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.
The word periodontal means “around the tooth.” Healthy gum tissue fits like a cuff around each tooth. Where the gum line meets the tooth, it forms a slight v-shaped crevice called a sulcus. In healthy teeth, this space is usually three millimeters or less.
Periodontal diseases are infections that affect the tissues and bone that support teeth. As the tissues are damaged, the sulcus develops into a pocket that is greater than three millimeters. Generally, the more severe the disease, the greater the pocket depth and bone loss. The enlarged pockets allow harmful bacteria to grow and make it difficult to practice effective oral hygiene. Left untreated, periodontal diseases may eventually lead to tooth loss.
It's possible to have periodontal disease without apparent symptoms. That's why regular dental visits and periodontal examinations are very important.
The most common type of periodontal disease are GINGIVITIS and PERIODONTITIS
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 the mildest form of periodontal disease. It causes the gums to become red, swollen, and bleed easily. There is usually little or no discomfort at this stage. Gingivitis is reversible with professional treatment and good oral care at home.
CHRONIC PERIODONTITIS is a form of periodontal disease that results in inflammation within the supporting tissues of the teeth. Patients experience progressive loss of tissue attachment and bone. Chronic periodontitis is characterized by pocket formation and/or recession of gum tissue and is the most frequently occurring form of periodontitis. It is prevalent in adults, but can occur at any age. Progression of attachment loss usually occurs slowly, but periods of rapid progression can occur.
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
- Crowded teeth, improper bite alignment
- Clenching or grinding of teeth
- Hormonal changes, including pregnancy, menstruation and menopause
- Systemic diseases, including blood disorders and diabetes
- Medications, including calcium channel blockers and anti-convulsants
WARNING SIGNS OF PERIODONTAL DISEASE
- Gums that bleed easily
- Red, swollen or tender gums
- Gums that have pulled away from your teeth
- Persistent bad breath
- Pus between the teeth and gums
- Loose or separating teeth
- A change in the way your teeth fit together when you bite
- A change in the fit of partial dentures
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 the elimination of the disease process from the gums, periodontal ligaments and bones that surround the teeth, and the restoration of health that can be predictably maintained in the future. Shallower pockets, less than 3 mm, are easier to maintain and keep healthy.
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.
Scaling and root planing are performed to clean the tooth surface and remove bacterial plaque and calculus deposits from the gum pockets. These deposits are the source of the infection. This may be the only treatment necessary in cases of gingivitis and very mild periodontitis.
When deep pockets develop, it is difficult to completely remove plaque and tartar even with thorough daily oral hygiene. If the pockets do not heal after scaling and root planing, periodontal surgery may be needed to reduce the pocket depth and make teeth easier to keep clean. Surgery allows the dentist to access hard-to-reach areas that require the removal of tartar and plaque. The gums are sutured back into place or into a new position to make tissue snug around the tooth. Bone surgery, including bone grafts, may be used to rebuild or reshape bone destroyed by periodontal disease. Splints, bite guards or other appliances may be used to stabilize loose teeth and to aid the regeneration of tissue during healing. If excessive gum tissue has been lost, a gum graft may be performed. After surgery, the dentist may apply a protective dressing over teeth and gums and a special mouth rinse may be recommended or prescribed. An antibiotic and mild pain reliever also may be prescribed.
Additional treatment methods may be necessary to treat periodontal disease and restore health.
These may include:
- Bone grafts for bone regeneration
- Gingival (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
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.
This information was adapted from the ADA brochure " Periodontal Disease: Don't Wait Till it Hurts."