Nancy R. Ekelman D.D.S.
PERIODONTICS AND ORAL IMPLANTOLOGY
Periodontics is the dental specialty relating to the prevention, diagnosis, and treatment of diseases of the supporting and surrounding tissues of the teeth and gums. It also includes the maintenance of the health, function and esthetics of these structures and tissues. A periodontist is a dentist who has had additional years of specialized training in periodontics in a post-doctoral educational program.
Periodontal Disease is a bacterial infection of the gums, bone and ligaments that support the teeth and anchor them to the jaw. The bacteria are normal inhabitants of the mouth and form a film of dental plaque and calculus (tartar) on the teeth. These bacteria cause the supporting structures of the teeth to deteriorate. This eventually leads to tooth loss.
Periodontal disease can occur at any age. Over half of all people over the age of 18 have some form of the disease. After age 35, over 75% of all people are affected. Unfortunately, the disease process is usually asymptomatic and painless. The disease can be easily detected during regular dental examinations.
The most common type of periodontal disease are GINGIVITIS and PERIODONTITIS
HEALTHY GUMS AND BONE: Gums appear light pink and are sharply defined. Bone completely surrounds the roots of the teeth. Teeth are firmly anchored into the bone.
GINGIVITIS is infection of the gingiva (gum tissue), and is the initial stage of the disease process. Gums become red, swollen and may bleed easily. Underlying bone levels are unaffected.
PERIODONTITIS is classified as being Mild, Moderate or Severe, depending upon the amount of destruction to the gums, ligaments and bone that surround teeth. As the disease progresses, gums separate from the teeth and form gum pockets. These pockets get deeper as more underlying bone is destroyed. Gum pockets will collect increasing amounts of bacterial plaque and calculus (tartar) as the disease process worsens. Teeth will loosen as more bone is lost.
The response of the gums and bone to dental plaque may be modified by one or more of the following factors.
Periodontal disease can be easily detected by a general dentist or periodontist during regular examinations. A periodontal charting should be performed for all teeth. A periodontal probe, with ruled millimeter markings, is used to measure the depth of the space between the teeth and gums. Ideally, normal measurements range between 1 and 3 millimeters. Depths greater than this may signify the presence of periodontal pockets and associated gum disease. Dental radiographs should be taken to evaluate any evidence of bone damage has occurred as a result of the disease process.
The main goal of periodontal treatment is elimination of the disease process from the gums, ligaments and bone that surround the teeth, and restoration of dental health.
Initial treatment involves educating patients in the proper methods of effective, daily plaque removal and oral hygiene. This is a critical component of successful therapy.
Scaling and root planing are performed by the clinician under local anesthesia to debride the tooth structure and remove bacterial plaque and calculus deposits (the source of the infection) from the gum pockets. In mild cases of gingivitis and periodontitis, antibiotic or irrigation with anti-microbials (chemical agents) may be suggested in conjunction with scaling and root planing to control and target periodontal pathogens. The purpose of this phase of treatment is to improve the overall tissue quality especially prior to surgical phase.
In cases which demonstrate deeper gum pockets and underlying bone loss, it becomes necessary to surgically eliminate the diseased gum pockets and bony destruction with osseous (bone) surgery. The gum is reflected and retracted away from the teeth to expose the underlying roots and bone deformities. The bone is contoured to approximate a normal physiologic profile, and the gum is sutured back to place. When the gum heals, normal probing depth is re-established between the gum and tooth. The reduced probing depth facilitates easy removal of plaque by patients at home and by hygienists during professional cleaning.
Additional treatment modalities may be necessary to treat periodontal disease and restore health.
These may include:
Bone grafts for bone regeneration:
Gum grafts to treat gum recession and pathological root exposure
Cosmetic plastic surgery of the gums to improve appearance
Fabrication of night guards for bruxism (tooth grinding)
Removal of diseased roots on some types of molars
Use of medications such as antibiotics, fluoride and antimicrobial rinses
Once the active phase of treatment is complete and health has been restored, it is extremely important that patients be seen by a hygienist for routine dental and periodontal cleaning on a regular basis. This regimen, along with diligent home care and oral hygiene, will give the best chance for preventing recurrence of disease and maintaining long term periodontal health.