Periodontology
First Periodontology clinic in Valencia.
In June 1988 we started our activity as the first exclusive Periodontics clinic in Valencia. Since then we have had the opportunity to successfully treat up to 10,000 patients.
<<Minimally Invasive>> Treatment.
We always try to carry out treatments that offer a quick cure and avoid potential side effects that more aggressive treatments can lead to.
Precise prognostic in the long term.
Our experience allows us to predict the long term result with precise efficacy.
ISO Quality pioneers
We are also pioneers in the implantation of the ISO 9001-2000 Quality system.
- About Periodontology
- The Value Of The Experience In Periodontology
In June 1988 we initiated our activity as the first exclusive periodontics clinic in Valencia. Throughout the years we have had the opportunity to solve thousands of Periodontitis cases with a satisfactory result and confirm the efficiency of the treatment, specially the check-ups to control Periodontitis and maintain the dentition.
It is a pleasure to see people who have been with us for so many years on a daily basis. As time goes by, we can definitely confirm the efficiency of treating any gum problems that may occur.
The experience we have gained over the years allows us to confront any situation from a practical point of view. This gives us an advantage when presenting to each person their expectations of the treatment and the success of such in a more realist manner.
Nevertheless, the frequency of gum diseases (Gingivitis, Periodontitis or Pyorrhea) is due to the lack of information available about these problems to the general public.
- The Surprise and Suffering
Many patients learn about their periodontitis problem too late. At the Martinez Canut Dental Clinic we have experienced many critical situations when diagnosing and informing patients about a serious problem. In the majority of cases we hear the same response: "¿How haven't I realised before?" "I take care of my teeth and brush them everyday…"
The way to explain this is that periodontitis doesn't give many warning signs. Someone could even look at their teeth in a mirror and think they have a clean and healthy dentition, but in reality their gums could be suffering from Periodontitis (being detached from the tooth with bacteria and tartar on the inside).
The main objective of the treatment is to remove the bacteria that are hidden under the gum and that stick to the surface of the root of the tooth. It also involves the removal of tartar which is a result of the mineralisation of layers of bacteria. This tartar is as if it were bacterial fossils and they stick to the root with great force which makes it hard to eliminate. We do this by using very precise instruments that detach and remove the bacteria and tartar.
Other frequent questions are: "¿Is it going to hurt?" or "¿How can you put an instrument inside my gum?". The answer is very simple: when the gum is suffering, it detaches from the tooth and creates a space in which we can insert small instruments, the same way bacteria got in. It isn't painful, to the extent that the anesthesia has an effect.
We call the procedure of detaching and eliminating bacteria and tartar, scraping and root planing. The term curettage has also been used, but it's not adequate because it was used to describe the manoeuvre of scraping inside the gum, something that isn't done anymore. In other words, it consists of scratching the surface of the root leaving it clean of bacteria allowing the gum that was detached, re-attach to the root.
There are occasions when surgery is needed in order to gain better access to the area of cleaning, this is done by opening a skin flap which separates the gum even more. Another goal of the surgery is to give the gum a different form and therefore can adapt better to the tooth, especially when the pockets are deep.
With this, a more efficient method of brushing can be achieved at home.
It is very important to bear in mind and control all of the different risk factors, such as smoking, bruxism, etc… as they could determine a worse evolution of the disease.
Lastly, we can't talk about periodontal treatment without mentioning the check-ups, as these are key with regard to the long term success of the treatment.
- The Lack of Knowledge About Diseases
The explanation below was written to answer all of the questions that so many people, with gum disease, have asked over our years of professional experience.
We call periodontal disease a group of illnesses that affect the gum (Gingivitis) and the other tissues that hold a tooth in place (Periodontitis, previously called Pyorrhea). Periodontology is the branch of dentistry that studies and treats these problems.
