Who is a periodontist?
A periodontist is a dentist who specializes in the prevention, diagnosis and treatment of periodontal disease and in the placement of dental implants. A periodontist typically has had two to three years of additional training in diagnosing and treating gum disease and its associated problems.
Periodontists are familiar with the latest techniques for diagnosing and treating periodontal disease. Moreover, periodontists can perform cosmetic periodontal procedures to improve your smile. Often, dentists refer their patients to a periodontist when their periodontal disease is advanced.
What is the definition of Periodontics?
Periodontics is a dental specialty that involves the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.
What are the signs of gum disease?
Gum disease is the leading cause of tooth loss in adults. Persistent swollen, red or bleeding gums, sensitive teeth, and bad breath are just some of the warning signs of periodontal (gum) disease? a serious infection that, left untreated, can lead to tooth loss.
In general, here are the major warning signs:
⇒ Any change in the way your teeth fit together when you bite
⇒ Bleeding gums after tooth brushing or eating hard food
⇒ Emerging spaces between your teeth
⇒ Pain in the mouth
⇒ Persistent bad breath
⇒ Pus between your teeth and gums
⇒ Receding gums (pulling back from your teeth) or teeth appearing longer than before
⇒ Swollen or tender gums
⇒ Unexplained mouth sores
What are the causes of periodontal disease?
Plaque is the primary cause of periodontal disease. However, other factors can contribute to gum disease. These include:
⇒ A family history of dental disease
⇒ Bad habits such as smoking, which impedes growth and repair of gum tissue, and poor oral hygiene
⇒ Poor nutrition
⇒ Hormonal changes from pregnancy, puberty, menopause, and monthly menstruation. These changes can make gums more sensitive, thereby making it easier for gingivitis to develop
⇒ Illnesses such as cancer or HIV that interfere with the immune system. Diabetes also affects the body's ability to use blood sugar, and thus, diabetics are at higher risk of developing periodontal disease
⇒ Some drugs (such as diphenylhydantoin, also called Dilantin, the anti-angina drug nifedipine, also called Procardia or Adalat), can cause abnormal growth of gum tissue, calcium channel blockers, which are used to control high blood pressure or for people with heart problems, cyclosporine, a medication that suppresses the immune system and is used to keep the body from rejecting transplanted organs, and oral contraceptives)
⇒ Some medications, which lessen the flow of saliva, which has a protective effect on teeth and gums
⇒ Clenching or grinding your teeth
What is plaque?
image_1603661_rightPlaque is a film of bacteria that forms on your teeth and gums after eating foods that produce acids. These foods may include carbohydrates (starches and sugars), such as candy and cookies, and starchy foods such as bread, crackers, and cereal.
When plaque remains in your mouth for an extended period of time, it allows the bacteria to "eat away" at the surfaces of your teeth and gums. Ironically, the areas surrounding restored portions of teeth (where fillings or amalgams have been placed) are particularly vulnerable to decay and are a breeding ground for bacteria.
Plaque can lead to gum irritation, soreness, and redness. Sometimes, your gums may begin to bleed as a result of plaque. This gradual degeneration can often cause gums to pull away from teeth. This condition is called receding gums.
Long-term, plaque can lead to serious problems. Sometimes, the bacteria can form pockets of disease around tooth structures, eventually destroying the bone beneath the tooth.
What is Gingivitis?
If caught early, gingivitis can be treated fairly easily and effectively. A small mirror and a probing tool is used to spot bleeding gums. The more spots that bleed, the more likely your gum disease is severe. Hard mineral deposits (tartar) above and below the gum line are a problem area that is usually addressed during this treatment, as are areas where your gums are pulling away from your teeth and pockets have formed between your teeth and gums. Deeper pockets indicate severe gum disease. Paper strips may be inserted into the spaces between your teeth and gums to measure the amount of fluid present. The amount of fluid indicates how much swelling and inflammation you have. X-rays of your teeth may be taken to look for bone damage and other problems.
What is Periodontitis?
Periodontitis (periodontal disease) which literally means around the teeth is a bacterial infection that affects soft tissue (gum) and supporting hard tissue (bone) around the teeth.
