Periodontics

Periodontics or Periodontology, is the dental specialty dealing with periodontal (gum) disease. Periodontal disease is caused by bacteria in dental plaque - the sticky white gelatinous material that continually builds up on the teeth. The bacteria cause inflammation of the surrounding tissues, which can have two consequences: 

1. Gingivitis - fairly superficial inflammation of the gums with redness, swelling and increased tendency to bleeding on brushing.

2. Periodontitis - deeper inflammation of the gums with loss of some of the bone supporting a tooth. As this progresses the tooth may loosen and perhaps eventually need to be removed. The gums may recede as bone is lost or the gum may come away from the tooth creating a 'pocket'. The progression of periodontal disease is extremely variable - a small amount of supporting bone may be lost over a period of many years in mild forms of the disease; with severe forms rapid breakdown of the supporting structures can occur.

Who gets Periodontal disease?

All ages can be affected by periodontal disease but chronic periodontitis normally only affects adults. The most common cause, though not the whole story, is inadequate oral hygiene. This results is the accumulation of plaque around teeth and allows the initiation or progression of periodontal disease. If plaque is left on the surface of the tooth for some time, it can start to mineralise and form calculus ('tartar') - this is a hard material and cannot be easily brushed off, but bacteria are still present within it and can cause continued inflammation. There would appear to be some genetic susceptibility to periodontal disease - some people seem much more prone to the condition whereas others are very resistant. Other factors which can increase the risk of disease include:

1. Smoking - smokers have been shown to have higher levels of periodontal disease than non-smokers and the tissues do not respond as well to treatment.

2. Diabetes and some other systemic diseases which can reduce the body's resistance to bacteria. Especially uncontrolled diabetes can lead to increased severity of periodontal disease. Based on the literature improving the gum condition might improve the control of glucose levels and vice-versa.

3. Genetics

4. Hormonal changes - in pregnancy or associated with oral contraceptives.

5. Some medicines can cause an increased tendency for the gums to swell.

6. Tooth anatomy - localised areas which may trap plaque and are difficult to keep clean.

7. Stress - Scientific evidence suggests that stress can be associated with rapidly progressive bone loss and aggressive periodontal disease.

8. Other factors such as obesity and grinding of the teeth have been identified as risk indicators of periodontal disease. Unfortunately the available evidence can be inconclusive.

Why do I need to see a Periodontist?

If you have been asked to see a Periodontist, this is because it is felt your particular gum problem needs the attention of an expert. He is the best person to make an accurate assessment of the level of disease in your mouth, discuss the most appropriate treatment and either carry out the treatment himself or make a treatment plan for the dental hygienist to follow. 

The first visit 

The aim of the initial visit is to understand your problems and concerns and carry out a detailed examination. The consultation is normally scheduled for 1 hour.

At this visit a general assessment of the oral cavity with particular focus on the periodontal condition will be carried out. This will include a comprehensive examination of your dentition, gums and oral tissues. A considerable amount of clinical data will be collected.

Furthermore the status of your dentition and the tissues supporting the teeth will be evaluated on radiographs (x-ray). Up to 12 detailed small radiographs or a panoramic radiograph may be needed. Following the above investigations the diagnosis, prognosis and all treatment options will be discussed with you. 

What can be done about it?

Diagnosis of the problem is an important first step and early diagnosis can lead to the best treatment outcome. Clinical examination can reveal whether the gums are healthy or diseased by their appearance, whether they bleed easily on gentle probing and if there are any periodontal pockets, indicating that the gums have become detached from their normal position against the tooth and bone had been lost. X-rays are a useful adjunct and can show more clearly the amount and pattern of bone loss around a tooth or teeth. 

Treatment of gingivitis

If the gums are inflamed but there has been no loss of the supporting bone i.e. the condition is gingivitis only, this can usually be easily treated by careful removal of plaque and calculus by the dentist or dental hygienist, followed by regular and thorough plaque removal at home by brushing and flossing. The gums would then normally be expected to be back to good health after a couple of weeks. Thereafter it is important that good oral hygiene is maintained together with regular visits to the dental hygienist (the frequency tailored to suit your individual requirements) to maintain the health of the gums and prevent future problems.

Treatment of periodontitis

If there has been loss of the supporting bone around teeth, a careful record should be made of the extent of this - usually by measuring the depths of pockets with a measuring probe. This will help determine the extent of the problem and hence the treatment needed, and give a baseline record for later comparison to check the response to treatment. Treatment is again aimed at thorough removal of plaque and calculus, though this may be more difficult where pockets are present as the deposits will be on the root surface underneath the gum. A local anaesthetic is sometimes needed for this procedure. If there is generalised periodontitis throughout the mouth, a number of treatment sessions may be required to make sure treatment is thorough and the best conditions are in place for good healing. For advanced forms of periodontitis, gum surgery may be needed to obtain sufficient access to clean the roots of the teeth. The goals of treatment are to arrest the progression of the disease and create a stable gum situation which is easily maintained, though it is unusual for new bone to grow back around teeth. Maintenance of good health of the gums is again of great importance following treatment to prevent relapse.