Periodontics

Take Action Against Gum Disease

The term “periodontics” refers to the dental specialty that pertains to the prevention, diagnosis and treatment of periodontal disease that affects the gums and jawbone. The gum tissues serve to surround and support the teeth and the underlying jawbone anchors teeth firmly in place. Periodontists have completed several years of extra dental training and are concerned with maintaining the function, health and aesthetics of the jawbone and tissues.

Priodontics — Woman Checked-up by Dentist in Springfield, IL

Reasons for periodontal treatment

Periodontal disease is a progressive condition which begins with mild gum inflammation called gingivitis. It is the leading cause of tooth loss in adults living in the developed world, and should be taken very seriously. Periodontal disease (often called gum disease) is typically signified by red, swollen, painful, or bleeding gums, but in some cases has no noticeable symptoms.

Periodontal disease generally begins when the bacteria living in plaque cause an infection in the surrounding tissues of the teeth, causing them to become irritated and painful. Eventually, this infection will cause the jawbone to recede and the tooth to become loose.

There are several reasons why periodontal treatment may be necessary:

Moderate/advanced gum disease

This occurs when the gums are bleeding, swollen or red around most teeth and the jawbone has begun to recede.

Localized gum recession

The infection which propagates moderate or advanced gum disease often begins in one area. Gum recession may also be caused due to over brushing with a hard bristle brush, or due to a tooth that is not positioned properly. Immediate treatment is required to prevent further spreading.

Before crown lengthening

The periodontist may lengthen the crown of the tooth by removing surrounding soft tissue to provide more tooth exposure.

Ridge augmentation

This procedure, often called “recontouring” may be required to correct an uneven gum line. Before embarking on treatment, a periodontist needs to treat any bacterial infections and periodontitis.

In the case of mild/moderate periodontal problems, the focus of the periodontist will be on curing the underlying bacterial infection and then providing advice on the most appropriate home cleaning methods.

Sometimes a deep scaling is needed to remove the bacterial plaque and calculus (tartar) from the teeth and tissues. Where periodontal disease is advanced and the jawbone has regressed significantly, more intensive cleaning may be recommended and loose teeth that cannot be saved will be removed.

The periodontist is trained in all aspects of dental implant procedures, which can restore functionality to the mouth when teeth have been affected by periodontitis.

Because periodontal disease is progressive, it is essential to remove the bacteria and calculus build up to halt the spread of the infection. Your dentist will be happy to advise you on effective cleaning methods and treatment options.

What is a Periodontist?

A periodontist is a dentist who specializes in the soft tissues of the mouth and the underlying jawbone which supports the teeth. A dentist must first graduate from an accredited dental school before undertaking an additional three years of study within a periodontology residency training program, in order to qualify as a periodontist.

The primary focus of this residency training is on both surgical and non-surgical management of periodontal disease and the placement of dental implants.

Conditions Treated by a Periodontist

The periodontist is mainly concerned with: preventing the onset of gum disease (periodontal disease); diagnosing conditions affecting the gums and jawbone; and treating gingivitis, periodontitis, and bone loss. Periodontal disease is a progressive condition and the leading cause of tooth loss among adults in the developed world.

The periodontist is able to treat mild, moderate and advanced gum disease by first addressing the bacterial infection at the root of the problem, providing periodontal treatment, then providing information and education on good oral hygiene and the effective cleaning of the teeth.

The most common conditions treated by a periodontist are:

Gingivitis

This is the mild inflammation of the gums which may or may not be signified by pain and bleeding.

Mild/moderate periodontitis

When the pockets between the teeth and the soft tissues are measured to be between 4-6mm it is classified as moderate periodontitis (gum disease).

Advances periodontitis

When the pockets between the teeth and the soft tissues in general exceed 6mm in depth, significant bone loss may occur; causing shifting or loss of teeth.

Missing Teeth

When teeth are missing as a result of bone loss, the periodontist can implant prosthetic teeth. These teeth are anchored to the jawbone and restore functionality to the mouth.

Treatments Performed by a Periodontist

The periodontist is able to perform a wide range of treatments to halt the progression of gum disease, replace missing teeth and make the appearance of the smile more aesthetically pleasing.

Here are some of the treatments commonly performed by the periodontist:

Implant placement

When a tooth or several teeth are missing, the periodontist is able to create a natural-looking replacement by anchoring a prosthetic tooth to the jawbone.

Osteoplasty (hard tissue recontouring)

Once periodontitis has been treated, the periodontist can recontour the hard tissue to make the smile both natural-looking and aesthetically pleasing.

