Periodontics

PERIODONTICS

Periodontics involves the diagnosis, treatment and prevention of gum disease by a general dentist or a periodontist. A periodontist is a dentist who has had additional years of specialized training in periodontics at a post-doctoral educational program and is certified as such.

Periodontal Disease is a bacterial infection of the gums, bone and ligaments that support the teeth and anchor them in the jaw. The bacteria are normal inhabitants of the mouth and form a film of dental plaque and calculus (tartar) which stick to the teeth. The bacteria produce poisonous toxins which stimulate the immune response to fight the infection. If the disease process is not stopped, the supporting structures of the teeth will continue to be destroyed. This eventually leads to tooth loss.

Periodontal disease can occur at any age. Over half of all people over the age of 18 have some form of the disease. After age 35, over 75% of all people are affected. Unfortunately, the disease process is usually asymptomatic and painless. The disease can be easily detected during regular dental examinations.

HEALTHY GUMS AND BONE

Gums appear light pink and are sharply defined. Bone completely surrounds the roots of the teeth. Teeth are firmly anchored into the bone.

GINGIVITIS is infection of the gingiva (gum tissue), and is the initial stage of the disease process. Gums become red, swollen and may bleed easily. Underlying bone levels are unaffected.

PERIODONTITIS is classified as being Mild, Moderate or Severe, depending upon the amount of destruction to the gums, ligaments and bone that surround teeth. As the disease progresses, gums separate from the teeth and form gum pockets. These pockets get deeper as more underlying bone is destroyed. Gum pockets will collect increasing amounts of bacterial plaque and calculus (tartar) as the disease process worsens. Teeth will loosen as more bone is lost.

Lower teeth -SEVERE PERIODONTITIS - Upper teeth

HEALTHY

GINGIVITIS

MODERATE PERIODONTITIS

SEVERE PERIODONTITIS

CONTRIBUTING FACTORS TO PERIODONTAL DISEASE

The response of the gums and bone to dental plaque may be modified by one or more of the following factors.

• Poorly fitting dental restorations
• Smoking
• Crowded teeth, improper bite alignment
• Clenching or grinding of teeth
• Hormonal changes, including pregnancy, menstruation and menopause
• Diet
• Systemic diseases, including blood disorders and diabetes
• Medications, including calcium channel blockers and anti-convulsants

WARNING SIGNS OF PERIODONTAL DISEASE

• Bleeding gums
• Tenderness, swelling, red color
• Abscess (pus oozing from the gums)
• Foul odor
• Loose teeth
• Pain

DIAGNOSIS OF PERIODONTAL DISEASE

Periodontal disease can be easily detected by a general dentist or periodontist during regular examinations. A periodontist is a dentist who specializes in the diagnosis, prevention and treatment of gum disease. A periodontal charting should be performed for all teeth. A periodontal probe, with ruled millimeter markings, is used to measure the depth of the space between the teeth and gums. Ideally, normal measurements range between 1 and 3 millimeters. Depths greater than this may signify the presence of periodontal pockets and associated gum disease. X-rays should be taken to see if bone damage has occurred as a result of the disease process.

TREATMENT OF PERIODONTAL DISEASE

The main goal of periodontal treatment is eradication of the disease process from the gums, ligaments and bones that surround the teeth, and restoration of health that can be predictably maintained in the future.

PHASE I

Initial treatment involves educating patients in the proper methods of effective, daily plaque removal and oral hygiene. This is a critical component of successful therapy.

Additional treatment modalities may be necessary to treat periodontal disease and restore health.
These may include:

• Bone grafts for bone regeneration
• Gum grafts to treat gum recession and pathological root exposure
• Cosmetic plastic surgery of the gums to improve appearance
• Fabrication of night guards for bruxism (tooth grinding)
• Splinting or bonding teeth together for increased strength and stability
• Orthodontics (braces) to straighten and realign teeth
• Removal of diseased roots on some types of molars
• Use of medications such as antibiotics, fluoride and antimicrobial rinses

MAINTENANCE

Once the active phase of treatment is complete and health has been restored, it is extremely important that patients be seen by a hygienist for routine dental and periodontal cleaning on a regular basis. This regimen, along with diligent home care and oral hygiene, will give the best chance for preventing recurrence of disease and maintaining long term periodontal health.