Key Differences Between Gingivitis, Periodontitis, and Aggressive Periodontitis: Updated Clinical Review

Periodontal diseases, ranging from gingivitis to aggressive periodontitis, differ significantly in severity, progression, etiology, and treatment.

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This academic article critically examines these distinctions based on current scientific evidence and emphasizes their clinical implications for dental professionals.

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1. Definitions and Main Characteristics

1.1 Gingivitis
The mildest and most common form of periodontal disease, characterized by gum inflammation and bleeding, generally caused by plaque accumulation without loss of periodontal support tissues. Gingivitis is fully reversible with proper oral hygiene, flossing, and regular professional cleanings.
1.2 Periodontitis
Progression from untreated gingivitis, involving irreversible destruction of the periodontal ligament and alveolar bone. It results in periodontal pocket formation, gum recession, tooth mobility, and eventual tooth loss if left untreated. Management often requires deep scaling and root planing, sometimes combined with systemic antibiotics or surgical intervention.
1.3 Aggressive Periodontitis
A less common but highly destructive form of periodontitis, progressing rapidly—often in patients under 30 years old—with no apparent systemic disease. Key features include:
° Rapid attachment loss (≥ 2 mm/year) and alveolar bone destruction.
° Absence of systemic conditions explaining progression.
° Strong family history suggesting genetic predisposition.
° Hyperactive immune response with elevated mediators such as PGE₂ and IL-1β.

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2. Etiology, Risk Factors, and Microbiology

➤ Gingivitis & Chronic Periodontitis: Initiated by plaque and calculus accumulation; aggravated by smoking, diabetes, genetic factors, stress, or inadequate oral hygiene.
➤ Aggressive Periodontitis (AP):
° Involves a complex interplay of genetic predisposition and host hypersensitivity, including neutrophil and monocyte dysfunction and altered antibody responses (Benza-Bedoya, 2009).
° Smoking worsens disease progression by impairing gingival microcirculation, modulating immune response, and favoring pathogenic bacterial colonization.
° Highly virulent bacteria such as Aggregatibacter actinomycetemcomitans produce collagenases, leukotoxins, and other toxins that inhibit periodontal tissue repair.

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3. Comparative Clinical Progression

4. Diagnosis and Clinical Management
➤ Gingivitis: Clinical diagnosis; managed with improved oral hygiene, patient education, and professional cleanings.
➤ Periodontitis: Requires periodontal probing, radiographic assessment, and deep scaling and root planing; advanced cases may need surgical therapy or systemic antibiotics.
➤ Aggressive Periodontitis:
° Differential diagnosis involves detailed history, comprehensive periodontal examination, and ruling out systemic conditions.
° Treatment strategies include:

• Initial phase: Intensive plaque control, reinforcement of interdental cleaning.
• Corrective phase: Deep scaling, root planing, removal of defective restorations, and caries treatment.
• Regenerative or surgical phase: Periodontal surgery, regenerative procedures, and implant placement as needed.
• Maintenance: Highly individualized, with close monitoring due to rapid progression risk.

💬 Discussion
Gingivitis, chronic periodontitis, and aggressive periodontitis represent different points along the periodontal disease spectrum. Gingivitis is entirely reversible, while advanced forms require intensive interventions. Early detection is critical, particularly for aggressive periodontitis, which has distinct genetic, immunologic, and microbiologic profiles requiring specialized clinical management.

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✍️ Conclusion
° Gingivitis is an early, reversible, and highly manageable periodontal condition.
° Chronic periodontitis involves irreversible tissue destruction and requires professional periodontal therapy.
° Aggressive periodontitis progresses rapidly in otherwise healthy young individuals and demands prompt, specialized intervention and long-term follow-up.

📚 References

✔ Andrii Iemelyanenko. (2025, April 12). What Is the Difference Between Gingivitis and Periodontitis? Health.com. Retrieved from https://www.health.com/gingivitis-vs-periodontitis-11684200

✔ Nico De Pasquale. (2025, May 29). Healthy Gums vs. Unhealthy Gums: How To Tell the Difference. Health.com. Retrieved from https://www.health.com/healthy-vs-unhealthy-gums-11698782

✔ Benza-Bedoya, R. (2009). Periodontitis agresiva: Clasificación, características clínicas y etiopatogenia. Acta Odontológica Venezolana, 47(3). Retrieved from https://ve.scielo.org/scielo.php?pid=S0001-63652009000300020&script=sci_arttext

✔ Benza-Bedoya, R. (2009). Periodontitis agresiva: Diagnóstico y tratamiento. Acta Odontológica Venezolana, 47(4). Retrieved from https://homolog-ve.scielo.org/scielo.php?pid=S0001-63652009000400019&script=sci_arttext

✔ Medigraphic. (2018). Aggressive Periodontitis: Diagnosis and Clinical Management. Odovtos - International Journal of Dental Sciences, 20(3). Retrieved from https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=76787

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Common Pediatric Periodontal Diseases: Signs, Diagnosis, and Treatment Strategies

Although periodontal diseases are more common in adults, children and adolescents are not immune. Pediatric periodontal conditions, if left untreated, can compromise both oral and systemic health and may result in premature tooth loss.

