GINGIVECTOMY PERIODONTAL SURGERY

Gingivectomy is periodontal surgery that removes and reforms diseased gum tissue or other gingival buildup related to serious underlying conditions. For more chronic gingival conditions, gingivectomy is utilized after other non-surgical methods have been tried, and before gum disease has advanced enough to jeopardize the ligaments and bone supporting the teeth. Performed in a dentist’s office, the surgery is primarily done one quadrant of the mouth at a time under local anesthetic. Clinical attachment levels of the gum to teeth and supporting structures determine the success of the surgery. Surgery required beyond gingivectomy involves the regeneration of attachment structures through tissue and bone grafts.

Purpose
Periodontal surgery is primarily performed to alter or eliminate the microbial factors that create periodontitis, and thereby stop the progression of the disease. Periodontal diseases comprise a number of conditions that affect the health of periodontium. The factors include a variety of microorganisms and host conditions, such as the immune system, that combine to affect the gums and, ultimately, the support of the teeth. The primary invasive factor creating disease is plaque-producing bacteria. Once the gingiva are infected by plaque-making bacteria unabated due to immuno-suppression or by oral hygiene, the bacterial conditions for periodontitis or gum infections are present. Unless the microorganisms and the pathological changes they produce on the gum are removed, the disease progresses.

According to a report by the U.S. Surgeon General in 2000, half of adults living in the United States have gingivitis, and about one in five have periodontitis. According to the same report, smokers are four times more likely than nonsmokers to have periodontitis, and three to four times more likely to lose some or all of their teeth. By region, individuals living in the Southern states have a higher rate of periodontal disease and tooth loss than other regions of the country. Severe gum disease affects about 14% of adults aged 45–54 years. One of the main risk factors for gum disease is lack of dental care. Initiatives by the Centers for Disease Control and Prevention have begun to study the relation between periodontal disease and general health. There is growing acknowledgment of the public health issues related to chronic periodontal disease.

The delivery of oral surgery, or even dental care, to individuals in the United States is difficult to determine. Race, ethnicity, and poverty level stratified individuals making dental visits in a year. While 70% of white individuals made visits, only 56% of non-Hispanic black individuals and only 50% of Mexican-American individuals made visits. Seventy-two percent of individuals at or above the federal poverty level made visits, while only 50% of those below the poverty level made visits. Since it is also estimated that more than 100 million Americans lack dental insurance, it is likely that periodontal surgery among the people most likely to have periodontal disease (low-income individuals with nutritional issues, with little or no preventive dental care, and who smoke) are the least likely to have periodontal surgery.

In the most severe cases, graft surgery may be necessary to restore tissue ligament and bone tissue destroyed by pathogens. In healthy gums, there is very little space between the gum and tooth, usually less than 0.15 in (4 mm). With regular brushing and flossing, most gums stay healthy and firm unless there are underlying hereditary or immunosuppressive conditions that affect the gums. The continuum of progressive bacterial infection of the gums leads to two main conditions in the periodontium: gingivitis and periodontitis. Such external factors as smoking, and certain illnesses such as diabetes are associated with periodontal disease and increase the severity of disease in the gum tissue, support, and bone structures. Two types of procedures are necessitated by the severity of gum retreat from the teeth, represented by periodontal pockets. Both nonsurgical and surgical procedures are designed to eliminate these pockets and restore gum to the teeth, thereby ensuring the retention of teeth.

Gingivitis
Gingivitis occurs when gum tissue is invaded by bacteria that change into plaque in the mouth due to diseasefighting secretions. This plaque resides on the gums and hardens, becoming tartar, or crystallized plaque, known also as calculus. Brushing and flossing cannot remove calculus. The gum harboring calculus becomes irritated, causing inflammation and a loss of a snug fit to the teeth. As the pockets between the gum and the teeth become more pronounced, more residue is developed and the calculus becomes resistant to the cleaning ability of brushing and flossing. Gums become swollen and begin to bleed.

A dentist or periodontist can reverse this form of gum disease through the mechanical removal of calculus and plaque. This cleaning procedure is called curettage, which is a deep cleaning process that includes scraping the tartar off the teeth above and below the gum line and planing or smoothing the tooth at the root. Also known as dental débridement, this procedure is often accompanied by antibiotic treatment to stave off further microbe proliferation.

Periodontitis
Periodontitis is the generalized condition of the periodontium in which gums are so inflamed by bacteria-produced calculus that they separate from the teeth, creating large pockets (more than 0.23 in [6 mm] from the teeth), with increased destruction of periodontal structures and noticeable tooth mobility.

Periodontitis is the stage of the disease that threatens significant ligament damage and tooth loss. If earlier procedures like scaling and root planing cannot restore the gum tissue to a healthy, firm state and pocket depth is still sufficient to warrant treatment, a gingivectomy is indicated. The comparative success of this surgery over such nonsurgical treatments as more débridement and more frequent use of antibiotics has not been demonstrated by research.