Gingivitis is the inflammation of the gum due to a build up of bacteria around the tooth. If this situation becomes worse, Periodontitis happens, because these bacteria travel deeper between the root and the gum, detaching it from the tooth and making a lesion called Periodontal Pocket, whose depth can be easily measured . The resulting destruction of the gum and bone lead to mobility of the tooth and consequently the loss of it. One out of every five adults, two or three suffer from Periodontitis, one of them being in an advanced stage of the disease.
Although the main cause of this disease is the bacteria, there are various factors that predispose someone to it or stimulate its progression. The most important ones are genetic predisposition (weaker immune defenses against these bacteria), inadequate brushing, smoking and the habit of grinding teeth.
Periodontitis doesn't have many warning signs. In many cases, the only sign is bleeding of the gum and sometimes not even that, smokers don't often get this warning sign. Another sign is the loss of gum (making the teeth appear longer and with gaps in them) or, on the contrary, the inflammation and enlargement of the gum. Cold foods or drinks can cause pain and discomfort as well as the appearance of bad breath. When a tooth becomes loose and moves in its socket, it's normally a sign of advanced Periodontitis.
Due to the frequency of Periodontitis and the lack of signs that come with it, the importance of frequent check-ups is evident in order to diagnose the disease as soon as possible and start treating it.
Diagnosing the disease in time leads to a higher chance of treating it successfully rather than a very advanced stage of Periodontitis. In really extreme cases, the only possible option is to avoid losing the teeth as quickly as it would happen without treatment.
The success of this treatment depends on what the professional can do, eliminating the tartar and bacteria from inside the gum and leaving it healthy, but it also depends on the will power and cooperation of the patient. This is because the treatment is efficient only if all three of these conditions are met and that depend on the patient:
- Brush your teeth, especially in between each tooth, applying the specific technique and time for your case.
- Attend periodic check-ups, normally every three to six months depending on each case, to avoid the progress of the disease.
- Avoid the predisposing factors of this disease. Smoking is the clearest example.
As you can see, the solution to this problem highly depends on how the patient acts.
- Prevention: Periodontal Check-ups
Even if we perfect the brushing technique, it is possible for some bacteria to return and build up in the interior of the gum and therefore the disease will re-appear.
We have to bear in mind that bacteria is always in the mouth and it tends to stick to the surface of the tooth, especially in the gap between the gum and the tooth.
Periodontal check-ups, also known as maintenance or periodontal support therapy, consists of regular check-ups, normally every three to six months depending on each case, to avoid the reappearance of the disease.
In each check-up we evaluate the possible pockets and other parameters such as inflammation and bacteria deposits. We use these results as a guide to establish a precise and exact plan to clean the affected areas.
In conclusion, the success of the treatment depends on controlling all risk factors, proper brushing techniques and completion of the check-ups. It has been proven that by following all of the above, we can stabilise the disease and maintain the situation including the teeth that have previously suffered from severe Periodontitis.
- When Is Periodontal Treatment Necessary?
In some cases we start to think of Periodontitis as a "Modern Illness". Modern Illnesses are those linked to lifestyle and everyday habits present in our society like: stress, lack of oral care, grinding your teeth, tobacco…
It's not uncommon that our first encounter with patients is with someone who rushes to the consult, in a hurry, stressed, phone on for any emergency call, problems to organise appointments… If this person also smokes and grinds their teeth… we have a problem that is very difficult to solve.
Sometimes, the combination of different risk factors can cause more harm than the bacteria themselves. This happens because those bacteria take advantage of predisposed individuals whose defenses against diseases are weakened.
The success of Periodontal treatment and following maintenance is undeniable, being well established and thoroughly documented. This is why, when all negatively influencing factors are controlled, we can ensure that those teeth that have lost a significant amount of their supporting structures remain healthy and stable over time.
On the contrary, despite the initial treatment, if the remaining factors aren't addressed, not only the external ones but those directly related to treat the disease such as brushing, regular check-ups, controlling the intake of tobacco and wearing a night guard in cases of severe bruxism, the chances of keeping the disease under control are minimal.
