A red, swollen, sensitive gum that bleeds easily when brushing or biting an apple is a sign of gingivitis, an inflammation of the gums due to a excess dental plaque, or even tartar. Microbes are deposited on the teeth in the form of a colorless film, dental plaque, which contains a multitude of bacteria. If it is not removed by brushing, this film turns into tartar, a rough and porous deposit which accumulates especially between the teeth and at the joint with the gums.
“Very common, gingivitis is favored by tobacco and cannabis, alcohol but also stress, pregnancy, menopause, diseases such as diabetes and certain medications. In smokers, the bleeding is masked, so they must be particularly vigilant, ”underlines Dr. Virginie Monnet-Corti, dental surgeon.
The elderly, wearers of braces, diabetics, those taking drugs that reduce saliva production (neuroleptics, etc.) are also more affected. But there may be a family ground which exposes to a production of scale more important and more difficult to eliminate.
If you neglect your gums, you run the risk of developing periodontitis, which causes chronic inflammation that affects the whole body. At an advanced stage, it promotes the development of atherosclerotic plaques in the arteries and increases the risk of cardiovascular damage by 25%. By increasing insulin resistance in the tissues, it can make diabetes worse. Finally, in pregnant women, the risk of giving birth prematurely to a low-weight baby is multiplied by 3 to 7.
Gingivitis: simple scaling is enough
A descaling supragingival (above the gums) removes plaque and tartar in one session. It is sometimes accompanied by an air polishing with bicarbonate and the application of antiseptics under the gum. Then, we use a specific toothpaste and an antiseptic mouthwash for about a week, until the gums return to their normal pink appearance.
And above all, we adopt a rigorous hygiene and the dentist’s instructions are scrupulously followed. A check-up is usually scheduled after four months. To prevent gingivitis, the ideal is to make an appointment with your dentist every six months, who will offer one to two scalings per year as needed.
Periodontitis: deep scaling
If you notice swelling of the gums, bleedingteeth that move or move apart, a bad breath, it is high time to consult! When the gum peels off, “pockets”, real bacteria nests, can form between the gum and the tooth. This time, it is the bone and the ligaments that are affected by the inflammation.
The practitioner first looks for possible causes of infection (decay, poorly adapted crown) to treat them. He assesses bone loss using a graduated probe gently slipped between the gum and the tooth, which highlights the periodontal pockets. From 4-5 mm deep, it is indeed a periodontitis.
A radiographic assessment completes the examination. The dentist then performs root surfacing to remove tartar and bacteria stuck to the roots using ultrasound. This treatment is generally performed in two one-hour sessions, under local anesthesia. The teeth remain sensitive to the cold for a few days. After a few weeks of effective oral hygiene, the gums firm up and adhere again to the roots.
If the stage is more advanced: make way for surgery
Two to three months later, the situation must be reassessed. In 5 to 10% of cases, pockets greater than 6 mm remain and surgical treatment is necessary. Under local anesthesia, the surgeon incises the gum to denude the roots, clean the pockets and eliminate otherwise inaccessible inflammatory tissue. The gums are then sewn up and the stitches removed eight days later.
“Sometimes we use regeneration materials or fillers to stabilize the teeth, like adding soil to a flower pot. The gum heals in fifteen days, the bone in six months. In cases of aggressive periodontitis, antibiotic treatment is necessary”, specifies Dr. Virginie Monnet-Corti. To avoid recurrence, it is always necessary to plan control sessions every four to six months.
The roots are bare: the grafting solution
If the surgeon notices that the gum is retracting on one or two teeth, he can reinforce it with a graft that covers the exposed root, by taking a small piece of tissue from the palate. Sometimes the front teeth “grow out” unattractively and the “collars” become very sensitive to cold and brushing, but the gums are not swollen.
The dentist will confirm that it is not a question of bacterial loosening, but of “gingival recession”, sometimes a consequence of age or too vigorous and poorly directed brushing which can tear a gum that is too thin. Here too, tissue grafts taken from the palate allow the gums to be reconstructed.
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