What are the types of periodontal disease (periodontitis)?
Periodontal (which literally means "around the tooth") diseases are serious bacterial infections that destroy the gums and bones that hold your teeth in your mouth. Left untreated, these diseases can lead to tooth loss. There are many forms of periodontal disease, including:
⇒ Aggressive periodontitis
⇒ Chronic periodontitis
⇒ Periodontitis from systemic diseases
⇒ Necrotizing periodontal diseases
What are the stages of periodontal disease (periodontitis)?
Actually, gingivitis and periodontitis are two distinct stages of gum disease.
Gingivitis, also generally called gum disease or periodontal disease, describes the events that begin with bacterial growth in your mouth and may end ? if not properly treated ? with tooth loss due to destruction of the tissue that surrounds your teeth. Gingivitis usually precedes periodontitis. However, not all gingivitis progresses to periodontitis. In the early stage of gingivitis, bacteria in plaque build up and cause the gums to become inflamed (red and swollen) and often easily bleed during tooth brushing.
Although the gums may be irritated, the teeth are still firmly planted in their sockets. No irreversible bone or other tissue damage has occurred at this stage.
When gingivitis is left untreated, it can advance to periodontitis. In a person with periodontitis, the inner layer of the gum and bone pull away from the teeth and form pockets. These small spaces between teeth and gums collect debris and can become infected. The body's immune system fights the bacteria as the plaque spreads and grows below the gum line. Toxins or poisons produced by the bacteria in plaque as well as the body's "good" enzymes involved in fighting infections start to break down the bone and connective tissue that hold teeth in place. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. When this happens, teeth are no longer anchored in place, they become looser, and tooth loss occurs.
Aggressive periodontitis is a form of periodontitis that occurs in normally healthy people and includes rapid attachment loss and bone destruction and familial aggregation.
Chronic periodontitis, the most common form of periodontitis, results in inflammation of the supporting tissues of the teeth, progressive attachment and bone loss and is characterized by pocket formation and/or recession of the gingiva.
Progression of attachment loss usually occurs slowly, but periods of rapid progression can occur.
Necrotizing periodontal diseases are infections characterized by necrosis, or death, of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly seen in individuals with systemic conditions including, but not limited to, HIV infection, malnutrition and immunosuppression.
Is there a genetic link to periodontal disease?
According to the American Academy of Periodontology, up to 30% of the general population may be genetically susceptible to gum disease. Despite aggressive oral care habits, these people may be six times more likely to develop periodontal disease. Identifying these people with a genetic test before they even show signs of the disease and getting them into early interventive treatment may help them keep their teeth for a lifetime.
Periodontal disease may be passed from parents to children and between couples, according to an article in the September 1997 issue of the Journal of the American Dental Association. Researchers suggest that bacteria causing periodontal disease are passed through saliva. This means that when a family or couple come into contact with each other's saliva, they're at risk for contracting the periodontal disease of another family member. In some cases, treatment of gum disease may involve entire families. If one family member has periodontal disease, all family members should receive a periodontal disease screening.
How to prevent periodontal disease?
Brushing is the most effective method for removing harmful plaque from your teeth and gums. Getting the debris off your teeth and gums in a timely manner prevents bacteria in the food you eat from turning into harmful, cavity -causing acids.
Most dentists agree that brushing three times a day is the minimum; if you use a fluoride toothpaste in the morning and before bed at night, you can get away without using toothpaste during the middle of the day. A simple brushing with plain water or rinsing your mouth with water for 30 seconds after lunch with generally do the job.
Since everyone's teeth are different, see me first before choosing a brushing technique. Here are some popular techniques that work:
⇒ Use a circular motion to brush only two or three teeth at a time, gradually covering the entire mouth.
⇒ Place your toothbrush next to your teeth at a 45-degree angle and gently brush in a circular motion ? not up and down. This kind of motion wears down your tooth structure and can lead to receding gums, or expose the root of your tooth. You should brush all surfaces of your teeth - front, back, top, and between other teeth, rocking the brush back and forth gently to remove any plaque growing under the gum.