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Early diagnosis and appropriate intervention are crucial to preserving healthy dentition throughout life. This article reviews the most frequent periodontal diseases in pediatric dentistry, their clinical signs, diagnostic approaches, treatment options, and current best practices.

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✅ Most Common Pediatric Periodontal Diseases

1. Dental Plaque-Induced Gingivitis
° The most frequent periodontal condition in children.
° Typically caused by inadequate oral hygiene and biofilm accumulation.

2. Non-Plaque-Induced Gingival Lesions
° Caused by viral, fungal, or allergic reactions.
° Includes primary herpetic gingivostomatitis and erythema multiforme.

3. Aggressive Periodontitis (Localized or Generalized)
° Rapid tissue destruction with familial tendencies.
° Often affects permanent first molars and incisors.

4. Periodontitis Associated with Systemic Conditions
° More prevalent in children with diabetes, Down syndrome, or immune disorders.
° May present as early or atypical periodontal breakdown.

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✅ Signs and Symptoms

° Red, swollen, or bleeding gums
° Halitosis (bad breath)
° Gum recession
° Tooth mobility
° Formation of periodontal pockets
° Discomfort or pain while chewing

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✅ Diagnosis
A comprehensive periodontal evaluation includes:

1. Clinical Examination
° Probing depth and bleeding on probing
° Assessment of plaque and calculus levels
° Mobility and attachment loss

2. Radiographic Evaluation
° Intraoral periapical and bitewing X-rays to detect alveolar bone loss.

3. Medical and Family History
° Identification of underlying systemic diseases or genetic predisposition.

4. Microbiological Testing (if indicated)
May be used in severe or rapidly progressing cases.

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✅ Treatment Options

Note: Mechanical debridement is the first-line therapy in nearly all cases. Surgical intervention may be considered in advanced disease.

✅ Recommendations

° Educate caregivers and children about daily oral hygiene.
° Schedule dental visits every 6 months—or more frequently in high-risk patients.
° Encourage a balanced diet low in sugars and high in vitamins C and D.
° Use antimicrobial mouth rinses (e.g., chlorhexidine) when indicated.
° Monitor periodontal status in children with systemic illnesses closely.

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💬 Discussion

The incidence of periodontal diseases in children is lower than in adults; however, the potential for rapid progression—especially in aggressive periodontitis—requires early recognition. Pediatric patients may not report symptoms, and caregivers may overlook subtle signs like mild gum bleeding. Therefore, preventive care and regular screenings are vital. Collaboration between dentists, pediatricians, and parents is essential to manage systemic factors that exacerbate periodontal conditions.

💡 Conclusions

Pediatric periodontal diseases, though often mild, can lead to serious complications without proper care. Early detection, consistent oral hygiene, and individualized treatment protocols are key to long-term oral health. Dental professionals must remain vigilant in identifying at-risk children and intervening promptly to prevent irreversible damage.

📚 References

✔ Albandar, J. M., & Susin, C. (2020). Periodontal diseases in children and adolescents. Periodontology 2000, 82(1), 125–142. https://doi.org/10.1111/prd.12325

✔ Jepsen, S., Caton, J. G., Albandar, J. M., Bissada, N. F., Bouchard, P., Cortellini, P., ... & Papapanou, P. N. (2018). Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. Journal of Periodontology, 89(S1), S237–S248. https://doi.org/10.1002/JPER.17-0733

✔ American Academy of Periodontology. (2020). Comprehensive Periodontal Therapy: A Statement by the American Academy of Periodontology. https://www.perio.org

✔ Fine, D. H., Markowitz, K., Fairlie, K., Tischio-Bereski, D., Ferrendiz, J., Furgang, D., ... & Gunsolley, J. (2013). A randomized, double-blind, placebo-controlled trial of amoxicillin/metronidazole for the treatment of localized aggressive periodontitis. Journal of Clinical Periodontology, 40(6), 517–527. https://doi.org/10.1111/jcpe.12094

✔ Casarin, R. C. V., Ribeiro Edel, P., Mariano, F. S., & Casati, M. Z. (2021). Periodontal therapy in children and adolescents: A clinical overview. Clinical Advances in Periodontics, 11(3), 151–158. https://doi.org/10.1002/cap.10100

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Gum Recession: Causes, Consequences, and the Most Effective Treatments in 2025

Gum recession is a common oral health issue that involves the apical migration of the gum margin, exposing the root surface of the tooth. While often unnoticed in early stages, it can lead to both cosmetic and functional problems.

