Periodontics is a specialty of dentistry that focuses on the tissues that support and surrounds the teeth and also addresses the inflammatory processes that destroy the gums and supporting tissues. A periodontist is well trained and knowledgeable in the area of prevention, diagnosis, and treatment of periodontal diseases. Periodontics is one of the eight specialties fully recognized by the American Dental Association.
Periodontal disease is caused by bacterial infections. They range from simple gum inflammation to advanced disease that involves damage to the bone and soft tissues that surrounds and holds the teeth.
Stages of periodontal Disease
- Gingivitis: This is the early stage of periodontal disease. It is characterized by swollen and inflamed gums.
- Mild periodontitis: This stage is characterized by the development of periodontal pockets and early loss of bone teeth
- Moderate to advanced periodontitis: This is the most advanced stage of periodontal disease. It is characterized by significant bone loss, deepening of periodontal pockets and possibly loss of soft tissues around the teeth
Signs and Symptoms of Periodontitis
- Painful and highly sensitive teeth
- Sunken teeth and receding gums
- Swollen and tender gums that bleed easily.
- Bleeding gums while brushing and/or flossing (also known as a pink toothbrush), or at other times.
- Loose, separating or bulging teeth.
- Pus between the gum and tooth
Here are ten reasons you may want to see a periodontist
Bleeding Gums
A bleeding gum is a symptom of gingivitis, a condition in which the gums become irritated and inflamed. Inadequate plaque removal is the major cause of bleeding gums.
Occasional bleeding of the gums is very common among people who tend to brush their teeth too vigorously or wear dentures that don’t fit correctly. Frequent gum bleeding can also be a sign of a more serious underlying condition, including
- Cancer of the blood (Leukemia and lymphoma).
- Blood clotting disorder (like hemophilia,
- Poor nutrition.
- Vitamin deficiency
Chronic Bad Breath.
Bad breath is a common condition. Almost everyone has experienced some element of unpleasant bad breath at some time. Chronic and persistent bad breath (also known as halitosis) is a sign of a gum disease. Halitosis is caused by an accumulation of dental plaque and food debris on the teeth and tongue, due to poor oral hygiene.
Bad breath can be an embarrassing experience for so many people. It can be a source of anxiety in social gatherings. It can also take away your confidence, preventing you from getting too close to other people or developing an intimate relationship. Common causes of bad breath include
- Medications for depression, high blood pressure, and anti-histamine. Examples of drugs are phenothiazines, amphetamines, disulphiram
- Alcoholic drinks.
- Acidic foods and dairy products.
Broken Tooth.
A broken or fractured tooth might be another reason you may want to visit a periodontist. This is usually common in children, probably due to their high level of physical activity, but it can also happen to anyone. Common causes of a fractured tooth include biting hard on a hard object, auto accidents, sports injuries, blow or impact to the face and falling on a hard surface with the face.
Mild chips on the edges or cusps of teeth are often asymptomatic and can be treated by cosmetic bonding or other methods.
A serious fracture of the tooth occurs when the distinct part of the tooth is separated into two, away from each other. This requires immediate treatment because it is very painful, and can also become infected. In this case, a root canal treatment is the best option and involves extracting the whole tooth. The easiest way to prevent a broken tooth is prevention. This can be achieved by wearing a protective device (such as a customized mouthguard) during any contact sport. Also, a visit to a periodontist for a regular dental check-up is very important, where the teeth are carefully examined for early signs of fracture.
To Prevent the Risk of Heart Disease
People with periodontal disease (also known as gum disease) have an increased risk of developing a heart attack, stroke, or another serious cardiovascular event. Studies have found that people with gum disease are almost twice as likely to suffer from coronary artery disease as those without periodontal disease. Periodontitis is an inflammatory condition caused by oral bacteria. These bacteria can travel to the heart, through the bloodstream, attaching to fatty plaques in the coronary arteries (heart blood vessels) and contributing to clot formation. The build-up of fatty proteins coupled with the thickening of the walls of the coronary arteries can obstruct the normal flow of blood, restricting the supply of nutrients and oxygen required for the heart to function effectively.
People with pre-existing heart conditions are at risk of developing infective endocarditis from periodontal disease. Infective endocarditis leads to the inflammation of the inner lining of the heart or the heart valves.
You are Diagnosed with Diabetes
Diabetics have an increased risk of developing gum disease than normal healthy people. Diabetes is a metabolic disorder characterized by elevated blood sugar level. if diabetes is poorly controlled, higher sugar levels in the mouth fluids is an excellent medium for the growth of microbes, most especially anaerobic bacteria that can cause gum disease. Poor blood sugar control also decreases the ability of the host immune system to combat infections. On the other hand, the uncontrolled periodontal disease may also make it more difficult to control diabetes.
In addition, because of the vascular changes that occur with diabetes, the effective free flow of nutrients and removal of wastes from body tissues that is normally seen in a normal healthy human may become impaired. This impaired blood flow can weaken the gums and bone. This makes them more susceptible to infection. Coupled with poor oral hygiene, smoking, diabetes can lead to severe gum disease.
Pain when Eating or Chewing on Food.
Almost everyone, at one point or another, has probably experienced some degree of tooth pain, from minor aches and sensitivity to acute distress. The most common cause of tooth pain, when eating or chewing food, is dental decay. A constant and severe tooth pain, accompanied with swelling of the gums, and sensitivity to touch indicate an acute infection in the tooth, possibly accompanied by an abscess (pus-filled sac) in the surrounding gum and bone tissue. Sharp pain when biting down on food can be caused by a loose filling or a hole in the tooth. Any tooth pain, regardless of the characteristics and degree of severity of the pain, should be evaluated by a periodontist as soon as possible.