- Periodontal Regeneration?
Certain lesions involving the loss of the bone that supports the tooth can be treated in a surgical way using materials and substances that promote the regeneration of the lost bone and other supporting tissues.
However, not all of these lesions respond to this type of treatment as specific conditions have to be met by both the lesion and the patients themselves.
Although periodontal regeneration can achieve excellent results, the reality is that it's not suitable for all patients, and when it is, it usually applies to specific areas rather than the whole mouth. The regeneration of tissue happens inside the gum, which means the process isn't visibly perceived by the patient.
This reality goes against the expectations of many people we have spoken to who believe it is possible to regenerate all lost tissue. Unfortunately, it isn't possible to regenerate every structure, when bone loss is generalised, which is what more often happens, there is no way to recover what has been lost.
This is why we can't resolve the appearance of "black holes" between the teeth caused by the loss of bone and gum tissue. You can find more information about this in the section "The Spaces Between Teeth".
- Restoration of Lost Gum Tissue
Gingival recession refers to the loss of gum tissue that leaves part of the root exposed.
This loss is caused by one or various factors such as having thin or delicate gums, bacterial inflammation associated with gingivitis or periodontitis and the abrasion caused by hard tooth brushing.
There are some techniques known as gum grafting which allow us to reconstruct the missing tissue and cover the exposed root.
In some cases, we can cover the entire exposed root, specifically when the bone between the teeth remains intact. On the other hand, when the bone between the teeth has been lost, due to Periodontitis, we can only cover the highest point of the remaining bone.
- The Spaces Between The Teeth
The appearance of dark spaces between the teeth is a consequence of the loss of gum tissue and the bone that supports the tooth. Once these spaces develop, it is not possible to regenerate the lost tissue.
Periodontal treatment can sometimes make these spaces more noticeable, particularly when there is significant bone loss. This happens because the gums reduce in size as inflammation is controlled, causing those spaces to become more apparent.
On one occasion, we spoke with a patient who chose not to undergo treatment due to fear that the effect explained in the paragraph above would occur in their front teeth. When we saw them again two years later, the disease had progressed and the loss of bone and gum tissue had become worse and those spaces were far bigger than if they had received the treatment.
When these spaces become an aesthetical concern for the patient, they can be closed using composite which provides excellent results.
Another consequence of the enlargement of these spaces is that food particles become trapped more easily between the teeth. This is true, but just as these particles can get trapped easily, they can also be easily removed with dental floss or interdental brushes. In contrast, before treatment, when the gums are loose, some of these particles, especially the bacteria, get trapped beneath the gum tissue.
- Bruxism and TMJ Problems
Bruxism involves clenching or grinding the teeth being much more common than most people think. Most individuals show some signs of bruxism, having been established that only 5 to 20% are actually aware of the habit.
Naturally, those who make noise while grinding their teeth are more likely to notice it, but this doesn't mean that those who don't make a sound don't have Bruxism.
Bruxism occurs more frequently and intensely during sleep, although it can also happen during the day.
There is a clear relation between Bruxism and stress as a result of specific issues or anxiety or any other psychological conditions. In addition, this is a highly dynamic habit, varying both over time and its intensity.
Bruxism can also be present during childhood. In many cases, it occurs as a result of physiological adaptation where the wearing down of teeth occurs as a consequence of tooth eruption. In other cases, like adults, it can be related to levels of stress. The noise that may occur when grinding teeth doesn't always reflect the true severity of Bruxism. This noise may occur when upper and lower teeth come into contact and disappear when the tooth surfaces have worn down and adapted to the new situation.
In adults, when Bruxism is severe, other consequences can be: muscle pain and tension, headaches, limited mouth movement and temporomandibular joint (TMJ) problems. This joint is located very close to the ear, so in some cases, TMJ issues can be confused with earache. Bruxism can also affect the teeth themselves, not only the wearing down of the surface, but because the continuous excessive pressure can cause tooth pain.