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✅ What Is Gum Recession?
Gum recession refers to the progressive loss of gum tissue surrounding the teeth, resulting in visible root surfaces. It may affect a single tooth or multiple teeth. The Cairo classification (2011) is currently the most widely used clinical system to describe its severity and predict treatment outcomes.

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✅ Common Causes of Gum Recession
Gum recession is multifactorial, and its most common causes include:

1. Aggressive Toothbrushing
° Using excessive force or horizontal scrubbing
° Hard-bristled toothbrushes or abrasive toothpaste

2. Periodontal Disease
° Chronic inflammation and destruction of connective tissue
° Bone loss and periodontal pockets

3. Tooth Misalignment
° Teeth positioned outside the bone housing
° Orthodontic movement without periodontal planning

4. High Frenum Attachment or Muscle Pulls
° Mechanical interference in the attached gingiva

5. Thin Gingival Biotype
° Thin gums are more prone to trauma and retraction

6. Smoking and Oral Piercings
° Chronic irritation and reduced blood supply to the gums

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✅ Health Risks and Consequences of Gum Recession
If left untreated, gum recession can lead to:

° Tooth sensitivity (especially to cold or brushing)
° Root surface cavities
° Progressive periodontal attachment loss
° Cosmetic concerns (exposed roots, black triangles)
° Difficulties with oral hygiene
° Emotional distress related to smile aesthetics

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✅ Evidence-Based Treatments for Gum Recession (2025 Update)

1. Addressing Traumatic Habits
° Patient education on non-traumatic brushing techniques
° Using soft or ultra-soft brushes and non-abrasive toothpaste

2. Non-Surgical Periodontal Therapy
° Scaling and root planing (SRP) in cases involving inflammation
° Regular plaque control and maintenance visits

3. Mucogingival Surgery (Advanced Regenerative Techniques)
° Subepithelial connective tissue graft (CTG) – gold standard
° Free gingival graft (FGG) – for increasing keratinized tissue
° Tunnel technique with biomaterials – minimally invasive approach
° Acellular dermal matrix grafts – alternative to autogenous tissue
° Platelet-rich fibrin (PRF) – improves healing and outcomes

4. Orthodontic Treatment
° Indicated in cases where misaligned teeth contribute to recession
° Requires coordination between orthodontists and periodontists

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✅ Clinical Recommendations for U.S. Dental Patients

° Always assess gum thickness and attachment level before starting restorative or orthodontic treatments.
° Educate patients on proper brushing methods and tools.
° Avoid hard bristles, abrasive pastes, or alcohol-based rinses.
° Perform routine periodontal evaluations to catch early signs.
° Refer to a periodontist when aesthetics or severe root exposure are involved.

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💬 Discussion
Gum recession is often underestimated in dental practice but plays a crucial role in both periodontal health and aesthetics. In 2025, surgical techniques have evolved significantly, offering less invasive procedures with better cosmetic results. Technologies such as PRF and biomimetic materials have improved predictability and healing.
That said, the foundation of long-term success lies in identifying and addressing the underlying causes—especially traumatic brushing or anatomical predispositions. Without this, even the most advanced grafting procedures are likely to fail.

💡 Conclusion
Gum recession is more than a cosmetic issue—it can compromise oral health and patient well-being. Effective treatment depends on the proper diagnosis, behavioral modification, and—in many cases—advanced periodontal surgery. Preventive care and patient education remain key to managing this condition successfully.

