Periodontology FAQ’s

The word “periodontal” literally means “around the tooth.” Periodontal diseases are bacterial gum infections that destroy the gums and supporting bone that hold your teeth in your mouth. Periodontal diseases can affect one tooth or many teeth.

The main cause of periodontal diseases is bacterial plaque, a sticky, colourless film that constantly forms on your teeth. If the plaque is not removed, it can turn into a hard substance called calculus or tartar in less than two days. Tartar is so hard it can only be removed by an oral health professional, such as a dentist or dental hygienist. The bacteria in plaque infect the gums, and release poisons that cause redness and inflammation (irritation). The inflammation and the poisons themselves cause destruction of the tissues that support the teeth, including the bone. When this happens, the gums separate microscopically from the teeth, forming pockets that fill with even more plaque causing even more infection.

A periodontist is a dentist who specializes in the prevention, diagnosis and treatment of periodontal disease and in the placement of dental implants.

Periodontists are also dentistry’s experts in the treatment of oral inflammation. They receive extensive training in these areas, including three additional years of education beyond dental school. Periodontists are familiar with the latest techniques for diagnosing and treating periodontal disease. In addition, they can perform cosmetic periodontal procedures to help you achieve the smile you desire.

Often, dentists refer their patients to a periodontist when periodontal disease is present. However, you don’t need a referral to see a periodontist. In fact, there are occasions when you may choose to go directly to a periodontist or to refer a family member of friend to your own periodontist.

If you value your oral as well as overall health, anytime is a good time to see a periodontist for a periodontal evaluation. Sometimes the only way to detect periodontal disease is through a periodontal evaluation. A periodontal evaluation is especially important if you exhibit any symptoms of periodontal disease.

Around 10% of the population is susceptible.

Our knowledge is improving all the time of why this is, although 3 major factors are thought to be responsible: Family history, stress and smoking are all important risk factors.

Stopping smoking is an important part of reducing the risk of developing the disease.

Certain general diseases such as diabetes or cardiovascular disease may also make an individual more susceptible.

Are you at risk of periodontal disease? See perio.org

Most people know that maintaining healthy teeth and gums is a necessary step in achieving overall wellbeing. In fact, now not only dentists encourage brushing and flossing, but many doctors also promote oral hygiene as a way to help keep the rest of the body healthy.

Several research studies have suggested that gum disease may be associated with other health issues, including heart disease, stroke and diabetes. And with more and more research reinforcing the connection between periodontal and systemic health, scientists are beginning to understand why these connections exist. One theory points to chronic inflammation as the culprit. Inflammation is the body’s natural response to harm, such as an injury or infection. For many years, dentists believed that gum disease developed as a result of a bacterial infection caused by the build-up of plaque between the teeth and under the gums.

While plaque build-up is still a factor in the development and progression of gum disease, researchers now suspect that the more severe symptoms, namely swollen, bleeding gums; recession around the gum line, and loss of the bone that holds the teeth in place, may actually be caused by the chronic inflammatory response to the bacterial infection, rather than the bacteria itself.

Scientists hypothesize that the chronic inflammatory response mechanism may be the reason behind the periodontal-systemic health link. Many of the diseases associated with periodontal disease are also considered to be systemic inflammatory disorders, including cardiovascular disease, diabetes, rheumatoid arthritis, kidney disease and even certain forms of cancer, suggesting that chronic inflammation itself may be the basis for the connection.
More research is needed to pinpoint the precise biological mechanisms responsible for the relationship between gum disease and other disease states.

However, since previous findings have indicated that gum disease sufferers are at a higher risk for other diseases, it is critical to maintain periodontal health in an effort to achieve overall health.

Dentists recommend daily oral care, including regular brushing and flossing, and routine visits to the dentist to avoid gum disease. If gum disease develops, consultation with a dental professional such as a periodontist can lead to effective treatment.

A periodontist is a dentist with three years of additional specialized training in the prevention, diagnosis and treatment of gum disease.

