Periodontology

What Is Periodontology?
Periodontology is an entire branch of dentistry dedicated to studying the gums and bone surrounding the teeth, researching new techniques for treating periodontal diseases, saving teeth, and replacing lost teeth with dental implants.

What is Periodontal Disease?
The term "periodontal" stems from two Greek words: "perio" meaning "around" and "dontal" meaning "tooth." Thus, periodontal disease is a progressive, usually painless disease of the gums caused by bacterial infections which attack the gums, bone and ligaments around the teeth. It can occur at any age, but occurs in greatest number after age 35. Currently, it is responsible for 70% of adult tooth loss. Most individuals are unaware of the presence of periodontal disease until they recognize one ore more of the following warning signs.

Warning Signs of Periodontal Disease

  • bleeding gums (when brushing or flossing)
  • bad breath
  • red, swollen or tender gums
  • loose teeth
  • pus that appears between the teeth and gums when the gums are pressed
  • change in bite
  • change in fit of dentures
  • receding gum line which has pulled away from the teeth

Causes of Periodontal Disease
The primary cause of gum disease is the buildup of bacterial plaque which hardens into a rough deposit called calculus (tartar) if it is not periodically removed. Toxins are produced by the bacteria in the plaque, and over time, these irritate the gums, making them red, swollen, sore and more prone to bleeding. While these are early symptoms of periodontal disease, as it progresses, more damage is done to supporting tissues around the teeth. As the gum is weakened, it begins to pull away from the teeth, and pockets are often formed which provide more space for plaque to fill. Ultimately, the disease can infect the bone if it is not brought under control and treated, resulting in loosening of the teeth and eventual tooth loss.

Types of Periodontal Disease
Gingivitis and Periodontitis
The two most common types of periodontal disease are gingivitis and periodontitis. Gingivitis occurs earliest, affecting only the gum tissue. It is the mildest form and is still reversible. Periodontitis, on the other hand, is more advanced, affecting the gums, bone and other supporting structures around the teeth in many cases. Teeth become loose and eventually will fall out or necessitate removal. This stage requires more complex intervention and often surgical procedures.

Different Treatment Methods Exist
Depending on the type and extent of periodontal disease that a patient presents with, different treatment methods can be applied.

To begin with, the periodontist will conduct a thorough examination of the patient's gums, teeth and mouth. Key elements that the periodontist will look for include color and firmness of the gums, checking if teeth are loose and the extent of gum tissue loss which has occurred. The teeth are usually cleaned thoroughly, involving the removal of tartar deposits and plaque which often buildup and attack beneath the gumline. Frequently at this time, tooth roots are planed in order to provide a smooth root surface so that gum tissue may subsequently heal and allow successful reattachment to the tooth. In other cases, the patient's bite (occlusion) may require some adjustment.

Since periodontal diseases are caused by bacterial infections which attack the gums, bone and ligaments, antibiotics or antimicrobial irrigation with mouth rinses and other chemical agents may be indicated to control and prevent further growth and spread of bacteria.

More advanced stages of periodontal disease may necessitate surgical intervention. Here, the goals are to remove the calculus (tartar) from any deep pockets around the teeth, reduce the pockets, smooth any root surfaces and reshape gum tissue so it will be easier to keep clean. Each individual case will be different. However, several common treatment procedures include:

  • Scaling and Root planning - Scaling involves the removal of the calculus (tartar) deposits around the teeth. Root planning involves smoothing the surfaces of the roots so that gum tissue can successfully reattach to the tooth.
  • Curettage - Curettage is the removal of infected soft tissue lining the pocket.
  • Gingivectomy - Gingivectomy is the surgical removal of the actual pockets which have become infected.
  • Flap Surgery - Flap Surgery involves the creation of a gum flap which allows access to the tooth root in order to remove the calculus, plaque and infected soft tissue. The gum is then surgically secured back in place.
  • Bone Grafting - In advanced stages of periodontitis, infection can progress all the way to the bone and surrounding fibers. However, there is hope in many cases for partial regeneration through the surgical insertion of a bone graft (either the patient's bone or artificial bone) which enables new tissue to grow.
  • Gingival Grafting - In cases where gum tissue has been extensively lost around the tooth root, a gingival graft which is taken from healthy tissue in the mouth may be utilized.

Non-Surgical Treatment
Treatment methods depend upon the type of disease and how far the condition has progressed. In some instances, non-surgical periodontal treatment may be the initial step. If successful after re-evaluation by a periodontist, this form of treatment may be an end point to periodontal therapy. A thorough cleaning which may include scaling will remove calculus deposits beneath the gumline. To aid in the healing process, tooth roots may be planed. planning smooths the root surface so the gum tissue may heal next to the tooth. In some cases, the occlusion (bite) also may require adjustment. When deep pockets between teeth and gums (4 to 6 mm or greater) are present, it is difficult for dentists to thoroughly remove plaque and tartar. Patients can seldom, if ever, keep these pockets clean and free of plaque. Consequently, surgery may ultimately be needed to restore periodontal health.