⇒ Don't forget the other surfaces of your mouth that are covered in bacteria - including the gums, the roof and floor of your mouth, and most importantly, your tongue. Brushing your tongue not only removes trapped bacteria and other disease-causing germs, but it also freshens your breath.
⇒ Remember to replace your brush when the bristles begin to spread because a worn toothbrush will not properly clean your teeth.
⇒ Effective brushing usually takes about three minutes. Believe it or not, studies have shown that most people rush during tooth brushing, spending less.
What is flossing?
Flossing is a method for removing bacteria and other debris that cannot be reached by a toothbrush. It generally entails a very thin piece of synthetic cord you insert and move up and down between the sides of two adjoining teeth.
Why is flossing important?
Many dentists believe that flossing is the single most important weapon against plaque. In any event, daily flossing is an excellent and proven method for complementing your brushing routine and helping to prevent cavities, periodontal disease, and other dental problems later in life. It also increases blood circulation in your gums. Floss removes plaque and debris that stick to your teeth and gums.
How often to floss
Floss at least once every day. Like brushing, flossing should take about three minutes and can easily be done while doing another activity, such as watching television. Do not attempt to floss your teeth while operating a motor vehicle or other machinery.
There are two common methods for flossing, the "spool method" and the "loop method".
The spool method is the most popular for those who do not have problems with stiff joints or fingers. The spool method works like this: Break off about 18 inches of floss and wind most of it around your middle finger. Wind the rest of the floss similarly around the middle finger of your other hand. This finger takes up the floss as it becomes soiled or frayed. Move the floss between your teeth with your index fingers and thumbs. Maneuver the floss up and down several times forming a "C" shape around the tooth. While doing this, make sure you go below the gum line, where bacteria are known to collect heavily.
The loop method is often effective for children or adults with dexterity problems like arthritis. The loop method works like this: Break off about 18 inches of floss and form it into a circle. Tie it securely with two or three knots. Place all of your fingers, except the thumb, within the loop. Use your index fingers to guide the floss through your lower teeth, and use your thumbs to guide the floss through the upper teeth, going below the gum line and forming a "C" on the side of the tooth.
With either method of flossing, never "snap" the floss because this can cut your gums. Make sure that you gently scrape the side of each tooth with the floss.
Your gums may be tender or even bleed for the first few days after flossing - a condition that generally heals within a few days.
For Those With Special Needs
If you have dexterity problems or a physical disability, you may find it difficult to hold onto your toothbrush or dental floss. Try these techniques:
⇒ Enlarge the brush handle with a soft material such as a sponge, rubber ball or bicycle handle grip.
⇒ Lengthen the handle with a piece of wood or plastic such as a ruler, popsicle stick, or tongue depressor.
⇒ Tie floss into a loop for easier handling.
⇒ Use a wide elastic band to attach the brush to your hand.
⇒ Use an electric toothbrush or commercial floss holder.
Gingivitis can be reversed in nearly all cases when proper plaque control is practiced. Proper plaque control consists of professional cleanings at least twice a year and daily brushing and flossing. Brushing eliminates plaque from the surfaces of the teeth that can be reached; flossing removes food particles and plaque from in between the teeth and under the gum line.
Highly concentrated fluoride gels, mouth rinses, or dietary supplements are another source of this important substance. In addition, anti-cavity varnish, or sealants (which are thin, plastic coatings) also provide an additional barrier against harmful bacteria and other foreign matter.
Regular dental visits are also important. Daily cleaning will help keep calculus formation to a minimum, but it won't completely prevent it. A professional cleaning at least twice a year is necessary to remove calculus from places your toothbrush and floss may have missed.
Other health and lifestyle changes that will decrease the risk, the severity and the speed of gum disease development include:
⇒ Smoking cessation
⇒ Stress reduction
⇒ Proper nutrition
Plaque is a film of bacteria that forms on your teeth and gums after eating foods that produce acids. These foods may include carbohydrates (starches and sugars), such as candy and cookies, and starchy foods such as bread, crackers, and cereal.