For more information on the role of inflammation in oral health, tips on how to prevent or treat gum disease, to find out if you are at risk visit perio.org.

Periodontal diseases are multi-factorial. This means that there is not just one cause of periodontal diseases but rather multiple factors that can affect the health of your gums.

• TOBACCO use significantly increases the risk of developing periodontal diseases and can negatively affect treatment.
• HORMONAL CHANGES during pregnancy, puberty and menopause can cause the gums to become red, tender and bleed easily.
• GENETICS and family history of periodontal diseases indicate a greater likelihood of developing these diseases.
  STRESS can make it more difficult for the body to fight off infection, including periodontal diseases.
• Some MEDICATIONS such as oral contraceptives, antidepressants and certain heart medicine, can affect oral health.
• DESTRUCTIVE HABITS such as improper oral hygiene technique, oral piercing, drug or alcohol abuse can affect periodontal health.
• POOR NUTRITION can make it harder for the body to fight off infection.
• SYSTEMIC DISEASES that interfere with the body’s immune system may worsen the condition of the gums and supporting bone.

There are various forms periodontal disease that exist. The following is an overview of the main specific types:

Gingivitis: As the mildest form of the periodontal diseases, gingivitis causes the gums to become red, swollen, and bleed easily. There is usually no discomfort at this stage.
Chronic Periodontitis: Chronic periodontitis is a condition resulting in inflammation within the soft tissues surrounding the teeth causing progressive attachment and bone loss. It is diagnosed by bone loss on a dental X-ray, the formation of gum pockets and/or receding gums. It is most common in adults, but can occur at any age.
Aggressive Periodontitis: This form occurs in patients who are otherwise in good health. Common features include rapid attachment loss and bone destruction. There are two forms of aggressive periodontitis:

• LOCALIZED AGGRESSIVE PERIODONTITIS – Most often occurs near puberty and usually involves attachment loss around first molars and/or front teeth but may involve one or two additional teeth.
• GENERALIZED AGGRESSIVE PERIODONTITIS – Usually, but not always affects people under 30 years of age. It involves attachment loss on at least three permanent teeth in addition to first molars and incisors.

Periodontitis as a Manifestation of Systemic Disease: As the name indicates, this form is associated with one of several systemic diseases that are related to periodontitis, such as diabetes.

Necrotizing (Ulcerating) Periodontal Diseases: These types of periodontal diseases cause ulcers in the gums between the teeth and are most commonly observed in individuals with certain conditions including, but not limited to, HIV infection, malnutrition and immunosuppression. Stress, smoking, and poor oral hygiene sometimes can contribute to this problem.

Specialist management is normally required for severe forms of chronic periodontal disease, cases of aggressive periodontitis, and cases where periodontal disease is associated with systemic disease.

What are the signs of periodontal diseases?

Periodontal diseases are often silent, meaning that symptoms may not materialize until significant bone loss has occurred. Some people may have periodontitis and not experience any symptoms and be unaware that they have disease.

Common symptoms and signs of periodontal diseases include:

RED, SWOLLEN OR TENDER GUMS
BLEEDING WHILE BRUSHING OR FLOSSING
GUMS PULLING AWAY FROM THE TEETH MAKING TEETH APPEAR LONGER
LOOSE OR SEPARATING TEETH
PUS BETWEEN THE GUM AND TOOTH
PERSISTENT BAD BREATH
A CHANGE IN THE WAY YOUR TEETH FIT TOGETHER WHEN YOU BITE
A CHANGE IN THE FIT OF PARTIAL DENTURES

If you notice any of these symptoms, you should see a periodontist for a complete periodontal examination.

A periodontist is a dentist who specializes in the prevention, diagnosis and treatment of tissues surrounding the teeth. In addition, periodontists are experts in the placement and maintenance of dental implants.

Once your periodontal health has been evaluated, your periodontist will work with you to determine the best treatment options to control your disease and bring you back to health. By devising a structured a program of: Prevention; Intervention; and long term Management it is possible to successfully treat periodontal diseases.