Let us consider a very common scenario: A patient comes to the clinic as an emergency with severe toothache (without any cavities or any other apparent problem) and frequent mood changes. In these cases, the patient normally says: "My mouth is affecting me generally now… I feel exhausted…". In reality, these patients already feel unwell and Bruxism intensifies it with further repercussions on the teeth.
Treatment for Bruxism usually involves multiple approaches: wearing a night guard, muscle relaxants, physiotherapy and, of course, managing and addressing stressful situations.
- Gum Health in Childhood and Adolescence
Gums During Childhood
It is very common for children's gums and teeth to occasionally worry their parents. Fortunately, most of these situations are not serious and it is always reassuring for us to explain that there is no need for concern.
In children, gum inflammation (Gingivitis) is almost constant, often as a result of tooth eruption and the presence of bacteria due to lack or inadequate brushing.These situations are normally reversible as the teeth erupt and oral hygiene improves.
Serious gum diseases (Periodontitis) in children do exist, but fortunately, they are rare. These are normally systematic conditions that also affect the gums as well as other parts of the body. During routine check-ups, the professional will identify any significant issues of this kind. The situation that most often concerns the parents is when the adult teeth are coming in whilst milk teeth are falling out. The gums are inflamed around the teeth, making chewing and brushing more difficult.
To make matters more worrying, the front adult teeth very rarely emerge in their rightful place, they often appear tilted or crooked. Time and natural development of the tooth normally help improve this situation.However, In any event, the professional will advise on the possibility and moment to carry out any orthodontic correction.
Another common concern is the perception of a longer, emerging or newly erupted, lower permanent incisor, either because it has little gum surrounding it or has lost gum tissue when erupting. Some parents ask if that tooth will be lost or not. Fortunately, it won't. These situations are common and usually not serious. They usually occur because the tooth is positioned towards the outer part of the gum and bone structure, leaving it more exposed or with a very thin surrounding of gum. This tissue may recede and sometimes expose the root, but despite appearances, it usually isn't a serious problem. In some cases, a gum graft may be recommended to restore the missing tissue and cover the root.
Years ago, these gum grafts were more frequent. Today, in some cases, it is advisable to wait and monitor as the problem may resolve naturally with growth and development. However, in other more severe cases, performing a graft is recommended as the first option for treatment.
During the child's regular check-ups, the professional will inform the parents of any issues of this kind.
Gums During Adolescence
How can Periodontitis begin? This is a very common question asked by parents who have suffered from the disease themselves and don't want their children to experience the same.
Periodontitis can occur during adolescence or early adulthood. Since the disease doesn't show many symptoms and is quite common, it is very important to carry out routine check-ups in the general public to detect any early signs of gum problems, such as periodontal pockets, through a thorough examination.
It is necessary that people understand that, although it is common, gum bleeding isn't normal.Bleeding gums is a sign of a disease that must be prevented or treated.
We are pleasantly surprised to see parents who have suffered from Periodontitis bring their children in to determine whether or not they have the same condition and to detect it early on.
We think this is an excellent idea for two main reasons. First, there could be a natural or inherited predisposition to developing this disease (this predisposition is linked to a slower immune response to the bacteria responsible for Periodontitis). Secondly, this disease is so common that it is extremely important to examine the entire population in order to identify the problem in the earlier stages.
It is truly rewarding to see how much things have changed. A few decades ago, the vast majority of people were neither examined or treated for Periodontitis, which is why half of the older generation have lost their teeth.
Nowadays, we are able to identify and treat the problem much earlier and work as a team with the parents to avoid the disease developing in younger generations.
There is a variant of Periodontal disease known as Necrotizing Ulcerative Gingivitis, more common in younger people. It consists of a quick destruction of the gum tissue between the teeth and can progress to bone loss if it becomes chronic. Specific bacteria combined with a weakened immune system is the cause of this specific disease. We often observe this condition in situations associated with stress, exam periods, smoking or inadequate oral hygiene.