References

✔ Cairo, F., Pagliaro, U., & Nieri, M. (2011). Treatment of gingival recession with coronally advanced flap procedures: a systematic review. Journal of Clinical Periodontology, 35(Suppl 8), 136–162. https://doi.org/10.1111/j.1600-051X.2008.01267.x

✔ Chambrone, L., Tatakis, D. N., & Romanelli, H. C. (2018). Root coverage procedures for the treatment of localized recession-type defects: An updated Cochrane systematic review. Journal of Periodontology, 89(7), 760–778. https://doi.org/10.1002/JPER.16-0805

✔ Pini Prato, G. P., Franceschi, D., Cortellini, P., & Chambrone, L. (2020). Mucogingival surgery for the treatment of multiple gingival recessions: A systematic review. Periodontology 2000, 84(1), 315–338. https://doi.org/10.1111/prd.12344

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Top Antibiotics and Mouthwashes for Periodontal Treatment: Updated Guide with Doses and Benefits

Periodontal disease is a chronic inflammatory condition affecting the supporting structures of the teeth. It is a leading cause of tooth loss in adults in the United States. Proper management involves mechanical plaque removal along with adjunctive therapies like systemic antibiotics and antiseptic mouthwashes.

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These agents are particularly useful in moderate to severe periodontitis, or in patients with systemic risk factors. This article outlines the most commonly prescribed antibiotics and rinses in periodontal care, their dosages, clinical indications, and therapeutic advantages.

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✅ Signs and Symptoms of Periodontal Disease

° Red, swollen, or bleeding gums
° Persistent bad breath (halitosis)
° Gum recession and loose teeth
° Deep periodontal pockets
° Pain or discomfort when chewing

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✅ Periodontal Treatment Overview

° Scaling and root planing (SRP): The cornerstone of non-surgical periodontal therapy
° Oral hygiene education: Proper brushing and flossing techniques
° Antimicrobial therapy: Selective use of systemic antibiotics and antiseptic rinses
° Surgical therapy: For advanced or refractory cases

✅ Common Antibiotics in Periodontal Therapy

Note: Pediatric doses must be weight-adjusted and prescribed by a qualified healthcare professional.

✅ Most Used Antiseptic Mouthwashes in Periodontal Care

Caution: Chlorhexidine is highly effective but should not be used continuously for more than 2–3 weeks due to risk of staining and altered taste.

💬 Discussion
Recent studies confirm that systemic antibiotics, particularly the combination of amoxicillin and metronidazole, enhance periodontal healing when used adjunctively in patients with advanced periodontitis. However, routine use is not recommended to avoid antimicrobial resistance.
Chlorhexidine remains the gold standard among antiseptic rinses in post-operative care or during active periodontal therapy. Yet, due to aesthetic side effects like tooth staining, essential oils and CPC-based rinses are better tolerated for long-term daily use.

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💡 Conclusions
The use of antibiotics and antimicrobial mouthwashes in periodontics should be selective and evidence-based. While they do not replace mechanical debridement, they play a valuable role in enhancing treatment outcomes in severe or high-risk cases. Rational and limited use helps reduce bacterial resistance while improving oral and systemic health.

📚 References

✔ Albandar, J. M. (2014). Global risk factors and risk indicators for periodontal diseases. Periodontology 2000, 65(1), 29–51. https://doi.org/10.1111/prd.12061

✔ Herrera, D., Sanz, M., Jepsen, S., Needleman, I., & Roldán, S. (2020). A systematic review on the effect of systemic antimicrobials in periodontitis treatment. Journal of Clinical Periodontology, 47(S22), 164–175. https://doi.org/10.1111/jcpe.13235

✔ Sanz, M., Herrera, D., Kebschull, M., & Chapple, I. L. C. (2020). EFP S3 Level Clinical Practice Guideline for the treatment of periodontitis. Journal of Clinical Periodontology. https://doi.org/10.1111/jcpe.13290

✔ van Winkelhoff, A. J., & Herrera, D. (2022). Antimicrobials in the treatment of periodontitis: A review of clinical efficacy and resistance. Periodontology 2000, 89(1), 131–148. https://doi.org/10.1111/prd.12410

✔ Slots, J. (2019). Systemic antibiotics in periodontics. Journal of Periodontology, 90(12), 1458–1466. https://doi.org/10.1002/JPER.18-0718

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Is Gingivitis or Periodontitis Contagious? A Scientific Overview of Transmission, Symptoms, and Microbiota

Gingivitis and periodontitis are common forms of periodontal disease affecting millions worldwide. While traditionally considered non-communicable, emerging research has challenged this notion, raising concerns about whether these conditions might be transmissible through saliva and close contact.

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✅ Gingivitis and Periodontitis: Definitions and Symptoms
Gingivitis is an early stage of periodontal disease characterized by inflammation of the gingiva without loss of attachment. Its signs include red, swollen gums, bleeding on brushing, and halitosis.
Periodontitis, a progression from untreated gingivitis, involves destruction of the supporting structures of teeth, including alveolar bone. It manifests as gingival recession, deep periodontal pockets, tooth mobility, and eventual tooth loss.
Both conditions are influenced by poor oral hygiene, genetic predisposition, smoking, and systemic diseases. However, increasing attention has turned to the potential of direct bacterial transmission.

