at Sydney Periodontics
Periodontal disease is an inflammatory disease of the supporting tissues of the teeth (gums and bone). Periodontal disease covers a broad spectrum of conditions ranging from a mild gingivitis to an advanced periodontitis.
Periodontal disease is caused by an accumulation of plaque on the tooth surface, around and below the gum margin. Plaque consists mainly of bacteria which produce toxins. These toxins stimulate the body’s immune system to produce inflammation in the gum tissues. In its mildest form of disease, gingivitis, the gums are red, swollen and bleed easily. There is usually little or no discomfort at this stage.
If left untreated, gingivitis can progress to a periodontitis. The inflammation becomes chronic and the bone that supports the teeth is gradually destroyed. As bone is lost, spaces or pockets develop between the gum and the tooth. More plaque accumulates in these pockets and so the inflammation and bone destruction continues. Eventually the teeth will become loose and subsequently will be lost.
Although plaque is the main cause of periodontal disease, other factors such as age, smoking and some medications can increase the risk of developing periodontitis. Some people are genetically predisposed to periodontal disease.
When you are referred to a specialist for a periodontal assessment, the periodontist will usually begin with a full review of a patient’s medical and dental histories. This will include any current medications and those taken in the past two years. This history will assist in identifying risk factors and any medical conditions which must be considered before treatment is commenced.
This will be followed by a clinical examination where the oral tissues are examined and the bite (occlusion) is assessed. The periodontist will measure and record pocket depths, levels of recession and mobility for each tooth. X-rays may also be taken to assess the health of the bone which is supporting the teeth.
Following a thorough examination, the periodontist is able to formulate a course of treatment which is suitable for each individual. Treatment options will be discussed at this stage.
Treatment of periodontal disease
This is a reversible condition and can be treated simply by providing patients with a good oral hygiene routine. If plaque has been present for some time, it may have transformed into hard, rough deposits (calculus) and these will need to be removed with scaling by a clinician. Gingivitis is usually treated by your general dentist or hygienist.
More extensive treatment is required when bone loss has occurred and the pockets around the teeth become too deep to clean with daily oral hygiene methods. The aim of periodontal treatment is to reduce the pocket depths to stop the progression of disease and eliminate inflammation. It will then be possible to maintain a healthy periodontium with good daily oral hygiene practices.
Initially, periodontitis is treated conservatively with scaling and root planing to remove infected tissue and deposits. Deep pockets are carefully cleaned to remove all plaque and calculus and the root surfaces are smoothed. This is usually carried out with local anaesthesia and will require 2-4 appointments. Some tenderness may be experienced following the procedure but this will subside as the gum tissue heals.
A re-evaluation of initial treatment is carried out 2-3months after the initial scaling and root planing. Oral hygiene is assessed and pocket depths are re-measured. Pockets which remain greater than 5-6mm and bleed upon probing will require further treatment.
Periodontal surgery is needed in areas where conservative scaling and root planing has been unsuccessful in stopping the progression of periodontitis. The gum is folded back to give direct access to the root surfaces. This is especially useful where bone loss extends to the areas between the roots of molars. Infected tissue and deposits can be removed more successfully. Sometimes irregular bone surfaces are smoothed before replacing the gum.
Treatment of periodontal disease
Supportive periodontal therapy
Management of peri-implant disease
Soft tissue grafting
Cosmetic periodontal surgery
Surgical procedures in orthodontic treatment