**Gum Diseases**

Gum diseases (periodontal disease) are infectious diseases that affect not the tooth itself but the tissues surrounding and supporting the tooth. Even teeth without any decay can be lost due to this disease. Periodontal diseases are the most common chronic diseases in society, affecting one or more teeth in children, adolescents, adults, and the elderly. They are often painless, making their symptoms difficult for patients to notice, and in many cases, patients consult a doctor late.

The tissues supporting the teeth include the gums, tooth root, jawbone, and fibers that connect the tooth root to the jawbone, collectively referred to as the "periodontium." When the infection affects only the gums, it is called "gingivitis." The symptoms of gingivitis include red, swollen, shiny, soft gums that bleed easily. Bleeding is the most important symptom.

**Gingivitis:** Gums appear thickened, bleeding, and bright red.

In more advanced cases, when other tissues mentioned above are also affected along with the gums, it is defined as "periodontitis." Symptoms of periodontitis include bleeding gums, red/blue-purple color change, gum recession, gum enlargement, displacement, spacing, elongation, mobility of teeth, abscess formation, sensitivity, and bad breath. Pain is generally seen with the formation of an abscess. As a result, an infection in the periodontium leads to aesthetic disorders, loss of chewing function, and a diseased and weakened infrastructure that cannot support future prostheses.

 

**Periodontitis:** In addition to the symptoms of gingivitis, abscesses, spacing between teeth, discharge of pus from the gums, and significant deformities are seen.

**Types of Periodontal Diseases**

The type of periodontal disease is an important factor affecting the success of periodontal treatment. There are many types of periodontal diseases.

The most common ones are:

Gingivitis

Chronic periodontitis

Aggressive periodontitis

 

**Gingivitis**

It is the mildest form of periodontal diseases. The most important cause is microbial dental plaque. It is noticeable by swelling, red color, shininess, bleeding during brushing or spontaneously, and bad breath in the gums. There is either no pain or very little pain at this stage. Gingivitis can be completely cured with treatment and proper oral care. Additionally, foreign objects lodged in the gums can cause abscess and acute pain.

 

**Chronic Periodontitis**

It is the most common type of periodontitis. It is present in most adults. It progresses very slowly, and its symptoms are noticed late or ignored as normal. Therefore, sometimes treatment may be delayed. It is an infection and destruction of the tissues supporting the tooth. Sequentially, the gums, fibers connecting the gum to the tooth and the tooth root to the tooth bone erode, creating a pocket. Microbial dental plaque and tartar on the root surface under the gum, as well as bacteria and food residues in the pocket space, accumulate and multiply, causing the infection to progress to deeper tissues and reducing the bone support of the tooth.

 

Symptoms include dark red, purplish gum color, gum recession/enlargement, spacing, elongation, rotation, mobility of teeth, functional disorder, accumulation of food residues between teeth and inside pockets, abscess formation, bad breath, and aesthetic disorder. While early and mid-level chronic periodontitis is treated with non-surgical methods, advanced chronic periodontitis is treated with additional surgical methods. Some systemic diseases like diabetes and factors affecting the immune system, stress, and smoking influence the severity of chronic periodontitis and its response to treatment.

 

**Aggressive Periodontitis**

It is a type of periodontitis that affects young individuals less frequently but more severely. This condition can also be hereditary. Individuals are systemically healthy. There are 2 types: localized and generalized. In the localized type, clinical signs related to the gums are less, but pocket depth and bone destruction are advanced. In the generalized type, clinical signs are noticeable, and bone loss affects more teeth. Its treatment is more difficult and complex compared to chronic periodontitis.

 

**Periodontal Diseases Associated with Systemic Diseases**

Periodontal diseases can develop as an oral sign of some blood diseases, metabolic diseases, genetic diseases, and diseases affecting the immune system. Treatment is carried out together with a medical doctor.

 

**Necrotizing Periodontal Diseases**

These are periodontal diseases that cause the gums between the teeth, which are triangular in shape, to start necrotizing from the tip and, if untreated, progress to bone erosion. They are more common in smokers, those under psychological stress, those with very poor oral hygiene, and AIDS patients. Patients complain of severe pain.

 

**Gum Abscess and Periodontal Abscesses**

Foreign objects lodged in the gums cause gum abscesses. There is redness, swelling, and sensitivity in the

 

 affected area. In cases with advanced bone erosion and untreated, the number of bacteria increases inside the periodontal pocket, resulting in periodontal abscesses that affect deep tissues. They show symptoms such as pain, swelling, red-purple color, bleeding, and discharge of pus.

