Periodontal (perio) disease is often referred to as gum disease – an infection that can cause tooth loss and is associated with several serious health conditions. That’s why it is so important to have oral exams and preventative dental hygiene treatments at least twice a year with Dr. Özkalfa’s team at GriDent to assess your periodontal health.

Our dentists have had extensive periodontics training and uses the latest techniques for diagnosing and treating periodontal disease, including dental implants and other cosmetic dentistry procedures to help you achieve the smile you desire

What are the symptoms to diagnose periodontitis?

  • bleeding gums
  • teeth are getting longer because gums are receding
  • mouth odour occurs
  • the front teeth shift and tilt
  • there are gaps between teeth that weren’t there before

What increases the risk for periodontal diseases?

Periodontal (gum) disease is a chronic bacterial infection that affects the gums and bone supporting the teeth. The primary cause of gum inflammation that starts gum disease is plaque – the sticky colorless coating that constantly forms on your teeth and contains bacteria.

Gingivitis, the milder form of gum disease, is frequently caused by lack of oral hygiene and results in red, swollen or bleeding gums. You can reverse gingivitis by getting professional dental care from Dr. Sherri Worth and taking better care of your teeth at home, including daily brushing and flossing, eating well and not smoking.

Periodontisis is a more serious form of periodontal disease. If untreated, plaque can spread below the gum line, producing toxins and triggering an inflammatory response in the body that causes tissues and bone supporting the teeth to break. When gums separate from the teeth, pockets are formed that become inflamed and deepened with time. Often, this process has very mild symptoms until it results in tooth loss.

What means scaling and root planing?

Scaling and root planning are the most common and conservative form of treatment for periodontal (gum) disease. In the procedure of scaling the calculus, which is usually called as tartar and plaque, are removed. Plaque is a sticky substance and it is full of bacteria. The calculus is formed when the plaque hardens in time.

The calculus and the plaque attach to the tooth surfaces, especially below the gum line along the root surface. And the plaque is more likely to stick to rough surface so the root surfaces need to be smoothed down. The process of root planning is for smoothing down the root surface. In this procedure all the calculus are removed and the root-surface irregularities are smoothed.

When it’s applied?

In order to remove the plaque and calculus, which cause periodontal disease, scaling and root planning are done. In the early stage of disease, especially gingivitis, this treatment is enough for to get the condition under control. But in the advanced cases this procedure can be the first step of the treatment.

Preparation for the scalling?

A local anesthetic can be given to numb the area that will be worked. These procedures can cause discomfort for some patients.


Ultrasonic scalers and hand instruments are used in the procedure of scaling and root planning. Ultrasonic instruments are electric or air-powered devices. They have two components. The first one is a relatively dull metal tip. It vibrates at a very high frequency and knocks plaque and calculus off the tooth. The second one is a water irrigation system that cools the tip and helps to flush out the debris from the teeth. The hand instruments have cutting edges and they are pressed against the teeth. The hand instruments are called as scalers and curettes. They are not powered instruments. There are various shapes and sizes of them. They are used for different teeth and also for different surfaces of the same tooth.

Firstly the ultrasonic instruments are used to remove large deposits of plaque and calculus from the crowns and the roots of the teeth. The hand instruments are used to remove all the remaining material and to make the tooth surface clean and smooth. The dentist may not see the plaque or calculus when he/she is working under a gum line. So the sense of roughness on the root surface orientates him/her.

For the early stage of gum disease (gingivitis) or more advanced gum disease located in only one part of the mouth (localized periodontitis) scaling and root planning is usually completed in one visit. If there is periodontitis, a quarter of the mouth is done in one visit. So, four visits are needed to complete the treatment.


Some soreness and sensitivity to hot and cold can exist for two to three days after the treatment. Over-the-counter relievers can be helpful for abolishing the pain. An antiseptic mouth rinse can be used after scaling and root planning especially when there is soreness of the gums because the soreness prevents oral hygiene measures. Also you should continue on brushing and flossing. The first day after the scaling and root planning there can be minor bleeding.

What is gingivectomy and gingivoplasty?

Gingivectomy is the surgical removal of gum tissue (gingival). And the gingivoplasty is the surgical reshaping of gum tissue around the teeth with healthy gums. These procedures are performed by periodontist who are specialized in treating gums and the other supporting structures of the teeth.

What it’s used for?

Gingivectomy was developed to treat periodontal disease but today it is also used as a cosmetic technique.

There are two reasons for the gum tissue to be removed. There can be gaps (pockets) that have been formed between the teeth and gums, and they make it difficult to keep the area clean because of trapping particles and harboring colonies of bacteria. The pockets can be removed by a gingivectomy (trimming the gums) if they involve only the soft tissue.

There can be too much gum around the teeth. This can also make it difficult to keep the teeth and gums clean. Beside that this case is a cosmetic problem. In severe situations, this condition can interfere with chewing and speech. Certain drugs like anti-seizure medications can cause an overgrowth of gum tissue. Sometimes there may not be any apparent cause.

