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What is a Periodontist?

If you have been experiencing symptoms of periodontal disease, including red, swollen or tender gums or other pain in your mouth, bleeding while brushing your teeth, persistent bad breath, or a change in the way your teeth fit together when you bite, it may be a good idea to schedule an appointment with a periodontist.  However, you may be wondering “What exactly is periodontal disease?” and “Why is it a good idea to see a periodontist for treatment options?”  These are common questions, and their answers are important!

The word “periodontal” refers to the gum tissue and bone around the teeth.   Periodontal disease, also known as gum disease, is caused by the chronic inflammatory response to bacteria under the gums and around the teeth.  The bacteria irritate the gums and generate an inflammatory response which over time can break down and destroy the gums and bone that support the teeth.   When periodontal disease is left untreated, it is one of the primary causes of adult tooth loss.  Also, several research studies have found a relationship between periodontal disease and other serious health problems such as heart disease, diabetes, and rheumatoid arthritis.

A periodontist is a dentist who specializes in the prevention, diagnosis, and treatment of periodontal disease and other procedures involving the gums and bone around the teeth, such as the placement of dental implants.   Periodontists are also dentistry’s experts in the treatment of oral inflammation.  Periodontists receive extensive training in these areas, including three additional years of education beyond dental school.   The extra education and wide- ranging experience treating gum disease and inflammation assures that you are receiving the best possible care.   Periodontists are also familiar with the latest techniques for diagnosing and treating periodontal disease.  In addition, they can perform cosmetic periodontal procedures to help you achieve the smile you desire.

During your first visit, your periodontist will review your complete medical and dental history with you.   It is very important for your periodontist to know if you are taking any medications or are being treated for any other health condition, as it may affect your periodontal care.  Your gums will be examined to see if there is any gum line recession, and your teeth will be checked to see how they fit together when you bite.   Your periodontist will also take a small measuring instrument and place it between your teeth and gums to determine the depth of your pockets.  X-rays may also be taken to observe the health of the bone below your gums.   If treatment is needed, your periodontist will discuss the course of action with you.

What if I don’t have any symptoms of periodontal disease?   The first stage of gum disease, gingivitis, is often accompanied by little or no discomfort. Sometimes, the only way to detect periodontal disease is through a comprehensive periodontal evaluation!

Additionally, there are many risk factors that may increase your chances of having periodontal disease.   Even if you think you don’t have any symptoms of periodontal disease, you may want to see a periodontist if any of these risk factors apply to you: tobacco use, diabetes, heart disease, or family history of periodontal disease.  To determine your risk, take the AAP’s Risk Assessment Test, which can be found at perio.org.

If you’re not ready to see a periodontist, remember to brush your teeth twice every day, floss once every day, and see your dental professional every 6 months for a check-up and cleaning.   It is very important to take care of your teeth even if you don’t have periodontal disease!

Periodontal Disease and Initial Treatment

If you’ve recently been diagnosed with periodontal disease, you probably have some questions about your treatment.   Be assured that periodontists believe that periodontal therapy should be achieved in the least invasive and most cost-effective way possible; this includes non-surgical therapy.

Remember that the first step toward good oral health begins with proper oral hygiene.  This includes brushing your teeth at least twice each day and flossing at least once each day.   Good oral hygiene along with regular visits to a dental professional, such as a periodontist, can go a long way toward preventing certain forms of periodontal disease and reversing gingivitis, an early stage of periodontal disease.

If you have more significant disease, you may require an in-depth cleaning called scaling and root planing (SRP).   SRP is a careful cleaning of the tooth root surfaces to remove plaque from pockets and to remove bacteria and toxins from the tooth root.   Research has consistently shown that SRP reduces inflammation of the gums and reduces the amount of bacteria associated with periodontal disease.  Due to these positive findings, SRP is usually the first mode of treatment recommended for most patients. In fact, many people do not require any further active treatment after SRP.