 

**Frequently Asked Questions**

A) Toothbrush Selection and Usage

 

Toothbrushes vary in size, shape, arrangement, stiffness, and length of the bristles. Toothbrushes with small heads, densely packed bristles, rounded bristle tips, and straight-cut bristle bundles should be chosen. They should be soft or medium-hard to easily reach and clean all areas of the mouth and between the teeth. It is recommended to change the toothbrush every 3-4 months. Hard and incorrect brushing techniques can cause gum recession, loss of tooth surface, and sensitivity, and since they do not provide effective cleaning, decay and gum diseases cannot be prevented. Both teeth and gums should be cleaned with a toothbrush. During brushing, the bristles should be positioned so that half of them are on the tooth surface and the other half on the gum surface. Generally, this should be done without applying excessive force, without lifting the brush head, and following a certain order. By moving only the bristles, it is possible to effectively clean these areas where bacteria accumulate with small circular movements. Teeth and gums should be cleaned twice a day (after breakfast and dinner). Depending on different situations like gum recession and post-surgery, a periodontist may recommend different brushing methods. Battery-powered or electric toothbrushes can be recommended in addition to a natural toothbrush if effective brushing cannot be achieved with a normal toothbrush.

 

B) Toothpastes

Toothpaste supports the mechanical cleaning effect of the toothbrush and polishes the teeth. Toothpaste should be used in the amount of a chickpea. There are various types of toothpaste with different contents and properties for different purposes. In recent years, various substances have been added to toothpaste to develop plaque, decay, tartar, and sensitivity prevention effects. The periodontal disease specialist will recommend the appropriate one according to the case.

 

C) Cleaning Between Teeth

The areas between the teeth cannot be adequately cleaned with only a toothbrush. Since gum diseases mainly start from the gums between the teeth, cleaning these areas is very important. Various tools that can be inserted between the teeth are used for this purpose.

 

D) Dental Floss

Dental floss cleans microbial dental plaque and food residues between the teeth and under the gums. There are waxed, unwaxed, mentholated, fluoridated, and chlorhexidine dental floss varieties. Dental floss should be used after brushing. Dental floss is wrapped and secured around the middle fingers of both hands and directed with the index fingers. For patients who cannot use it this way, ready-made tools containing dental floss fixed on a carrier shaped like a slingshot for the upper and lower jaws can be used. When using it, it should be inserted down to the level below the gum and all tooth surfaces should be cleaned with up-and-down movements, taking care not to cut the gums. It should be applied at least once a day.

 

E) Superfloss

In the presence of bridge prostheses, since dental floss cannot pass between the teeth, superfloss is used to clean the surfaces between the teeth included in the prosthesis and under the bridge body. For this purpose, these flosses consist of a needle-like stiffened tip that allows passing between the bridge elements, a sponge-like cleaning part, and a normal dental floss part. It should be applied at least once a day.

 

F) Interdental Brushes

Interdental brushes are used to clean the areas between the teeth in the presence of wide, irregular, and concave tooth and root surfaces. They are ideal for complete cleaning of root surfaces after surgical operations. They are small brushes with a handle part and a cylindrical or conical changeable brush part that is placed on a carrier tip. They do not replace dental floss and should be used together every day.

 

G) Tongue Brush

The surface of the tongue serves as a reservoir for the settlement and accumulation of microbial dental plaque and food residues due to its structure. It should be cleaned to reduce both microorganisms and bad breath. For this reason, the surface of the tongue should be cleaned every day with a "tongue brush" or "tongue scraper" by applying a pulling motion from back to front.

 

H) Rinsing Devices

1) Rinsing Devices Used Above the Gumline (Waterpik)

These are devices that spray high-pressure water. They are for home use by the patient. They can be used as an aid in cleaning the areas between the teeth, prostheses, and orthodontic appliances. They clean soft bacterial plaque and coarse food residues. They cannot clean microbial dental plaque adhered to the tooth, so they cannot replace toothbrushes and dental floss. In addition, in untreated mouths with deep periodontal pockets, they can cause periodontal abscesses by pushing food residues into the pocket with pressure.

 

2) Rinsing Devices Used Below the Gumline (in Periodontal Pockets)

These are devices that work with normal pressure. They are used to rinse deep periodontal pockets with antimicrobial solutions. They are thin enough to enter the pocket. They can be used in the patient's daily home care together with other oral hygiene tools when necessary.

 

3) Mouthwashes

Mouthwashes may be recommended to patients in necessary cases to prevent the formation of microbial dental plaque and gingivitis and to facilitate the individual's oral care. Mouthwashes are never sufficient on their own; they chemically support the mechanical cleaning processes performed by toothbrushes and dental floss. They are selected and recommended by the periodontal disease specialist based on their ingredients and purposes.