Periodontal disease (Inflammation of the gums – Gingivitis)

Heavy smoking increases Gingivitis by limiting blood flow and oxygen supplies, and halting the immune system. Decreasing or quitting smoking altogether is a necessity for maintaining healthy gums.

The long term success depends on maintaining proper hygiene and visiting the dental hygienist regularly, every 3-6 months.

Signs of developing gingivitis

What do healthy gums look like?

Healthy gums should be a light pinkish color. They are close to the teeth, and do not bleed when the teeth are brushed correctly.

What is gingivitis?

It is a disease that damages the tissues that support the teeth in the jaw (gums, fibers, and jawbone). Without treatment, gingivitis causes loss of the teeth. Gingivitis is one of the most common diseases worldwide, and the primary reason for loss of teeth in adults, but can easily be avoided and treated.

What causes gingivitis?

According to latest research, the layer of bacteria known as plaque is the main cause for gum disease, especially when they are virulent.

Bacteria found in the mouth tend to concentrate around the teeth where remains of food can be found. The food residue provides an excellent host for the bacteria population. If this layer of bacteria is not removed, it turns into plaque, which can no longer be removed by brushing or flossing.

This plaque then serves as the ‘home base’ for additional accumulations of bacteria. This starts the development of the disease.

How does gingivitis develop?

Initially, bacteria and plaque accumulate, causing inflammation of the gums. At this stage, there is still no pain and the disease manifests only in swollen gums, bleeding during teeth brushing, and a bad taste and smell in the mouth. In more advanced stages, the bacteria succeed in actually tearing apart the connection between the tooth and the gum.

The gum then separates from the tooth. This creates a pocket in which food residue can accumulate, creating even more bacteria, worsening the inflammation, and making the surrounding tissue diseased. In the next stage of development, the jaw bone itself becomes damaged, causing osteoporosis (absorption of the bone due to loss of calcium). Slowly the tooth loses all support in the bone, and its extraction becomes inevitable.


Gingivitis is the lightest form of gum inflammation, before damage is caused to the bone. It is typified by red, swollen gums that bleed easily. But it can be healed with professional treatment by a dental hygienist, and maintaining dental hygiene at home.

Mild (moderate) periodontitis

This is a development of gingivitis. Damage to the gum and osteoporosis of the jaw bone can now be clearly seen on an x-ray. Moderate surgical procedure can treat this stage.

Acute (advanced) periodontitis

This is the most severe form of gum inflammation, and destroys the base of the teeth in the jaw bone, causing the teeth to move and opening spaces between them. It also causes aesthetic damage. Most importantly, it causes functional damage that may require extraction of the teeth.

In such cases, if it is not too late, treatment is extremely complicated and long term.

Can other illnesses cause periodontitis to become more severe?

Indeed, other illnesses can detrimentally affect gum inflammation. They include unchecked diabetes, or hormonal diseases that may worsen the state of the gums and speed up the destructive processes caused by the accumulating bacteria.

Does periodontitis affect our general health?

It is currently well known that untreated gum inflammation does harm our general health.

Without treatment, periodontitis may:

  • Increase the chance of heart disease (cardiovascular complications)
  • Make it more difficult to balance diabetes
  • May cause premature birth and underweight newborns
  • Participates in respiratory illnesses

Are there different types of gum inflammation?

Yes, different types are differentiated by their speed of development, aggressive progress, and age range of people in whom the disease begins to develop. Interestingly, most gum diseases are caused by one single factor – the layer of bacteria, which is different in each individual.

Can gum disease be healed?

Yes, except in very advanced cases where the tooth’s support has been destroyed. Early diagnosis increases your chances of successful treatment.

How is gum disease treated?

There is only one way: utterly remove the cause of the disease, which means removing all bacteria and accumulated plaque. Attempting to eradicate bacteria through disinfectants and antibiotics alone will NOT produce significant results.