The gums look more natural after reshaping them by the help of gingivoplasty. Malformed or asymmetrical gums, which are caused by genetics, disease or trauma, can be corrected by this procedure. Also this procedure can be applied for only the cosmetic purposes. Usually the gingivoplasty is done alone but it can be done during or after a gingivectomy or a gum graft in which some tissue is added to the gum line.

Preparation for gingivectomies?

The periodontist will talk you about oral hygiene that must assured after the procedure and will tell you about the other instructions that you should follow. A thorough cleaning and if possible a root planning is needed to remove tartar (calculus) from existing pockets.

How it’s done?

Usually the gingivectomies and gingivoplasties are done with scalpels. But also they can be done with electro surgery units, lasers and/or diamond dentals burs. The specialized instruments with angled blades that help to get around to teeth may be used by the periodontist too.

To numb the gums local anesthetic will be given by injection. It is from a few minutes to more than an hour for a gingivectomy take time. It depends on how much tissue is being removed. Gingivoplasties are done in few minutes.

Follow-Up after gingivectomies?

A periodontal dressing which is a type of bandage is placed on the gums after the procedure of gingivectomy or gingivoplasty. It is often 10 days after the procedure that this bandage has to stay on the gums. During these 10 days in which you have the periodontal dressing rests on your gums, you’ll have to follow a soft diet and you should avoid spicy and crunchy foods. A pain medication and a chlorhexidine mouthwash can be prescribed by the dentist or by periodontist.

During the healing period, you should keep your mouth clean. The teeth, which are found in the surgical area, shouldn’t be brushed while pack is in place. But you can brush and floss the rest of the mouth normally. You can gently brush and floss the teeth in the surgical area after the pack comes off. Bleeding is normal for the healing tissues when you brush or floss immediately after the dressing is removed.

7 to 10 days after the procedure the pack will be removed. In three or four weeks the gums will begin to look normal and it can be needed two to three months for the tissue to heal completely.

Soft-tissue grafts

Periodontal disease, physical trauma (brushing too hard, too often or with a hard brush), tooth position and aging are among the reasons of gum recession. If the gum recession is severe, some of the tooth’s root can be exposed. This can cause sensitivity to hot or cold temperatures and also root decay. Also the recession can create an appearance problem.

In soft-tissue grafts more gum tissue is added in order to prevent further recession. By the help of this procedure the exposed root area is covered and the sensitivity is stopped. And also the appearance of the tooth is improved. The people who have the gums naturally very thin carry a high risk of receding. For these people a soft-tissue graft may be done in order to prevent the problems in the future.

What is a gingival flap surgery?

In the procedure of gingival flap surgery the gums are separated from the teeth and folded back temporarily so the dentist can reach the root of the tooth and the bone.

What it’s used for?

The aim of the gingival flap surgery is to treat gum disease (periodontitis). This procedure is recommended for people with moderate or advanced periodontitis. If the gum infection is not eliminated by a non-surgical treatment the gingival flap surgery is used. In a conjunction with the osseous (bone) surgery, which is another procedure, the gingival flap surgery can be done too.

Preparation and treatment for gingival flap surgery?

Firstly, all the plaque and tartar (calculus) will be removed from around of the teeth and the oral hygiene is improved. Before starting the surgery, the periodontist will determine if your general health and your current medications allow for a surgical procedure.

Firstly, the area is numbed with a local anesthetic. Then the gums will be separated from the teeth with the help of a scalpel. Thus the periodontist can access directly to the roots and bone supporting the teeth. Then he/she will remove the inflamed tissue from between the teeth and from any holes (defects) in the bone. A procedure, which is called as scaling and root planning, is applied to clean plaque and tartar. If there are bone defects, they can be eliminated with osseous recontouring procedure. In this procedure it is possible to smooth the edges of the bone by using Er:YAG laser or rotating burs.

After these procedures, the periodontist will place the gums back against the teeth and they are anchored in place by using stitches. The surgical area can be covered by a periodontal pack or dressing which is an intra oral bandage.


After the procedure you may have mild to moderate discomfort. You can take pain medication that is prescribed by the periodontist. An over-the –counter pain reliever can assure your comfort.

To keep the mouth as clean as possible is very important while the surgical site is healing. You should go on brushing and flossing the rest of your mouth normally. If a periodontal pack is used to cover the surgical site, you can use a toothbrush to gently remove the plaque from the teeth. The antimicrobial mouth rinses, which contain chlorhexidine, are usually prescribed after the periodontal surgery. These rinses do not remove plaque from the teeth but they kill the bacteria and help the mouth to heal.

Some swelling can be formed but it is possible to minimize it by applying an ice pack to the outside of the face in the treated area. In order to prevent the infection, antibiotics can be prescribed. In 7 to 10 days the periodontist will check the area.

Many of us work through their problems subconsciously. Stress at work is one of the main reasons for teeth grinding.

Neck pain, tense jaw muscles and headaches can all be caused by teeth grinding.

The easiest and most effective treatment is a plastic guard that is worn at night. The health insurance covers the costs



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