Tooth decay leads to cavities and occurs when plaque remains on your teeth for an extended period of time, allowing the bacteria to 'eat away' at the surfaces of your teeth and gums. Ironically, the areas surrounding restored portions of teeth (where fillings or amalgams have been placed) are particularly vulnerable to decay and are a breeding ground for bacteria.
Plaque can lead to gum irritation, soreness, and redness. Sometimes, your gums may begin to bleed as a result of plaque. This gradual degeneration can often cause gums to pull away from teeth. This condition is called receding gums.
Long-term plaque can lead to serious problems. Sometimes, the bacteria can form pockets of disease around tooth structures, eventually destroying the bone beneath the tooth.
Nutrition and Gum Disease, is there a relation?
All dentists believe that people can prevent two of the most common diseases today - tooth decay and periodontal disease - simply by improving their diet.
Decay results when the hard tissues are destroyed by acid products from bacteria. Although poor nutrition does not directly cause periodontal disease, many researchers believe that the disease progresses faster and is more severe in patients whose diet does not supply the necessary nutrients. Poor nutrition can suppress your entire immune system, increasing your vulnerability to many disorders. People with lowered immune systems have been shown to be at higher risk for periodontal disease.
Eat a well-balanced diet; use moderation and choose a variety of foods. The important foods to choose include those from the four basic food groups: fruits and vegetables, breads and cereals, milk and dairy products, meat, chicken, fish or beans. And remember that so-called "fad diets" often restrict or eliminate entire food groups. Leading to serious vitamin or mineral deficiencies. Eating foods with antioxidant properties, for example, those containing vitamin E or vitamin C (vitamin E-containing foods include vegetable oils, nuts, green leafy vegetables; vitamin C-containing foods include citrus fruits, broccoli, potatoes) can help your body repair damaged tissue. Avoid clenching and grinding your teeth. These actions may put excess force on the supporting tissues of the teeth and could increase the rate at which these tissues are destroyed.
When snacking, try to avoid soft, sweet, sticky foods, such as cakes, candy and dried fruits. Better choices include nuts, raw vegetables, plain yogurt, cheese and sugarless gum or candy.
When you eat foods such as crackers, cookies and chips, include them as part of your meal, instead of by themselves. Believe it or not, some combinations of foods can actually neutralize harmful acids in the mouth and inhibit tooth decay.
Smoking, tobacco and gum disease, is there a problem?
Studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease. Smokers are much more likely than non-smokers to have calcium form on their teeth, have deeper pockets between the teeth and gums and lose more of the bone and tissue that support the teeth. Smoking also causes bad breath and stains your teeth. It also can, over time, lead to serious periodontal problems. People who smoke or chew tobacco are more likely to have deposits of plaque and tartar on their teeth, and are more likely to suffer from gum disease. Moreover, smokers are also slower to heal after a tooth extraction or oral surgery, and are more likely to suffer from oral cancer. We may be able to help you calm nicotine cravings with medication such as nicotine gum and patches. There are also smoking-cessation classes and support groups.
Dentistry health care that works: tobacco
The American Dental Association has long been a leader in the battle against tobacco-related disease, working to educate the public about the dangers inherent in tobacco use and encouraging dentists to help their patients break the cycle of addiction. The Association has continually strengthened and updated its tobacco policies as new scientific information has become available.
Frequently asked questions: tobacco products
What effects can smoking have on my oral health? Are cigars a safe alternative to cigarettes? Are smokeless tobacco products safe? The American Dental Association has some alarming news that you should know.
Smoking and Implants
Recent studies have shown that there is a direct link between oral tissue and bones loss and smoking.
Tooth loss and edentulism are more common in smokers than in non-smokers. In addition, people who smoke are more likely to develop severe periodontal disease.
The formation of deep mucosal pockets with inflammation of the peri-implant mucosa around dental implants is called peri-implantitis. Smokers treated with dental implants have a greater risk of developing peri-implantitis. This condition can lead to increased resorption of peri-implant bone. If left untreated, peri-implantitis can lead to implant failure. In a recent international study, smokers showed a higher score in bleeding index with greater peri-implant pocket depth and radiographically discernible bone resorption around the implant, particularly in the maxilla.