Treatment can vary depending on how far the disease has progressed. If diagnosed and treated in the early stages, simple non-surgical periodontal therapy may be sufficient. If periodontitis has advanced to the point where the periodontal pockets are deep and significant amounts of bone are lost, surgical therapy may be necessary.

Special management may also be required where periodontal disease is associated with systemic disease; this may involve inter-department referral within the Beacon Consultants Clinic for medical consultation / management prior to and during periodontal treatment.

Once periodontitis has been controlled, patients will require ongoing periodontal maintenance procedures to sustain health. This ongoing phase of treatment will allow your periodontist to assess your periodontal health and make sure that your infection stays under control or remains eliminated. During these re-evaluation appointments, your mouth will be examined, new calculus and plaque will be removed and, if necessary, your teeth will be polished and your bite will be checked. Periodontal diseases are chronic diseases, just like diabetes. Without careful, ongoing treatment, periodontal diseases can and often do recur.

Good oral hygiene and professional care are the keys to keeping your teeth for a lifetime. The best way to prevent periodontal diseases and tooth decay is to remove the bacterial plaque by thorough brushing and flossing every day. Good oral hygiene habits will help keep the formation of dental tartar to a minimum.

Regular dental visits that include a periodontal examination are also important to detect any changes in periodontal health and, if necessary, to remove hardened tartar in places that your toothbrush and floss may have missed. A professional cleaning (often called a prophylaxis) at least twice a year is recommended for patients with good periodontal health. If you have had any form of the periodontal diseases, you may need professional maintenance more frequently.

The key to successful management of periodontal disease is an accurate diagnosis, a patient specific prevention programme, the appropriate form of treatment, and a tailored supportive program there afterwards. The most effective way of delivering this is a specialist led service, involving a periodontist, your dentist, and dental hygienist.

BASIC TREATMENT – Scaling and Root Planing (SRP)

Scaling and Root Planing (SRP) is a meticulous cleaning of the root surfaces below the gum line to remove plaque, toxins and tartar from the root surfaces of the teeth. This procedure is more intensive than a routine general dental prophylaxis, or cleaning, which traditionally occurs every six months.

For comfort, your periodontist may numb the area prior to treatment. Research has consistently demonstrated that SRP reduces gingival inflammation and probing depths, and shifts the bacterial composition living in these pockets from one that is associated with disease toward one associated with health.

Therefore, SRP is usually the first mode of treatment recommended for most periodontal patients. In some cases, systemic antibiotics (usually antibiotic pills) or locally administered antibiotics (antibiotics placed into periodontal pockets) are prescribed at the time of SRP procedures.

Antibiotics are drugs that fight infections caused by the bacteria. Each time you take an antibiotic you increase your chance of developing drug resistant bacteria, so it is important to take antibiotics only when necessary.

It is important to remember that some patients may not respond optimally to SRP, with or without antibiotics. These patients often respond favourably to advanced periodontal procedures that may include measures aimed at regenerating the natural anatomy that was lost to disease.

MORE ADVANCED FORMS OF TREATMENT – Surgery

Periodontal surgery is necessary when your periodontist determines that the tissue around your teeth is unhealthy and cannot be repaired with non-surgical treatment.

There are various forms of surgical management of periodontal disease:

Flap Surgery. Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications. A dentist or periodontist may perform flap surgery to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the patient, dentist, and hygienist to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again. After surgery the gums will shrink to fit more tightly around the tooth. This sometimes results in the teeth appearing longer.

Bone and Tissue Grafts. In addition to flap surgery, your periodontist may suggest bone or tissue grafts. Grafting is a way to replace or encourage new growth of bone or gum tissue destroyed by periodontitis. A technique that can be used with bone grafting is called guided regeneration, in which a small piece of mesh-like fabric is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow.

Since each case is different, it is not possible to predict with certainty which grafts will be successful over the long-term. Treatment results depend on many things, including how far the disease has progressed, how well the patient keeps up with oral care at home, and certain risk factors, such as smoking, which may lower the chances of success. Ask your periodontist what the level of success might be in your particular case.