Gingivoplasty (soft tissue recontouring)

As gums recede due to periodontitis, the teeth may appear longer; causing a “toothy" smile. The periodontist can remove tissues or straighten the gum line to make the teeth look more even.

Bone grafting

Dental implants can only be positioned if there is sufficient bone to attach the prosthetic tooth to. If bone loss has occurred, bone grafting is an excellent way to add or “grow” bone so that an implant may be properly secured.

Deep pocket cleanings

As gingivitis and periodontitis progress, it becomes more difficult to cleanse the pockets between the soft tissues and the teeth. The periodontist can scale and root plane the teeth (sometimes under local anesthetic) to remove debris and infection-causing bacteria.

Crown Lengthening

In order to expose more of the natural tooth, the periodontist can remove some of the surrounding gingival tissue.

The periodontist is a highly skilled dental health professional who is able to diagnose and treat many commonly occurring soft tissue and bone problems in the oral cavity.

When to see a Periodontist?

A periodontist is a dentist specializing in the prevention, diagnosis and treatment of infections and diseases in the soft tissues surrounding the teeth, and the jawbone to which the teeth are anchored. Periodontists have to train an additional three years beyond the four years of regular dental school, and are familiar with the most advanced techniques necessary to treat periodontal disease and place dental implants. Periodontists also perform a vast range of cosmetic procedures to enhance the smile to its fullest extent.

Periodontal disease begins when the toxins found in plaque start to attack the soft or gingival tissue surrounding the teeth. This bacterium embeds itself in the gum and rapidly breeds, causing a bacterial infection. As the infection progresses, it starts to burrow deeper into the tissue causing inflammation or irritation between the teeth and gums. The response of the body is to destroy the infected tissue, which is why the gums appear to recede. The resulting pockets between the teeth deepen and if no treatment is sought, the tissue which makes up the jawbone also recedes causing unstable teeth and tooth loss.

Referrals from General Dentists and Self-Referral

There are several ways treatment from a periodontist may be sought. In the course of a regular dental checkup, if the general dentist or hygienist finds symptoms of gingivitis or rapidly progressing periodontal disease, a consultation with a periodontist may be recommended. However, a referral is not necessary for a periodontal consultation.

If you experience any of these signs and symptoms, it is important that you schedule an appointment with a periodontist without delay:
Bleeding while eating or brushing – Unexplained bleeding while consuming food or during the course of daily cleaning is one of the most common signs of periodontal infection.
Bad breath – Continued halitosis (bad breath) which persists even when a rigorous oral hygiene program is in place, can be indicative of periodontitis, gingivitis or the beginnings of an infection in the gum tissues.
Loose teeth and gum recession – Longer looking teeth can signal recession of the gums and bone loss due to periodontal disease. As this disease progresses and attacks the jawbone, (the anchor holding the teeth in place) the teeth may become loose or be lost altogether.
Gangrene in the tissues – Gangrene is hard to self-diagnose but the general dentist and periodontist will check for its presence in the soft tissues, alveolar bone and periodontal ligament.
Related health conditions – Heart disease, diabetes, osteopenia and osteoporosis are highly correlated with periodontitis and periodontal infections. The bacteria infection can spread through the blood stream and affect other parts of the body.

Diagnosis and Treatment

Before initiating any dental treatment, the periodontist must extensively examine the gums, jawbone and general condition of the teeth. When gingivitis or periodontal disease is officially diagnosed, the periodontist has a number of surgical and non surgical options available to treat the underlying infection, halt the recession of the soft tissue, and restructure or replace teeth which may be missing.

Gingivitis/mild periodontal disease – When the gum pockets exceed 4mm in depth, the periodontist or hygienist may perform scaling and root planing to remove debris from the pockets and allow them to heal. Education and advice will be provided on an effective cleaning regime thereafter.
Moderate periodontal disease – If the gum pockets reach 4-6mm in length, a more extensive scaling and root planing cleaning might be required. This cleaning is usually performed under local anesthetic.
Advanced periodontal disease – Gum pockets in excess of 6-7mm are usually accompanied by bone loss and gum recession. Scaling and root planing will always be performed as the initial nonsurgical treatment. In addition to tose nonsurgical treatments, the periodontist may recommend surgical treatment to reduce pocket depth.
Tooth loss – Where one or several teeth are missing due to periodontal disease, dental implants are an effective option. If the bone is strong enough to provide a suitable anchor for the prosthetic tooth, the implant can be placed. However, if the bone is severely eroded, bone grafts may be performed by the periodontist to provide a suitable anchor for the new tooth/teeth.