Many studies have shown that smoking can lead to higher rates of dental implant failure. In general, smoking cessation usually leads to improved periodontal health and a patient's chance for successful implant acceptance.
Women and gum disease, what are the risks?
Women have special needs when it comes to their oral health. That's because the physical changes they undergo through life - things like menstruation, pregnancy and childbirth, breastfeeding and menopause - cause many changes in the body, some harmful to teeth and gums.
Lesions and ulcers, dry sockets, as well as swollen gums, can sometimes occur during surges in a woman's hormone levels. These periods would be a prime time to visit the dentist. Birth control pills have been shown to increase the risk of gingivitis, and hormone replacement therapy has been shown to cause bleeding and swollen gums. Gum disease can also present a higher risk for premature births.
Some research has shown that women may be more likely to develop dry mouth, eating disorders, jaw problems such as temporomandibular joint disorders, and facial pain - all of which can be difficult from a physical and emotional standpoint.
Diabetes and gum disease, are there links?
People living with diabetes are vulnerable to a host of systemic problems in their entire body. Unfortunately, the mouth and teeth are not immune from such problems, and many diabetics with oral problems go undiagnosed until conditions become advanced.
Infections and other problems such as receding gums and gum disease, or periodontal disease, are common afflictions among diabetics for many reasons; for instance, diabetics often are plagued by diminished saliva production, which can hamper the proper cleansing of cavity-causing debris and bacteria from the mouth. In addition, blood sugar levels that are out of balance could lead to problems that promote cavities and gum disease.
As with any condition, good oral hygiene, including regular brushing, flossing and rinsing, as well as the proper diabetic diet, will go a long way in preventing needless problems.
When to visit the Periodontist?
Anytime is a good time to see our office for a proper evaluation.
Often, the only way to detect periodontal disease is through a periodontal evaluation. A periodontal evaluation may be especially important if:
⇒ You notice any symptoms of periodontal disease.
⇒ You are not satisfied with your current tooth replacement option, such as a bridge or dentures, and may be interested in dental implants.
⇒ You are thinking of becoming pregnant. Pregnant women who have periodontal disease may be seven times more likely to have a baby born too early and too small. In addition, about half of women experience "pregnancy gingivitis." However, women who have good oral hygiene and have no gingivitis before pregnancy are very unlikely to experience this condition.
⇒ You feel that your teeth are too short or that your smile is too "gummy." Or, if you are missing one or more of your teeth and are interested in a long-lasting replacement option.
⇒ You have a family member with periodontal disease. Research suggests that the bacteria that cause periodontal disease can pass through saliva. This means the common contact of saliva in families puts children and couples at risk for contracting the periodontal disease of another family member.
⇒ You have heart disease, diabetes, respiratory disease or osteoporosis. Ongoing research is showing that periodontal disease may be linked to these conditions. The bacteria associated with periodontal disease can travel into the blood stream and pose a threat to other parts of the body. Healthy gums may lead to a healthier body.
What is Scaling and Root Planing (deep cleaning?)
Many times, the early stages of periodontal disease are best treated with non-surgical periodontal therapy. This usually consists of placing a fine ultrasonic tip and curette in between the tooth and gum tissue to remove any plaque and calculus below the gumline. This procedure is called root planing. Four to six weeks later, periodontal pockets are eliminated due to gum shrinkage. Then the patient can personally maintain these areas with routine brushing and flossing.
Even in most severe cases of periodontal disease, non-surgical periodontal therapy most often precedes surgical therapy. This is done so that the overall tissue quality is improved prior to surgery and also limits the areas of required surgery.
What is a Flap Surgery?
Your bone and gum tissue should fit snugly around your teeth like a turtleneck. When you have periodontal disease, this supporting tissue and bone is destroyed, forming "pockets" around the teeth. Over time, these pockets become deeper, providing a larger space for bacteria to thrive and wreak havoc.
As bacteria accumulate and advance under the gum tissue in these deep pockets, additional bone and tissue loss follow. Eventually, if too much bone is lost, the teeth will need to be extracted.
Flap surgery is sometimes performed to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for you or your dental professional to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again.
