Periodontology is the field of dentistry that deals with the structure around teeth: gums and bone, as well as the diseases that can affect them. The word “periodontal” litarally means “around the tooth”. Periodontal diseases are gum infections that destroy the gums and supporting bone that hold your teeth in your mouth. Periodontal diseases can affect one or many teeth. The two most common and important periodontal diseases are called gingivitis and periodontitis.
Gingivitis is an inflammation in the gum tissues that causes gum to become red, tender, swolen and easy to bleed. At more advanced stages the inflammation progresses in the bone and causes attachement loss and bone loss. The disease is then called periodontitis. So periodontitis is an infection of both gum tissue and bone. In many cases teeth can start to be mobile and towards the final stages of the disease teeth can fall off the mouth. The good news is that periodontal diseases can be treated. The treatment of gingivitis is a good professional dental cleaning together with instruction of proper oral home care: toothbrushing and dental floss in a daily basis.
Gingivitis can be completely revesrible, if taken care of correctly. If left untreated, it can easily progress to the more advance and often irreversible disease of periodontitis. The treatment of periodontitis is divided in phases: the Phase I which is the conservative treatment and the Phase II which is the surgical treatment.
The conseravative treatment of periodontitis includes instruction of oral home care and a special cleaning of the roots beneath the gums that is called scaling and root planing. The scaling and root planing is done under local anesthesia and usually is finished in four seccions.
The periodontist may judge that some patients might benefit from the simultaneous systemic delivery of antibiotics during the scaling and root planing and prescribe the appropriate scheme. The tissues are left to heal for a period of four to six weeks and then a reevaluation is done.
At the end of this healing period the inflammation and infection are treated but the destruction in the soft tissue (root recession) and bone loss remain.
In some cases periodontitis has advanced to the point that periodontal pockets are deep and significant amounts of bone are lost. In these cases surgical therapy may be necessary. This surgical trerapy is the second phase of periodontal treatment. Below some examples of surgical cases are listed:
- Open flap debridement
It is a surgical treatment that offers access to the roots of teeth so as the scaling and root planing will be more effective than with the closed non surgical treatment. It may result to pocket elimination or pocket reduction.
- Soft tissue grafts
In many cases the root recession can be corrected with a soft tissue graft that is usually taken by the patient’s palate. In other cases which include thin natural gum tissue, the graft that is taken from the palate is used to thicken the recipient tissue.
- Guided Tissue Regeneration
It is a surgical treatment that results in regenaration of the periodontium: bone, periodontal ligament and connective tissue. In order to be successful, proper case selection is mandatory. Your periodontist will let you know if you are a candidate for this magnificent procedure. The materials that are used are bone graft from a bottle (xenograft or allograft) and a special membrane that through a mechanism of healing help your body make bone again.
After treatment of periodontitis and in order to maintain the therapeutic effect, frequent re-examinations and professional cleaning are required at regular intervals.
Studies have shown that three months after the last cleaning, the bacteria population multiplies to a point that bacteria become pathogenic. In other words there is a possibility that the periodontal disease progresses.
To avoid this progression, the maintenance visit for evaluation and teeth cleaning is essential. The frequency of the visit is tailored to the individual needs of each patient. Judging from the overall clinical appearance, general health, potential risk factors and oral home care, an individual might need the maintenance visit every three months, while somebody else might need it every six months.
A lot of periodontal patients come every four months for the scheduled maintenance visit, meaning three times a year. If you think that pretty much everybody needs to see the dentist twice a year for a dental cleaning, having to see your periodontist three times a year for the professional cleaning is manageable.