Cigarette Smoking
Researches have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease. The harmful chemicals found in cigarettes can cause serious damages to the teeth and its supporting structures. Smoking can lead to a gradual build-up of plaque and tarter
Smokers are also at a higher risk for developing precancerous changes (such as leukoplakia), leading to nasopharyngeal, lung, and oral cancers. It can cause the salivary glands to become inflamed and contribute to the deterioration of the bone structure. Dental procedures such as periodontal treatments, dental implants, and tooth extraction tend to be less likely successful in smokers than in non-smokers.
Smokers are required to visit a periodontist on a regular basis for an oral check-up. Smokers should also look out for long-lasting sores around the face, mouth, and neck. If the sores last longer than two weeks, it is a sign of a more serious condition.
You have a Family History of Periodontal Disease
Some people have the tendency to develop gum diseases due to their genetic makeup. Studies have shown that gum disease can be passed from one generation to another. In such individuals, a regular visit to a periodontist is important, as they can help look for signs of periodontitis and gingivitis. Scientists believe that there are certain regions on the chromosome that potentially harbour susceptibility genes for periodontal diseases.
Old Age
Age is a known risk factor associated with increased rates of periodontal diseases. The physiological and pathological changes that accompany aging have a cumulative effect on the strength and integrity of the gums, bones and supporting tissues.
To keep your Gums Healthy
A diseased gum is detrimental to the teeth and gum health. A regular visit to a periodontist for regular teeth cleaning will help prevent the build-up of plaques and tartar that may damage the gums.
How is Periodontitis Treated?
The aim of periodontist treatment is to limit and control the infection,
Scaling and Root Planing
Scaling and root planning smoothes the root of the teeth, thereby preventing the build-up of tartar and bacteria, and eliminates bacterial by-products that contribute to inflammation and delay healing or reattachment of the gum to the tooth surface. Patients are sedated with a local anesthetic to eliminate pain and discomfort during the treatment process.
This procedure is sometimes referred to as deep cleaning and is considered the “gold standard” treatment for patients with chronic periodontitis. It is very common for patients to experience some side effects after this procedure, which include numbness, tenderness of the gums and increased tooth sensitivity.
Medications
Medications may be combined with deep cleaning (scaling and root planning), but cannot be used as a substitute for surgery. Commonly used medications include;
- Antibiotic gel: This gel contains the antibiotic doxycycline. They are used to reduce the size of periodontal pockets and to control the growth of bacteria.
- Enzyme suppressant: They are used to suppress the host’s enzyme response. These enzymes can break down the gums and its supporting tissues if not fully They are used in combination with scaling and root planing.
- Oral antibiotics: Oral antibiotics are used to completely eliminate the causative agents which is bacteria. They are prescribed for the short-term treatment of an acute periodontal infection.
Surgery
Surgery might be indicated if gum inflammation is still persistent despite treatment with deep cleaning and medication.
Flap Surgery
A periodontist may perform flap surgery to remove tartar deposits in deep pockets. This procedure involves making tiny incisions into a section of the gum, so that the gum can be lifted back easily, thereby exposing the roots for more effective scaling and root planing. In some cases, due to excessive bone damage caused by inflammation, the underlying bone may be recontoured before the gum tissue are sutured tightly around the tooth. After the procedure, the teeth sometimes appear longer, making it easier to clean the deep pockets and maintain a healthy gum.
Bone Grafting
This procedure is used to restore teeth bones that may have been destroyed through inflammation. The graft may be a small fragment of the host’s bone or may be synthetic or harvested from a donor. The bone graft helps prevent tooth loss by firmly holding your tooth in the bone. It also helps in the regeneration and growth of natural bone.
Soft Tissue Grafts
Soft tissue graft is indicated for patients who may need to have some of their damaged gum tissue reinforced. This procedure is usually done by removing a small flap of tissue from the soft palate (roof of the mouth) or another donor source and attaching it to the affected site. This is done to cover exposed roots, prevent further recession and finally give your teeth an aesthetic appearance.
GuidedTissue Regeneration
This procedure is done by placing a special piece of biocompatible fabric between the diseased bone and tooth. This special fabric prevents unwanted tissue and germs from entering the healing area, allowing the damaged bone to grow back instead.
Tissue Stimulating Proteins
This procedure involves applying a special gel to a diseased tooth. This gel contains the same active proteins found in developing tooth enamel and stimulates the growth and repair of healthy gums and tissue.
References
Beube, F. (1956). The Periodontist as a Realist. Journal Of Periodontology, 27(1), 62-65. doi: 10.1902/jop.1956.27.1.62
Grover, H., Singh, Y., & Bhardwaj, A. (2015). Role of Periodontist in Pediatric Dental Patients. World Journal Of Dentistry, 6, 49-54. doi: 10.5005/jp-journals-10015-1312
Schallhorn, R., & McClain, P. (2014). Periodontal Regeneration: Management of Periodontal Osseous Defects by the Periodontist-Dental Hygienist Team. Journal Of Evidence-Based Dental Practice, 14, 42-52.e1. doi: 10.1016/j.jebdp.2014.04.008
Vishwas, A., & Shiromany, A. (2012). Oral Malodor-A Menace To Periodontist. Bangladesh Journal Of Medical Science, 11(2). doi: 10.3329/bjms.v11i2.9355
