Periodontics
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.
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 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 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.
If you experience any of these signs and symptoms, it is important that you schedule an appointment with our periodontist in Darien, CT 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 bloodstream and affect other parts of the body.
Diagnosis & 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 that 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 those 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.
Treatments Performed by a 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.
Gum Grafting
A gum graft (also known as a gingival graft or periodontal plastic surgery), is a collective name for surgical periodontal procedures that aim to cover an exposed tooth root surface with grafted oral tissue.
Exposed tooth roots are usually the result of gingival recession due to periodontal disease. There are other common causes, including overly aggressive brushing and trauma.
Here are some of the most common types of gum grafting:
- Free gingival graft – This procedure is often used to thicken gum tissue. A layer of tissue is removed from the palate and relocated to the area affected by gum recession. Both sites will quickly heal without permanent damage.
- Subepithelial connective tissue graft – This procedure is commonly used to cover exposed roots. Tissue is removed fairly painlessly from the outer layer of the palate and relocated to the site of gum recession.
- Acellular dermal matrix allograft – This procedure uses medically processed, donated human tissue as a tissue source for the graft. The advantage of this procedure is that there is no need for a donor site from the patient’s palate (and thus, less pain).
Soft Tissue Grafting
Soft tissue grafting is often necessary to combat gum recession. Periodontal disease, trauma, aging, over-brushing, and poor tooth positioning are the leading causes of gum recession which can lead to tooth-root exposure in severe cases.
When the roots of the teeth become exposed, eating hot and cold foods can be uncomfortable, decay is more prevalent and the aesthetic appearance of the smile is altered. The main goal of soft tissue grafting is to either cover the exposed root or to thicken the existing gum tissue in order to halt further tissue loss.
Crown Lengthening
Crown lengthening is generally performed to improve the health of the gum tissue or to prepare the mouth for restorative or cosmetic procedures. In addition, crown lengthening procedures can also be used to correct a “gummy” smile, where teeth are covered with excess gum tissue.
Crown lengthening exposes more of the natural tooth by reshaping or recontouring bone and gum tissue. This treatment can be performed on a single tooth, many teeth, or the entire gum line, exposing an aesthetically pleasing smile.
Sinus Augmentation
A dental implant is essentially an artificial tooth root that is attached to the jaw bone. Eventually, a replacement tooth or bridge will be firmly fixed to this root, restoring complete function to the tooth. The key to a successful and long-lasting implant is the quality and quantity of jawbone to which the implant will be attached. If bone has been lost due to injury or periodontal disease, a sinus augmentation can raise the sinus floor to allow for new bone formation.
In the most common sinus augmentation technique, a tiny incision is made near the upper premolar or molar region to expose the jawbone. A small opening is cut into the bone and the membrane lining the sinus on the other side of the opening is gently pushed upward. The underlying space is filled with bone graft material and the incision is closed. The bone which is used for this procedure may be from your own body or from a cadaver. Sometimes the dentist might use synthetic materials which can also stimulate bone formation. The implants are placed after healing has occurred; this will depend on the individual case. Sinus augmentation has been shown to increase the success of dental implant procedures.
Antibiotic Treatment
Periodontal disease is a progressive condition that leads to severe inflammation and tooth loss if left untreated. Antibiotic treatments can be used in combination with scaling and root planing, curettage, surgery, or as a stand-alone treatment to help reduce bacteria before and/or after many common periodontal procedures.
Antibiotic treatments come in several different types, including oral forms and topical gels which are applied directly into the gum pockets. Research has shown that in the case of acute periodontal infection, refractory periodontal disease, prepubertal periodontal disease, and juvenile periodontal disease, antibiotic treatments have been incredibly effective.
Antibiotics can be prescribed at a low dose for longer term use or as a short-term medication to deter bacteria from re-colonizing.
Maintenance
It only takes twenty-four hours for plaque that is not removed from your teeth to turn into calculus (tartar)! Daily home cleaning helps control plaque and tartar formation, but those hard-to-reach areas will always need special attention.
Once your periodontal treatment has been completed, your dentist and dental hygienist will recommend that you have regular maintenance cleanings (periodontal cleanings), usually four times a year. At these cleaning appointments, the pocket depths will be carefully checked to ensure that they are healthy. Plaque and calculus that is difficult for you to remove on a daily basis will be removed from above and below the gum line.