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The tissues that sit above the alveolar bone crest are considered the free gingiva. In healthy periodontium, the gingival margin is the fibrous tissue that encompasses the cemento-enamel junction, a line around the circumference of the tooth where the enamel surface of the crown meets the outer cementum layer of the root. A natural space called the gingival sulcus lies apically to the gingival margin, between the tooth and the free gingiva. A non-diseased, healthy gingival sulcus is typically 0.5-3mm in depth, however, this measurement can increase in the presence of periodontal disease. The gingival sulcus is lined by a non-keratinised layer called the oral sulcular epithelium; it begins at the gingival margin and ends at the base of the sulcus where the junctional epithelium and attached gingiva begins. [4] Attached gingiva [ edit ]

a b Hasan, A.; Palmer, R. M. (25 April 2014). "A clinical guide to periodontology: Pathology of periodontal disease". British Dental Journal. 216 (8): 457–461. doi: 10.1038/sj.bdj.2014.299. PMID 24762896. Rivera-Hidalgo, Francisco (October 1986). "Smoking and Periodontal Disease: A Review of the Literature". Journal of Periodontology. 57 (10): 617–624. doi: 10.1902/jop.1986.57.10.617. PMID 3534210. Also acute necrotizing ulcerative gingivitis and necrotizing ulcerative periodontitis, it is a type of periodontal disease different than many other periodontal diseases. Clinical characteristics include gingival necrosis (breakdown of the gums), gingival pain, bleeding, halitosis (bad breath), as well as a grey colour to the gingiva and a punched out appearance. [ clarification needed] It is treated through debridement, usually under local anaesthetic due to immense pain. To maintain and treat the condition completely, a chlorhexidine mouthwash should be recommended to the patient to use twice daily, oral health instruction should be provided (using a soft bristle toothbrush or electric toothbrush twice a day) and an interdental cleaning aid, such as floss or interdental brushes, which cleans the areas that the toothbrush cannot reach. The patient should also be educated on proper nutrition and diet and healthy fluid intake. Smoking cessation should occur not only to completely eradicate the disease but also for the health of the patient. Pain control can be done through ibuprofen or paracetamol/acetaminophen. In the case of an immunocompromised patient, antibiotics should be prescribed. Assessment of treatment should be done after 24 hours of treatment and continued every 3–6 months until signs and symptoms are resolved and gingival health and function restored. [55] Chronic periodontitis [ edit ]Many people can benefit from having periodontal treatment, and it will be up to your dentist to decide, after they’ve done a thorough periodontal assessment, which treatment you might benefit from. See your dentist if you are experiencing symptoms like: The early form of gum disease is called gingivitis. You can control this condition with treatment, by keeping your mouth and teeth clean, and seeing the dentist regularly. However, more advanced gum disease -- or periodontitis -- may require more extensive treatment. That’s when you need to see a periodontist. a b c Gurenlian, JoAnn R. (31 December 2007). "The Role of Dental Plaque Biofilm in Oral Health". American Dental Hygienists' Association. 81 (suppl 1): 116. Genco, Robert J.; Borgnakke, Wenche S. (June 2013). "Risk Factors for Periodontal Disease". Periodontology 2000. 62 (1): 59–94. doi: 10.1111/j.1600-0757.2012.00457.x. PMID 23574464.

Most periodontists offer sedation dentistry to keep you comfortable during your procedure. These options may include nitrous oxide, oral sedation or IV (intravenous) sedation. Hormonal changes in women and people assigned female at birth, such as pregnancy or using birth control pills, can increase your chances of developing periodontitis.

Causes

Plaque can cause gingivitis, the mildest form of gum disease. Gingivitis is irritation and swelling of the gum tissue around the base of your teeth. Gingiva is another word for gum tissue. Gingivitis can be reversed with professional treatment and good home oral care, but only if treated early before you have bone loss.

Neiva, Rodrigo F.; Steigenga, Jennifer; Al-Shammari, Khalaf F.; Wang, Hom-Lay (July 2003). "Effects of specific nutrients on periodontal disease onset, progression and treatment". Journal of Clinical Periodontology. 30 (7): 579–589. doi: 10.1034/j.1600-051x.2003.00354.x. PMID 12834494. Keeping your gums healthy will not only keep your smile looking good but may improve your overall health. Gum disease can increase your risk of such serious conditions as heart disease, and respiratory infections. Genetics and the host response have been shown to play an important role in periodontal disease development in studies on identical twins and isolated indigenous populations. [35] Periodontal disease also may result due to an abnormal or decreased immune response, rather than aggressive properties of bacterial pathogens. [36]Surgery can be done under general anesthesia and many people don’t feel pain after the surgery. Most will miss only one day of work. Phase III: The maintenance phase Healthy oral care leads to a brighter smile. When tending to your teeth, considering the distinction between a periodontist vs dentist is important to decipher your treatment. Often your dentist will recommend the best course of action, but it is also good to know the difference in professions. Both doctors have a few fundamental differences in their respective specialisms. Periodontal therapy should follow restorative method as the resolution of gingival inflammation may result in the repositioning of teeth or in soft tissue and mucosal changes. [42] Dufty, J; Gkranias, N; Donos, N (2017). "Necrotising Ulcerative Gingivitis: A Literature Review". Oral Health & Preventive Dentistry. 15 (4): 321–327. doi: 10.3290/j.ohpd.a38766. PMID 28761942. S2CID 32401805.

a b Martinez-Canut, Pedro; Llobell, Andrés; Romero, Antonio (June 2017). "Predictors of long-term outcomes in patients undergoing periodontal maintenance". Journal of Clinical Periodontology. 44 (6): 620–631. doi: 10.1111/jcpe.12730. PMC 5519943. PMID 28419497.

Preshaw, Philip M (15 September 2015). "Detection and Diagnosis of Periodontal Conditions Amenable to Prevention". BMC Oral Health. 15 (S1): S5. doi: 10.1186/1472-6831-15-s1-s5. PMC 4580822. PMID 26390822. Nash, David A. (October 2012). "Envisioning an oral healthcare workforce for the future". Community Dentistry and Oral Epidemiology. 40: 141–147. doi: 10.1111/j.1600-0528.2012.00734.x. PMID 22998319. During bone grafting, your dentist will place natural or synthetic bone in the area of the loss, which can help promote bone growth.