Bruxism

Bruxism refers to an oral parafunctional activity that occurs in most humans at some point in their lives. Grinding of the teeth and clenching of the jaw are the two main characteristics of this condition, which can occur during the day or at night.

Bruxism is one of the most common known sleep disorders and causes most of its damage during sleeping hours. The clenching and grinding which accompanies bruxism is symptomatic of a malfunctioning chewing reflex, which is turned off in non-sufferers when sleeping. For sufferers, deep sleep or even naps cause the reflex nerve control center in the brain to turn off and the reflex pathways to become active.

Typically, the incisors and canines (front 6 upper and lower teeth) of opposing arches grind against each other laterally. This side to side action puts undue strain on the medial pterygoid muscles and the temporomandibular joints. Earache, depression, headaches, eating disorders, and anxiety are among the most common symptoms of bruxism; these symptoms also accompany health issues such as chronic stress, Alzheimer’s disease, and alcohol abuse.

Bruxism is frequently misdiagnosed or not diagnosed at all, because it is only one of several potential causes of tooth wear. Only a trained professional can tell the difference between bruxing wear and wear caused by overly aggressive brushing, acidic soft drinks, and abrasive foods.

A BiteStrip® is an economical device used to diagnose bruxism at home. The device itself is a small electromyography which senses and monitors any activity in the jaw muscles during sleep. The frequency and severity of the condition can then be assessed and the best treatment plan can be formulated.

Reasons for the treatment of bruxism

Gum recession and tooth loss – Bruxism is one of the leading causes of gum recession and tooth loss. It damages the soft tissue directly and leads to loose teeth and deep pockets, where bacteria can colonize and destroy the supporting bone.
Occlusal trauma – The abnormal wear patterns on the occlusal (chewing) surfaces can lead to fractures in the teeth, which may require restorative treatment.
Arthritis – In severe and chronic cases, bruxing can eventually lead to painful arthritis in the temporomandibular (TMJ) joints (the joints that allow the jaw to open smoothly).
Myofascial pain – The grinding associated with bruxism can eventually shorten and blunt the teeth. This can lead to debilitating headaches and muscle pain in the myofascial region.

Treatment options for bruxism

There is no single cure for bruxism, though a variety of helpful devices and tools are available. Here are some common ways in which bruxism is treated:

Mouthguards – An acrylic mouthguard can be designed from tooth impressions to minimize the abrasive action of tooth surfaces during normal sleep. Mouthguards should be worn on a long-term basis to help to stabilize the occlusion as well as prevent damage to teeth and to the temporomandibular joint.
NTI-tss device – This device is fitted by a health professional and only covers the front teeth. The goal of the NTI-tss is to prevent the grinding of the rear molars by limiting the contraction of the temporalis muscle.
Botox® – Botox® can be injected into the muscles to relax and weaken them. Botox® is an excellent treatment for bruxism because it weakens the muscles enough to prevent grinding but not enough to interfere with everyday functions like chewing and speaking.

Other methods of treatment include relaxation exercises, stress management education, and biofeedback mechanisms. When the bruxing is under control, there are a variety of dental procedures such as crowns, gum grafts, and crown lengthening that can restore a pleasant aesthetic appearance to the smile.

Oral Cancer Exam

According to research conducted by the American Cancer Society, more than 30,000 cases of oral cancer are diagnosed each year. More than 7,000 of these cases result in the death of the patient. The good news is that oral cancer can easily be diagnosed with an annual oral cancer exam, and effectively treated when caught in its earliest stages.

Oral cancer is a pathologic process which begins with an asymptomatic stage during which the usual cancer signs may not be readily noticeable. This makes the oral cancer examinations performed by the dentist critically important. Oral cancers can be of varied histologic types such as teratoma, adenocarcinoma and melanoma. The most common type of oral cancer is the malignant squamous cell carcinoma. This oral cancer type usually originates in lip and mouth tissues.

There are many different places in the oral cavity and maxillofacial region in which oral cancers commonly occur, including:

Lips
Mouth
Tongue

Salivary Glands
Oropharyngeal Region (throat)

Gums
Face

Reasons for Oral Cancer Exams

It is important to note that around 75 percent of oral cancers are linked with modifiable behaviors such as smoking, tobacco use and excessive alcohol consumption. Your dentist can provide literature and education on making lifestyle changes and smoking cessation.

When oral cancer is diagnosed in its earliest stages, treatment is generally very effective. Any noticeable abnormalities in the tongue, gums, mouth or surrounding area should be evaluated by a health professional as quickly as possible. During the oral cancer exam, the dentist and dental hygienist will be scrutinizing the maxillofacial and oral regions carefully for signs of pathologic changes.

