antibiotic therapy in the first phase and treatment in the second phase for ulceronecrotic gingivitis and, if necessary, surgical removal of the enlarged gingiva in proliferative gingivitis. In desquamative gingivitis, the therapy is with local medications for pain relief and healing in the oral cavity, and the other therapy is within the framework of the general disease.

• Periodontal disease – periodontopathy

Periodontal disease is an infectious disease characterized by inflammation of the supporting tissues of the tooth (gingiva, periodontium, cementum and alveolar bone), progressive loss of attachment and resorption (loss) of the alveolar bone. The main cause of periodontopathy is dental plaque, namely subgingival, i.e. poor oral hygiene, or rather the interaction between bacteria from dental plaque and the immune system of the host – the patient. However, there are other risk factors that further contribute to the progression of the disease, but also make the host (human) more susceptible to it. These factors are: smoking, nutritional disorders, blood diseases (leukemia), endocrine diseases (diabetes), disorders of the immune system, and the like. The first sign of periodontopathy is bleeding from the gums, which should not be ignored, i.e. it should be an alarm for you to immediately contact our periodontal office for a periodontal examination. As the disease progresses, periodontal pockets are created, which are a predilection site for plaque deposition and further worsening of the disease, resorption (loss) of the bone, which leads to loosening of the teeth and a change in their position. If not treated in a timely manner, it certainly leads to tooth loss. At 'Dentoria' we have modern methods for early detection of this disease and treat it accordingly. We make the diagnosis with a detailed clinical examination and the most modern X-ray panorama or computed tomography. The method and long-term duration of treatment depend on the development and extent of the disease, but in any case, the results are visible after several treatments. In less advanced disease, we only perform curettage of the periodontal pockets and prescribe an antibiotic, strictly prescribed by the dentist, in order to prevent the progression of periodontitis. In more advanced forms of periodontitis, with extensive bone loss, which can be horizontal and vertical, at 'Dentoria' we apply regenerative techniques by placing artificial bone and membranes. Patients with periodontitis must come for regular check-ups, in order to maintain the achieved results and prevent the progression of the disease. There are several types of periodontitis:

– chronic periodontitis, which is a chronic, long-term inflammation of the supporting apparatus of the tooth, characterized by chronic loss of attachment and loss of jawbone, which in the final stage leads to tooth loss. Signs of this type of periodontitis are: inflammation with bleeding from the palate, the appearance of periodontal pockets, purulent secretion, the presence of subgingival calculi, retraction of the palate, loosening and change in the position of the teeth. It is the result of poor oral hygiene and the cumulative effect of general and local risk factors and genetic predisposition, and its signs most often appear in the elderly population, but can also occur in younger people. This form can be localized when it covers a small number of teeth, less than 30%, and is generalized when it is more than 30% of the dentition. Depending on the degree of progression, it can be in a mild, moderate or intensely expressed form;

– ulceronecrotic periodontitis occurs in patients with poor oral hygiene and reduced immunity as a result of some general diseases or drug therapy. It is characterized by deeper wounds – ulcerations of the gums, coated with white plaque, extensive loss of jawbone, severe pain and unpleasant odor from the oral cavity;

– juvenile periodontitis, occurs in children and adolescents, who are most often with reduced immunity, within the framework of some general diseases of the immune system. It is characterized by the absence of local predisposing factors, and there is an aggressive and rapid loss of the jawbone, which leads to tooth loss. A characteristic localization for this type of periodontitis is the loss of the jawbone in the area of the front teeth and first molars (6-teeth).