Periodontology (Gingival Diseases and Their Treatment)


Periodontology (Gingival Disorders and Their Treatment) is a branch of dentistry that examines the structure of soft (periodontal ligament, gingiva) and hard tissues surrounding the teeth (bone, cementum), the diseases that occur in these tissues and the treatment of them. Periodontology is a science that deals with the health of soft tissues such as gingiva surrounding teeth and dental implants replaced in place of lost teeth, the hard tissues such as jawbone supporting teeth and dental implants, and their treatment in case of sickness. Periodontology (Gingival Disorders and Treatment) is a branch of dentistry that deals with the health of the gingiva surrounding the teeth and tooth roots. Periodontology (Gingival Disorders and Treatment) branch includes tartars, gingival operations, flap operations, papillary operations, deep curettage and implantology.

The teeth cannot be directly attached to the bone called alveolar protrusion, in which they are located. Between the teeth and the bone, there is a tissue of fibers which we call the periodontal ligament. The periodontal ligament enables the force on the teeth to be transferred to the jawbone after reducing it. This structure is covered with the gingiva. These tissues around the tooth are called periodontal tissues and they constitute the scope of periodontology.


What are the Periodontal Diseases?


Gingivitis occurs in teeth that are not brushed for 7 days and in an unbrushed mouth. General indications of this disease are redness, swelling, and bleeding in the gingiva. Generally, gingival disorders such as pain and tingling are not observed at this phase. With the in time response of your dentist and your attention to oral hygiene, you can regain your healthy gingiva. If not treated, it will cause periodontitis.





Healthy gingiva is pale pink, mate and tight in consistency. The gingiva surrounds the tooth in the area of the neck like a collar and ends up in the form of a knife edge where it joins the tooth. There is a gap of approximately 1-1.5 mm between the tooth and the gingiva. This gap is called the gingiva groove. Periodontal diseases originate from this gingiva groove. Healthy gingiva does not bleed during brushing.




Gingival diseases are chronic, bacterial infections that occur in the periodontal tissues surrounding your teeth. They do not cause pain as long as they are not very progressed. Gingival diseases are serious infections and they can progress for many years without any significant symptoms in the mouth. If they remain untreated, even healthy non-decaying teeth may swing and fall due to the loss of supportive tissue. Gingival diseases can affect one or more teeth together or separately.


What are the indications of gingival diseases? Why the gingiva becomes infected?


It is bleeding during teeth brushing tooth and gingiva sensitivity, tooth and gingiva pain, gingival redness, gingival edema, itching sensation in the gingiva, bad breath in the mouth, gingival recession, teeth swinging, and exposure of the root surfaces.


Gingival disease begins when the bacteria plaque causes inflammation in your gingiva. A small progression of the disease in the gingiva is called gingivitis. During the gingivitis phase, there is inflammation of the gingiva, but the inflammation has not passed to the supporting bone of the tooth yet.


In Gingivitis,


There is bleeding in the gingiva when brushing.


The gingiva is red and swollen.


The contours of the gingiva are deformed and the surface is bright.


There is no pain.


If the gingival disease is not treated at this phase, it progresses to the next stage calledperiodontitis. In periodontitis phase, the inflammation has passed to the periodontal ligament and tooth’s supportive bone after the gingiva. The gingival groove between the tooth and the gingiva gets deeper due to inflammation and becomes a periodontal pocket. The existence of periodontal pocket facilitates the progression of gingival disease.


In Periodontitis,


There is bleeding on the gingiva when brushing or spontaneous bleeding.


The gingiva is red and swollen.


The contours of the gingiva are deformed and the surface is bright.


There are bad smell and taste in the mouth.


Periodontitis: Unlike gingivitis, periodontal tissues and bone are lost and it is now in an irreversible phase. There are different types of it. Genetic factors, poor oral hygiene and some systemic diseases affect the formation and progress of periodontitis.


Aggressive Periodontitis: The disease progresses quickly and causes destructive teeth loss. Along with gingival treatment, medication may be required. Chronic periodontitis is a condition that is generally observed above 35 years of age.


Necrotizing Ulcerative Periodontitis: It is shortly stated as NUP. There are necrotized inflamed areas on the gingiva and surrounding tissues. It is usually observed in individuals with HIV.


As the disease in the gingiva progresses, gingival recession occurs. As a result of the gingival recession, since the sensitive root surface of the teeth is exposed, sensitivity to hot and cold may arise.


Gingival disease continues to progress unless treated. Teeth begin to swing and gradually move away from each other, the gap between teeth gradually increases.






In the early stage of gingival diseases – during the gingivitis stage, treatment involves cleaning the plaque of bacteria and tartar on the teeth and smoothing the root surface. When the tartar and plaque are removed, the bacteria that cause gingival disease are also removed. This gingival treatment is usually sufficient to eliminate inflammation and to re-stick the gingiva to the tooth. In addition, the patient must be informed by the physician about the check of the bacterial plaque that causes inflammation, in other words, the oral hygiene.