The following signs will be investigated during a routine oral cancer exam:

Red patches and sores – Red patches on the floor of the mouth, the front and sides of the tongue, white or pink patches which fail to heal and slow healing sores that bleed easily can be indicative of pathologic (cancerous) changes.
Leukoplakia – This is a hardened white or gray, slightly raised lesion that can appear anywhere inside the mouth. Leukoplakia can be cancerous, or may become cancerous if treatment is not sought.
Lumps – Soreness, lumps or the general thickening of tissue anywhere in the throat or mouth can signal pathological problems.

Oral Cancer Exams, Diagnosis & Treatment

The oral cancer examination is a completely painless process. During the visual part of the examination, the dentist will look for abnormality and feel the face, glands and neck for unusual bumps. Lasers which can highlight pathologic changes are also a wonderful tool for oral cancer checks. The laser can “look” below the surface for abnormal signs and lesions which would be invisible to the naked eye.
If abnormalities, lesions, leukoplakia or lumps are apparent, the dentist will implement a diagnostic impression and treatment plan. In the event that the initial treatment plan is ineffective, a biopsy of the area will be performed. The biopsy includes a clinical evaluation which will identify the precise stage and grade of the oral lesion.

Oral cancer is deemed to be present when the basement membrane of the epithelium has been broken. Malignant types of cancer can readily spread to other places in the oral and maxillofacial regions, posing additional secondary threats. Treatment methods vary according to the precise diagnosis, but may include excision, radiation therapy and chemotherapy.

During bi-annual check-ups, the dentist and hygienist will thoroughly look for changes and lesions in the mouth, but a dedicated comprehensive oral cancer screening should be performed at least once each year.

Periodontal Scaling & Root Planing

The objective of scaling and root planing is to remove etiologic agents which cause inflammation to the gingival (gum) tissue and surrounding bone. Common etiologic agents removed by this conventional periodontal therapy include dental plaque and tartar (calculus).

These non-surgical procedures which completely cleanse the periodontium, work very effectively for individuals suffering from gingivitis (mild gum inflammation) and moderate/severe periodontal disease.

Reasons for scaling and root planing

Scaling and root planing can be used both as a preventative measure and as a stand-alone treatment. These procedures are performed as a preventative measure for a periodontitis sufferer.

Here are some reasons why these dental procedures may be necessary:

Disease prevention – The oral bacteria which cause periodontal infections can travel via the bloodstream to other parts of the body. Research has shown that lung infections and heart disease have been linked to periodontal bacteria. Scaling and root planing remove bacteria and halts periodontal disease from progressing, thus preventing the bacteria from traveling to other parts of the body.
Tooth protection – When gum pockets exceed 3mm in depth, there is a greater risk of periodontal disease. As pockets deepen, they tend to house more colonies of dangerous bacteria. Eventually, a chronic inflammatory response by the body begins to destroy gingival and bone tissue which may lead to tooth loss. Periodontal disease is the number one cause of tooth loss in the developed world.
Aesthetic effects – Scaling and root planing help remove tartar and plaque from the teeth and below the gumline. As an added bonus, if superficial stains are present on the teeth, they will be removed in the process of the scaling and root planing procedure.
Better breath – One of the most common signs of periodontal disease is halitosis (bad breath). Food particles and bacteria can cause a persistent bad odor in the oral cavity which is alleviated with cleaning procedures such as scaling and root planing.

What do scaling and root planing treatments involve?

Scaling and root planing treatments are only performed after a thorough examination of the mouth. The dentist will take X-rays, conduct visual examinations and make a diagnosis before recommending or beginning these procedures.

Depending on the current condition of the gums, the amount of calculus (tartar) present, the depth of the pockets and the progression of the periodontitis, local anesthetic may be used.

Scaling – This procedure is usually performed with special dental instruments and may include an ultrasonic scaling tool. The scaling tool removes calculus and plaque from the surface of the crown and root surfaces. In many cases, the scaling tool includes an irrigation process that can also be used to deliver an antimicrobial agent below the gums that can help reduce oral bacteria.

Root Planing – This procedure is a specific treatment which serves to remove cementum and surface dentin that is embedded with unwanted microorganisms, toxins and tartar. The root of the tooth is literally smoothed in order to promote good healing. Having clean, smooth root surfaces helps bacteria from easily colonizing in future.

Following these deep cleaning procedures, the gum pockets may be treated with antibiotics. This will soothe irritation and help the gum tissues to heal quickly.

During the next appointment, the dentist or hygienist will thoroughly examine the gums again to see how well the pockets have healed. If the gum pockets still measure more than 3mm in depth, additional and more intensive treatments may be recommended.