Treatment is offered at two levels, the conservative and the surgical:

  • Conservative therapy requires thorough deep-cleansing and root scaling, both of which promote removal of the accumulated plaque beneath the gums. Additionally, a demonstration of correct dental hygiene is given, providing instructions which must be strictly followed: correct brushing, correct use of dental floss, and additional accessories. Following these instructions will prevent the return of the disease. Several weeks after the cleansing processes, an examination is again held to assess further treatment. Although improvement should be seen in the condition of the tissue, a surgical procedure may be necessary in some cases.
  • Surgical procedure under localized anesthetic removes the pockets which could not be accessed even in deep cleansing.

What does gum surgery aim to achieve?

The primary goal is to halt the progress of the disease and prevent the teeth from falling out. Conventional surgery makes it possible to access and treat the pockets. During the procedure, the gums are separated from the teeth, which expose the roots of the teeth and the jaw bone. Then the bacteria, plaque and diseased tissues are removed. Once treatment is over, the gums are stitched back into place. The result of pocket reduction allows the gums to heal.

Occasionally after-effects may appear, such as sensitivity to cold, or spaces between the teeth due to removal of diseased tissue, but these phenomena pass after some time. In certain instances, it is possible to reconstruct the diseased jaw bone through bone grafts, and/or the use of membranes or proteins that stimulate tissue renewal. This is an innovative therapy known as regenerative therapy – further explanation provided below.

For post-operative gums to return to their normal condition, strict and constant maintenance of oral hygiene is vital, as well as period cleaning and follow-up by a specialist. At this stage, Moria Periodontal Center has decided not to purchase the laser equipment due to lack of sufficient evidence of its effectiveness in treating gums and installing implants (according to the Israel Association of Periodontology). However, we stay ahead of all new information regarding the development of any new equipment and technique.

Periodontal disease is not contagious.

How long does treatment take to achieve healthy gums?

A course of treatment can be from several weeks to several months, depending on the severity of the disease and any additional complications.

Is repeat treatment necessary? If so, how frequently?

No. There should be no need for recurring treatment, if the patient follows recommendations and maintains periodic examinations and cleaning sessions with the dental hygienist. These two actions together will maintain the results of periodontal treatment. Moria Periodontal Center offers follow-up care and support for all its patients.

Is periodontitis hereditary?

No. It is not inherited and in most cases can be avoided with periodic checkups and proper home care. However, a genetic factor does exist and increases the tendency to develop it, so checking with other family members is worthwhile.

Regenerative therapy – Guided Tissue Regeneration – GTR

This is a method that enables reconstruction of tissue integrated with bone grafting, membranes and growth stimulating proteins.

GTR and Periodontitis

In advanced periodontitis, the jaw bone is damaged by osteoporosis, so that the tissue supporting the teeth can no longer be healed with standard surgical procedures. Regenerative therapy means “to restore to its previous state”. It is the most innovative solution for reconstruction damaged tissue, integrating bone grafts, membranes and growth-stimulating proteins.

Bone grafting A chunk or particles of bone can be taken from the patient her- or himself, from the bone bank, from animals or from synthetic bone.

Membrane This is a sort of sieve made of natural collagen or a synthetic material. Its role is to envelope the bone graft and protect it from penetration of soft tissues during the healing process. The membrane allows the bone to grow and restructure around the tooth once the bone graft is completed. It is absorbed within some 4 to 6 weeks once its work is over. Occasionally the membrane is comprised of non-absorbable materials and therefore requires removal some months later.

Growth factors An innovative material serving to stimulate regeneration of tissue. Materials of this kind allow vital potential cells the movement needed to regenerate tissue. They stimulate and improve the healing process.

Phases of treatment – bone graft, growth factors, membrane placement

The area of the bone graft and growth protein are covered by regenerative membrane to allow healing and protection from further gum disease.

How treatment is carried out

Treatment begins with thorough cleaning of the diseased area, after which the specialist reconstructs the missing bone by adding bone graft integrated with growth protein, and if necessary, membrane. Once stitches are removed, the healing period commences. It can last from several weeks to several months. During this period, the growth-stimulating proteins integrated with the bone graft will encourage the regeneration of the natural bone. The membrane will be absorbed from 4 to 6 weeks after it has completed its work.

The results of treatment can be evaluated some weeks later, and the regenerated bone’s progress several months later, using x-rays. Regenerative treatments are not automatically covered by all insurance policies, therefore their cost must be covered as necessary by the patient.

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