If the gingival disease has reached the periodontitis phase, then the aim of treatment is to clean the tartar in the periodontal pockets, to eliminate the periodontal pocket, to create a smooth root surface for the gingiva to stick to the tooth and to obtain a gingiva form which easier to clean.


After the gingival treatment, it is required that the patients should be checked regularly and the resulting tartar and plaque should be removed. However, it is the responsibility of the patient to take the measure accordingliy in periodontal treatment. In order to maintain the health obtained from the treatment of the gingiva, the person must maintain effective oral care.




Bacteria plaque is the main factor in the formation of gingival diseases. For a healthy mouth, the bacteria plaque must be removed by oral care. If the plaque is not removed off the teeth, the calcium salts in the saliva stick to the teeth through the plaque, causing the formation of tartar. If there is no bacterial plaque on the teeth, calcium salts cannot stick to the tooth, so no tartar can form.


The byproducts of the bacteria inside the plaque affect the periodontal ligament that binds to the tooth to the bone, destructing the ligaments. The gingiva moves away from the tooth and the periodontal pocket forms. Because of the periodontal pocket, bacteria can easily progress to deeper tissues and, damage in the surrounding bone begins over the time.


In the formation of bacterial plaque followings plays a major role;


Insufficient and incorrect tooth brushing


Not using assistant hygiene materials such as dental floss or mouthwash


Lack of regular checkups for tartar..


Other factors that cause gingival diseases are:


Genetic Factors: Genetic tendency is found to be effective in certain forms of gingival diseases. In such cases, the disease progresses very quickly and causes tooth losses at early ages. For this reason, people with a family having history of tooth losses at early age should be under the supervision of a gingival disease specialist beginning from adolescence.


Systemic Diseases: Gingival health is negatively affected in diseases such as leukemia and AIDS that affect the body’s immune system, and in diabetes.


Drug use: Some drugs have been found to have negative effects on gingiva.


Pregnancy: Gingiva is affected by hormonal changes during this period.










The most important role in the prevention of gingival diseases belongs to the individual itself. Since the main cause of the disease is bacterial plaque, it is essential to prevent the formation of it. To prevent bacteria plaque formation, teeth and gingiva should be brushed regularly. In addition to regular oral care, regular dentist check  is also important for the prevention of gingival diseases. It may not be possible to completely prevent plaque formation by brushing. In this case, the plaque and tartar are cleaned by the dentist. Thanks to the dentist’s checks, problems that may occur are detected at an early stage.


What is a flap operation? How is flap operation performed?


If the patient has very deep pockets, flap operations are needed to perform a more effective cleaning and to remove inflamed tissue and tartar. In such cases, gingiva is lifted and the infected tissues underneath are cleaned, then the gingiva is closed again. If necessary, the missing tissue is tried to be compensated using bone grafts or the patient’s own bone particles.




Plaque is a transparent layer of soft accumulations that sticks firmly to the teeth and hard tissues in the oral cavity. You can notice the plaque by scratching your teeth with your nail. There are between 500 million and 2 billion bacteria in 1 milligram of the plaque. Tongue, lips and saliva, take the bacteria along with food and drinks from the teeth and transfer them to the stomach. So, bacteria release an adhesive substance called dextran to hold onto the tooth. Dextran is water-resistant, therefore, when the mouth is rinsed the plaque does not move away. Dextran also provides food to bacteria by capturing small particles of the consumed food. To summarize, the plaque is a structure consisting of bacteria, the adhesive dextran they release, and food residues. Bacteria in the plaque digest small food residues to release organic acids. These acids remain in contact with the tooth for a long time due to dextran. This contact causes the formation of decays.

Plaque usually occurs at the gingiva level and causes inflammation. Bacteria cannot produce acids that will harm the teeth and gingiva until 24 hours have passed for the formation of plaque. Therefore, the plague must be cleaned regularly. For plaque cleaning, it is necessary to brush the teeth at least twice with a fluoride-containing toothpaste and to floss once a day. Otherwise, the plaque transforms to tartar over time. The tartar cannot be removed from the tooth with the help of a toothbrush like plaque, but it can be removed by a dentist.




Tartar forms as a result of calcium salts in the saliva adhering to the teeth by means of a bacterial plaque. The main effect of tartar on disease is that it causes irritation in the gingiva and is surrounded by the bacteria continuously. Tartar causes the plaque to stay in close contact with periodontal tissues and create areas where plaque cleaning is not possible. Tartar may occur on dentures as well as dental surfaces.


Tartar is classified according to its place of formation:


Supragingival tartar It is the tartar that occurs above the gingival border and is visible. It occurs mostly on the cheek-facing surfaces of the upper first molar and on the tongue-facing surfaces of the lower incisors. Because the saliva canals are open to mouth in these areas.


Supragingival tartar: It is the tartar that occurs below the gingiva border and it cannot be seen. It is darker than the supragingival calculus and sticks more firmly to the tooth.


Supragingival and subgingival tartar usually occur together, but only one can occur without the other.