Periodontists specialize in treating conditions affecting the gums and other structures supporting a patient's teeth (such as ligaments and bone). According to the CDC, most adult patients in the U.S. have some degree of gum disease. Few patients seek timely treatment. Chronic gum inflammation is linked to other systemic health conditions including diabetes, heart disease, and Alzheimer's. Dental researchers have discovered that appropriate treatment of periodontal disease has a positive impact on chronic health conditions such as atherosclerosis.
Gingivitis is one of the most common gum problems. Bacteria trapped between the gums and the teeth lead to infection and inflammation. Typical symptoms of gingivitis include gum redness, swelling, tenderness, and bleeding. However, gum disease may also progress with no noticeable symptoms. Patients who allow plaque to build up along their gum line are at high risk for developing gingivitis. Patients who have regular prophylactic cleanings to remove plaque and follow a dentist-recommended oral hygiene routine at home experience a lower risk of gum disease.
Periodontitis is the next stage of gum disease. Untreated gingivitis often progresses to periodontitis. Pockets of infection can form in the spaces between gums and teeth as food particles and plaque accumulate. As the gums become increasingly inflamed, they recede and pull away from the patient's teeth. Patients often experience bad breath or a bad taste in their mouth due to chronic gum infection. Periodontitis tends to become progressively worse. Bacteria and the patient's own immune response begin to break down the gums, underlying bone, and connective tissue holding teeth in place. A patient's teeth may become loose and eventually fall out or require extraction.
Periodontists do a visual exam and measure the depth of the pockets along the gum line between the gums and the teeth with a probe to diagnose gum disease. They also take x-rays to identify any areas of bone loss. Deep cleaning techniques called scaling and root planing are the two most common initial treatments for gingivitis and periodontitis. A periodontist scales (scrapes) the patient's teeth to remove tarter accumulation and planes (smoothes) rough spots on the tooth roots. Planing helps remove existing germs and reduces the rough surface areas bacteria tend to colonize.
The periodontist may prescribe oral antibiotics to reduce the risk of recurring gum infection. The patient may have topical antibiotic gel inserted directly into infected gum pockets. The periodontist may also prescribe the use of custom molded plastic trays and a chemical debriding agent (such as Perio Protect) to break down and remove biofilm and continue treating periodontitis at home. A dentist will prescribe or recommend an antiseptic mouthwash for the patient to use at home on an ongoing basis.
Types of Periodontal Treatment
Laser: Some periodontists perform periodontal treatments including scaling and root planing using lasers in conjunction with hand tools. The laser destroys bacteria, removes diseased gum tissue, and seals the pocket to help keep food and germs out. Some periodontists feel laser treatment promotes faster healing, minimizes bleeding, reduces discomfort, and limits the chances of infection. Periodontists also use lasers to reshape a patient's gum line. Patients who have a "gummy" smile which makes their teeth look short or uneven may request this crown lengthening procedure.
Tissue Grafting: Patients who have moderate to advanced periodontal disease often lose significant amounts of gum tissue. As the gums recede, one or more of the patient's teeth may begin to look longer than normal. The receding gums may also leave tooth roots partially exposed. This can cause discomfort and mouth sensitivity as well as making roots susceptible to decay. Periodontists can sometimes graft healthy gum tissue taken from elsewhere in the patient's mouth into the affected areas to correct the cosmetic and functional problems caused by gum recession. Patients may also receive bone tissue grafting to restore volume to the gum line and correct the loss of underlying bone that often occurs from advanced periodontal disease or tooth loss. Periodontists sometimes perform bone grafting to prepare a patient's mouth to receive a dental implant.
Dental Implants: Many periodontists perform dental implant procedures to replace lost teeth. The dentist inserts a titanium post into the patient's jaw bone and the bone grows back around it holding the post in place. The dentist adds an abutment and crown to create a prosthetic that functions like a normal tooth. A patient's body tends to reabsorb jaw bone in areas that do not have functioning teeth. Dental implants help prevent this bone loss and keep surrounding teeth and gums healthier.