Periodontal Disease / Gum Disease

A periodontist is a dentist who specialises in the prevention, diagnosis and treatment of periodontal disease. More recently they also can improve the aesthetics of your gums. Periodontists receive extensive training in these areas, including three additional years of education beyond dental school. Periodontists are familiar with the latest techniques for diagnosing and treating periodontal disease. In addition, they can perform cosmetic periodontal procedures to help you achieve the smile you desire. 

Procedures periodontists use to treat gum disease: 

• Non Surgical Treatments 
• Surgical Treatments 
• Periodontal Surgery 
• Cosmetic Procedures

What is Periodontal disease? 

Periodontal (gum) disease, including gingivitis and periodontitis, are infections that if left untreated, can lead to tooth loss or implant loss. The word periodontal literally means “around the tooth”. Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth or implants. 

What causes Periodontal disease? 

Periodontal disease is caused by plaque. Plaque is a collection of germs (bacteria), which grows around teeth. This collection of germs release toxins that lead to inflammation of the gums. Plaque then burrows underneath the gums and creates a space between the teeth and gums. This space is called a pocket. Once the plaque is inside the pocket it causes further inflammation. This inflammation leads to gradual bone loss around the teeth. The bone loss is irreversible and can lead to eventual tooth loss. This process is known as Periodontitis. 

What other factors might contribute to periodontal disease?

Although plaque is the primary cause of periodontal disease, other factors affect the health of your gums including: 

• Tobacco smoking: smoking plays a very important part in the progression of periodontitis. Also, healing following treatment may take more time. 
• Family history/genetic susceptibility: certain periodontal diseases can be aggressive and there is sometimes a family history. 
• Diabetes: periodontal disease is often more severe in uncontrolled diabetics. 
• Stress: stress influences the rate at which periodontitis progresses. 
• Others: pregnancy, puberty and some medications

What are the signs of periodontal disease?

Periodontal disease usually progresses with few obvious signs and symptoms. Most people don’t experience pain with periodontal disease Which is why we screen every patient during your regular dental 6 month consultations and professional teeth cleaning. The Basic Periodontal Examination (BPE) is included in a full mouth consultation. The following are the most common symptoms of periodontal diseases:

• Bleeding gums during brushing 
• Red, swollen or tender gums 
• Loose and mobile teeth 
• Persistent bad breath 
• Bad taste 
• A change in the way teeth fit together when you bite 

Non-Surgical Treatments 

Treatment guidelines stress that periodontal health should be achieved in the least invasive and most cost-effective manner. This is often accomplished through non-surgical periodontal treatment, including scaling and root planing (a careful cleaning of the root surfaces to remove plaque and calculus [tartar] from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins), followed by adjunctive therapy such as local delivery antimicrobials and host modulation, as needed on a case-by-case basis. 

Many patients do not require any further active treatment. However, the majority of patients will require ongoing maintenance therapy to sustain health. Non-surgical therapy does have its limitations, however, and when it does not achieve periodontal health, surgery may be indicated to restore periodontal anatomy damaged by periodontal diseases and to facilitate oral hygiene practices. 

Surgical Treatments

 If you're diagnosed with periodontal disease, your periodontist may recommend periodontal surgery. This may be done using a laser or by conventional methods. Periodontal surgery is necessary when your periodontist determines that the tissue around your teeth is unhealthy and cannot be repaired with non-surgical treatment. Following are the four types of surgical treatments most commonly prescribed:

1. Pocket Reduction Procedures
2. Regenerative Procedures
3. Crown Lengthening
4. Soft Tissue Grafts 

Pocket Reduction Surgery 

During pocket reduction surgery, the surgeon will pull the gums back from the teeth and remove the tartar deposits that lie underneath. This eliminates the bacteria living beneath the gums and can help to prevent more severe symptoms of periodontal disease to develop. Pocket reduction surgery can help your gums and teeth look healthier, but it is not usually considered a cosmetic treatment. 

Regeneration 

Regeneration refers to a process that tries to regenerate the bone that holds the tooth underneath the gums that has been destroyed by pockets. Again, the gums are folded back. The bacteria is removed, and then bone grafts are attached to the bone to encourage the regeneration of the bone. This reconstructive surgery is used to repair the damage caused by periodontal disease and is also undergone as a cosmetic procedure. 

The gums are surgically removed from the teeth to expose more of the tooth underneath during crown lengthening surgery. This is used to treat gums that have swollen so much due to periodontal disease that they are covering a large visible part of one or more teeth. Crown lengthening surgery is also undergone for cosmetic reasons to treat smiles that may be considered "gummy."

The opposite of crown lengthening surgery, soft tissue graft does what it says. Soft tissue is grafted to the gums where they have receded as a result of periodontal disease, which makes the gums begin to grow over the exposed section. Receding gums can be a symptom of problems such as brushing the teeth too rigorously and so is also a cosmetic procedure, as well as repairing damage caused by periodontal disease.

Sometimes the gum can appear to indent where you have lost a tooth. This is due to the jawbone receding once it no longer holds a tooth and can make a dental implant look strange. If this occurs then a surgeon can fill the gum in during a ridge augmentation, creating the appearance of bone underneath the gum.