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✅ Microbiota in Periodontal Disease
The development of gingivitis and periodontitis is driven by a dysbiosis in the oral microbiota. Key pathogens involved include:

° Porphyromonas gingivalis
° Tannerella forsythia
° Treponema denticola
° Aggregatibacter actinomycetemcomitans

These bacteria are organized in complex biofilms and have virulence factors that allow them to evade the immune system and promote inflammation. Studies have shown these microbes can be found in the saliva of affected individuals, suggesting a potential route for interpersonal transmission.

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✅ Is Periodontal Disease Contagious?
While periodontal diseases are not classified as infectious diseases, evidence supports the possibility of bacterial transmission, especially among close contacts such as spouses, parents, and children.

➤ Salivary Transmission
A 2020 study by Kuru et al. demonstrated that spouses often share similar subgingival microbiota, especially when one partner has periodontitis (Kuru et al., 2020). Salivary exchange through kissing or sharing utensils may facilitate bacterial transfer.
➤ Vertical Transmission
Vertical transmission (from parent to child) has been observed with A. actinomycetemcomitans and P. gingivalis. A 2022 study by Liu et al. confirmed the early colonization of periodontal pathogens in children from mothers with periodontitis (Liu et al., 2022).
➤ Horizontal Transmission
Peer-to-peer transmission, though less documented, may occur in communal living environments or through shared personal items.

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✅ Clinical and Public Health Implications
Understanding the possible transmissibility of periodontal pathogens emphasizes the importance of:

° Early diagnosis and treatment
° Improved hygiene habits within households
° Avoiding shared oral hygiene tools
° Raising awareness among dental professionals and the public

However, the presence of pathogens does not guarantee disease. Host response, immune status, and environmental factors significantly influence disease development.

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✅ Conclusion
Current evidence suggests that gingivitis and periodontitis may be transmissible to a degree, particularly via saliva among close contacts. Though not contagious in the traditional sense like influenza, the oral microbiota associated with these diseases can spread and potentially contribute to periodontal pathology in others. This underscores the need for preventive strategies not only at the individual but also at the familial level.

📚 References

✔ Kuru, B. E., Laleman, I., Yalçin, F., & Teughels, W. (2020). The influence of periodontitis on oral microbiota transmission among family members. Journal of Clinical Periodontology, 47(3), 333–342. https://doi.org/10.1111/jcpe.13236

✔ Liu, X., Zhang, W., Wang, Y., Li, Y., & Zhou, X. (2022). Early transmission and colonization of key periodontal pathogens in children: A longitudinal study. Clinical Oral Investigations, 26(9), 5195–5205. https://doi.org/10.1007/s00784-022-04639-9

✔ Teles, R., & Wang, C. Y. (2021). Mechanisms involved in the association between periodontal diseases and cardiovascular disease. Periodontology 2000, 87(1), 254–273. https://doi.org/10.1111/prd.12380

✔ Slots, J. (2017). Periodontitis: Facts, fallacies and the future. Periodontology 2000, 75(1), 7–23. https://doi.org/10.1111/prd.12211

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Diabetes and gum health - Periodontitis

Diabetes is a disease that affects several organs and systems of our body, including the heart, kidneys and eyes. The oral cavity is also affected by this disease, for example periodontitis, xerostomia and fungi.

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A person with diabetes increases the risk of suffering from periodontal disease, even losing one or more teeth more quickly.

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Control of diabetes is essential to achieve successful periodontal treatment. That is why it is important to visit your doctor and dentist regularly for an early evaluation and treatment.

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Source: Youtube/ EFP European Federation of Periodontology
Image: CreakyJoints

What to expect after periodontal surgery - Post-Operative Guide

Periodontal surgery is one of the phases of gum treatment, and is responsible for the surgical procedure of the gums that are affected by periodontitis.

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🎯 WhatsApp Group All Odontology
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The main objective of periodontal surgery is to keep the supporting elements of the tooth healthy. Thanks to this procedure we can eliminate dental stones that could not be removed during the initial phases of periodontal treatment.

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We share a video from Dr. John Thousand IV, DDS, MSD, who explains what periodontal surgery is and the care that a patient should have after the surgical procedure.

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Source: Youtube/ Dr. John Thousand IV, DDS, MSD