In some cases, systemic antibiotics (antibiotics that are taken by mouth) are prescribed at the time of SRP to help control bacteria levels.   However, each time you take an antibiotic you increase your chance of developing drug resistant bacteria.  Therefore, it is very important to take antibiotics only when necessary.  Instead of a systemic antibiotic, your periodontist may prescribe a local delivery antimicrobial, medication that is delivered directly into periodontal pockets to control or kill periodontal bacteria.  In general, local delivery antimicrobials do not lead to antibiotic resistance.

When tooth surfaces are not in harmony between the upper and lower teeth, an occlusal adjustment may be necessary.   This is because teeth that do not properly fit together can affect the rate of progression of periodontal disease.   During this procedure, your periodontist may take a mold of your teeth to determine the areas of concern, which will be adjusted.  You may also need to wear an occlusal guard or night guard to be worn at certain times of the day to minimize the effects of teeth grinding.

Following adequate time to respond to your treatment, you will be asked to return to your periodontist to determine if further treatment is necessary.   If you need further treatment, your periodontist, in collaboration with your general dentist will develop a treatment plan to help restore your smile to a state of health.  If you don’t need further treatment, you’ll enter into a maintenance phase.   These appointments are usually more thorough than traditional six-month cleanings and may occur more often, which will help protect the health of your teeth and gums.

Regeneration

Your bone and gum tissue should fit snugly around your teeth like a turtleneck around your neck. When you have periodontal disease, this supporting tissue and bone can be destroyed, leading to pockets.   Eventually, too much bone can be lost, leading to teeth falling out or needing to be extracted.  To fix this, your periodontist may recommend a regenerative procedure that will reverse some of the damage by regenerating lost bone and tissue with the help of bone grafts.  Tissue grafts, procedures that place gum tissue in places where it has receded (such as exposed tooth roots), may also be utilized in regeneration procedures.

What is Inflammation?

Inflammation is the body’s instinctive reaction to fight off infection, guard against injury or shield against irritation.  Acute cases of inflammation are easily identifiable, and are often characterized by swelling, redness, heat and pain around the affected area.  While acute inflammation initially intends to heal the body, over time, if left untreated, it can lead to chronic inflammation.  Chronic inflammation can lead to dysfunction or destruction of the infected tissues, and potentially more severe health complications.

Most people know that maintaining healthy teeth and gums is a necessary step in achieving overall wellbeing.  In fact, now not only dentists encourage brushing and flossing, but many physicians also promote oral hygiene as a way to help keep the rest of the body healthy.  Several research studies have suggested that gum disease may be associated with other health issues, including heart disease, stroke and diabetes.  And with more and more research reinforcing the connection between periodontal and systemic health, scientists are beginning to understand why these connections exist.  One theory points to chronic inflammation as the culprit.

Inflammation is the body’s natural response to harm, such as an injury or infection.  For many years, dentists believed that gum disease developed as a result of a bacterial infection caused by the build-up of plaque between the teeth and under the gums.  While plaque build-up is still a factor in the development and progression of gum disease, researchers now suspect that the more severe symptoms, namely swollen, bleeding gums; recession around the gum line, and loss of the bone that holds the teeth in place, may actually be caused by the chronic inflammatory response to the bacterial infection, rather than the bacteria itself.

Scientists hypothesize that the chronic inflammatory response mechanism may be the reason behind the periodontal-systemic health link.  Many of the diseases associated with periodontal disease are also considered to be systemic inflammatory disorders, including cardiovascular disease, diabetes, rheumatoid arthritis, kidney disease and even certain forms of cancer, suggesting that chronic inflammation itself may be the basis for the connection.

More research is needed to pinpoint the precise biological mechanisms responsible for the relationship between gum disease and other disease states.  However, since previous findings have indicated that gum disease sufferers are at a higher risk for other diseases, it is critical to maintain periodontal health in an effort to achieve overall health.

Dentists recommend daily oral care, including regular brushing and flossing, and routine visits to the dentist to avoid gum disease.  If gum disease develops, consultation with a dental professional such as a periodontist can lead to effective treatment.  A periodontist is a dentist with three years of additional specialized training in the prevention, diagnosis and treatment of gum disease.

For more information on the role of inflammation in oral health, tips on how to prevent or treat gum disease, to find out if you are at risk, or to find a local periodontist, visit perio.org.

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