Periodontics

Periodontics is the branch of dentistry that deals with the gums and their underlying tissues, ie. the support structures of teeth. It’s important to maintain healthy gums without periodontal pockets in which bacteria may build-up. Plaque and tartar build-up above or below the gum line is the main cause of periodontal disease. Regular scaling and polishing helps maintain a healthy periodontium and reduces the risk of many diseases. Scientific reports have established a link between periodontal disease and the following  elements: the immune system, cardiovascular diseases such as bacterial endocarditis, stroke, or heart attacks, respiratory disease, and uncontrolled diabetes.

The patient must take responsibility for their at home care and exhibit proper oral hygiene. Otherwise, periodontal treatments will only be a temporary fix for their underlying problem.

Periodontics is the discipline that treats, among other things, gingivitis. Untreated gingivitis can lead to periodontal disease. Periodontal disease occurs when the inflammation spreads to the attachment apparatus and underlying alveolar bone, causing irreversible bone loss around the teeth.

Periodontal disease may be treated in the following different ways, depending on its severity: scaling and root planing, curettage, gingivoplasty or gingivectomy, laser treatments, or gum and/or bone grafts.

Gingivitis is, by definition, inflammation of the gums, and is the first phase of periodontal disease. If controlled by regular hygiene recalls and adequate oral hygiene measures, it may be reversed.

Gingivitis is caused by the accumulation of plaque. If plaque is not regularly cleaned off with a toothbrush and floss, bacteria will stick onto it and begin to multiply. Next, they will secrete toxins that may cause infections. To counter this, the body’s immune system sends its own cells that then attack the individual’s own infected tissue. Gingivitis presents as inflamed and red gums that may bleed when touched, brushed, flossed, or even when eating. It may be caused by a change in hormones, which may occur, for example, during pregnancy or puberty. Gingival response to plaque may be more exaggerated in these teens and pregnant women because their immune system is more active and responsive to bacteria. These patients require special attention.

Periodontal disease (or periodontitis) is the disease of the gums and their underlying tissues that support teeth:  the cementum, the periodontal ligament, and the alveolar bone. More significant changes occur in periodontal disease such as irreversible bone loss, and there is more significant plaque and bacteria that may build up between the tooth and the gums. This may lead to the following: inflammation, bleeding, halitosis (bad breath), gingival pain, periodontal abscesses, or mobile teeth.

Periodontal disease is diagnosed through clinical exams and radiographs, but more importantly by a complete periodontal exam, which includes measuring pocket depths by probing the teeth. Probing and determining the osseous architecture allows us to propose the appropriate treatment for your periodontal disease. Patients with generalized periodontitis require recalls at a 3-month interval.

Treating periodontal disease is more complicated than treating gingivitis. It requires a cooperative patient, as the follow-ups are more rigorous – patients are seen every 3 months. Treatments include: scaling and root planing, curettage, disinfection with pharmaceuticals and/or lasers, gingivoplasty, or gingivectomy.

When periodontal disease is refractory to treatment, antibiotics may be added. When the patient presents with recession, or lack of attached gingiva, we may suggest allogenic grafts, or autogenic grafts such as: free gingival grafts (FGG), or connective tissue grafts (CTG). If there’s a deep bony defect, we may suggest a bone graft by the means of guided tissue regeneration (GTR) and/or platelet rich fibrin (PRF), which promotes tissue formation and better healing.

Neglected periodontal disease may lead to: multiple areas of gingival recession, tooth loss, sensitive and/or mobile teeth, deformed dental arches, periodontal abscesses, or even total tooth loss.

Patients should be seen at least every 6 months for preventative care in order to avoid and allow early detection of periodontal problems.