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.

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.

Healthy
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.

Moderate Periodontitis
Lower teeth - SEVERE PERIODONTITIS
Upper teeth - 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.

Scaling and root planing are performed to clean the tooth structure and remove bacterial plaque and calculus deposits (the source of the infection) from the gum pockets. This may be the only treatment necessary in cases of gingivitis and very mild periodontitis.

PHASE II
In cases which demonstrate deeper gum pockets and underlying bone loss, it becomes necessary to eliminate the diseased gum pockets and bony destruction with osseous (bone) surgery. The gum is "flapped" and retracted away from the teeth to expose the underlying roots and bone deformities. The bone is contoured to approximate a normal physiologic profile, and the gum is sutured back to place. When the gum heals, normal probing depth is re-established between the gum and tooth (ideally 1-3mm). The attainment of minimal probing depth facilitates easy removal of plaque by patients at home and by hygienists during professional cleaning.

Sequence of Events During Osseous Surgery
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.

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