Risk Factors for Periodontal Disease
Several factors may put an individual at increased risk for developing or increasing the rate of progression of periodontal disease. The following risk factors should be discussed with the periodontist in order to determine a means of achieving the best oral health and hygiene.

  • Smoking and chewing tobacco
  • Poor diet, especially one high in sugar
  • Poorly fitting dentures or bridges, misaligned teeth, defective fillings
  • Grinding or clenching the teeth
  • Pregnancy or use of oral contraceptives
  • Medications: steroids, cancer therapy drugs, some calcium channel blockers, some anti-epilepsy
  • Drugs (consult your dentist/periodontist)
  • Systemic diseases such as HIV or diabetes

Can Periodontal Disease Be Prevented?
The good news to this question is that there are steps that can be taken to prevent periodontal disease! While more than half of adults over 35 have the early stages of periodontal disease, and while 3 out of 4 of these adults eventually are affected, the numbers do not have to be so high. Even if caught in the early stages, the possibility for gum disease reversal is good. For healthy gums and a healthy smile, keep in mind the following preventative steps:

  • Thoroughly brush and floss your teeth daily.
  • Avoid high sugar products and processed "junk food" and eat a balanced diet.
  • Note early signs of gum disease including red, puffy or bleeding gums.
  • Schedule regular checkups with your dentist twice a year for a cleaning and oral examination.

Women and Gum Disease
What you should know?

Women have special dental needs at different stages of life. Women are especially susceptible to periodontal disease at various stages of life. Hormonal changes such as puberty, menstruation, pregnancy and menopause can affect the blood supply to the gums, and response to irritants from plaque may be exaggerated. During these times your body experiences hormonal changes that can make your gums sensitive and increase your risks for gum disease. The condition worsens if patients are already prone to periodontal disease. All can influence your oral health and the need for dental treatment. We at Capitol Periodontal Group can help and guide our patients understand their unique dental and periodontal needs that can help promote good dental habits that keep teeth and gums healthy and a smile lasting a lifetime.

The Teen-Age Years
As you reach puberty, you increase your production of the sex hormones progesterone and estrogen. This hormonal increase can exaggerate the way your gum tissues react to the irritants in plaque. Your gums may become red, tender, swollen and likely to bleed easily when you chew or brush your teeth. The condition can be difficult to manage when you undergo orthodontic treatment such as wearing braces. After the early teen years you may notice less inflammation and bleeding. At Capitol Periodontal Group, we make sure that our patients get the adequate training on how to brush their teeth thoroughly and clean between your teeth daily with floss or interdental cleaners. We guide and recommend our patients to choose oral care products, including antimicrobial mouth rinses that are effective and safe and are endorsed by the American Dental Association Seal of Acceptance.

Your monthly Cycle
During menstruation, you may notice several changes in your mouth, including swollen gums, lesions, canker sores and swollen salivary glands. Some women don't notice any changes at all. For others, particularly those for whom plaque or pockets are a problem, there may be bleeding gums in the days before starts, but symptoms should not be ignored. As your periodontist diagnoses these problems, we may prescribe special cleanings, gum treatment or topical anesthetics to ease any discomfort.

Pregnancy and your oral health
During pregnancy, your body's hormone levels rise considerably. Gingivitis, especially common during the second to eight months of pregnancy, may cause red, puffy or tender gums that tend to bleed when you brush your teeth. This sensitivity is an exaggerated response to plaque and is caused by an increased level of progesterone in your system. We, at Capitol Periodontal Group will not only be in communication with your physician and your general dentist but we also may recommend a more frequent cleanings during your second trimester or early third trimester to help you avoid problems.

If you are taking oral contraceptives
One of the most common problems in women who take oral contraceptives, or birth control pills, is inflammed gums. The hormone in oral contraceptives increases the level of progesterone in your system. Prolonged use of birth control pills may cause your gums to turn red, bleed and swell in response to any local irritants in the mouth, such as food or plaque. Good oral hygiene is especially important when taking birth control pills.

Reaching Menopause
You may notice a number of physical changes when you reach menopause, including some that occur in the mouth. These may include burning sensation, altered taste sensations (salty, peppery or sour), a decrease in saliva flow that can result in dry mouth, and greater sensitivity to hot and cold foods or drinks. At Capitol Periodontal Group, our periodontists may diagnoses your oral problems related to menopause. We may communicate these signs and symptoms to your physicians who may recommend hormone replacement therapy. To insure your comfort during this stage of your life, we may prescribe you saliva substitutes to reduce mouth dryness and vitamin C and B complexes that may be effective and helpful in keeping your oral condition healthy.