A pocket reduction procedure is recommended if daily at-home oral hygiene and a professional care routine cannot effectively reach these deep pockets.
In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. This allows the gum tissue to better reattach to healthy bone.
In some cases, bone may be smoothed and reshaped so that plaque has fewer places to grow; and repaired (grafted) with bone from another part of the body or with man-made materials. A lining on the bone graft may be placed to help the bone grow back. The lining may need to be removed later.
The flap procedure should cure your gum disease if you maintain good dental care after the surgery. Your gums should become pink and healthy again.
What is Osseous Surgery?
Osseous (meaning "bone") surgery involves removing and/or reshaping the jawbone under the gum. Such a procedure is called for not because of gum disease per se, but because of most of the damage that occurs in the underlying bone. Actually, gum disease and its attendant infection that spreads below the gum tissue can destroy the bone structure below. The bone becomes irregularly shaped, preventing the gum from laying down flat.
What is the Bone Graft?
The term "periodontal defect" generally refers to a loss of bone and tooth attachment around the roots of your teeth. It is sometimes also called a "periodontal pocket," which refers to the small pocket of empty space that forms between the tooth root and the bone.
Why does bone grafting help?
By including bone grafting in an overall procedure to restore the tooth's attachment, dentists have found that they can regenerate lost bone and the ligaments that hold a tooth to that bone, restoring your tooth to its original state and insuring that you will have use of it for a good long time.
What is the procedure?
The doctor will make an incision and pull back the gum tissue around the tooth (called "flap surgery") to gain access to the tooth root and surrounding bone. The tooth root is cleaned via a procedure called "scaling and planing" to remove all accumulated tartar and calculus so that the tooth will reattach to periodontal ligaments. The bone grafting material is placed in the area of missing bone and the gum tissues are replaced and sutured closed.
What are Soft Tissue Grafts?
Soft tissue grafts can be used to cover roots or develop gum tissue where absent due to excessive gingival recession. During this procedure, your periodontist takes gum tissue from your palate or another donor source to cover the exposed root. This can be done for one tooth or several teeth to even your gum line and reduce sensitivity.
What are the benefits of this procedure?
A soft tissue graft can reduce further recession and bone loss. In some cases, it can cover exposed roots to protect them from decay. This may reduce tooth sensitivity and improve the esthetics of your smile. Whether you have crown lengthening to improve function or esthetics, patients often receive the benefits of both: a beautiful new smile and improved periodontal health & your keys to smiling, eating and speaking with comfort and confidence.
Soft tissue grafts are sometimes performed to treat gum disease or correct other abnormalities.
The procedure involves taking gum tissue from the palate or another donor source to cover an exposed root in order to even the gum line and reduce sensitivity.
Periodontal procedures are available to stop further dental problems and gum recession and to improve the esthetics of your gum line. For example, an exposed tooth root resulting from gum recession may not be causing you pain or sensitivity but is causing one or more of your teeth to look longer than the others. In other cases, an exposed tooth rooth causes severe pain because it is exposed to extremes in temperatures or different kinds of food and liquids.
Once contributing factors are controlled, a soft tissue graft procedure will repair the defect and help to prevent additional recession and bone loss.
What is a Gingivectomy Procedure?
A gingivectomy is necessary when the gums have pulled away from the teeth, creating deep pockets. The pockets make it hard to clean away plaque. Gingivectomy is usually done before gum disease has damaged the bone supporting your teeth. The procedure involves removing and reshaping loose, diseased gum tissue to get rid of pockets between the teeth and gums. After removing the gum tissue, a putty-like substance is placed over your gum line. This will protect your gums while they heal. If you maintain good dental care after surgery, a gingivectomy is likely to stop gum disease.
What is Crown Lengthening?
When getting a crown, the General Dentist must prepare your tooth to receive the crown. Sometimes there is not enough tooth surface above the gum line to accomplish this. A Periodontist can do crown lengthening to provide more tooth surface. This ensures a more stable crown with less gum irritation. Also, if you have a "gummy" smile or an uneven gum line, crown lengthening can make your teeth look longer and more even.