Periodontology

This is the specialty that diagnoses and treats conditions affecting the gums and the periodontal tissues.  Periodontal tissues are those structures that help support the tooth – including bone.  Some periodontists (the specialists in this area) will also place dental implants.

Periodontal disease is a condition that affects the supporting tissue of the mouth. There are two main stages of gum disease: gingivitis (the less severe condition, only affecting the gums) and periodontitis (where all the supporting structures are involved). Although there are numerous signs and symptoms associated with periodontal disease, you may not realise you have the disease. Your dentist will check for signs of periodontal disease during your checkup.

The symptoms are gums that tend to bleed easily, especially when brushing, gums that are sensitive and turn red, detachment of the gums from the teeth creating spaces that are known as periodontal pockets, constant bad breath or bad taste in the mouth and loose teeth.  Periodontal disease can lead to permanent teeth loss, a change in the bite, or a change in the fit of partial dentures. Many older adults will loose more teeth as a result of periodontal disease than dental decay (caries).

Being Referred to a Specialist
If you’re referred to a dentist who specialises in this field, you should expect a variety of solutions to treat your issue, including surgical and non surgical approaches. Most treatment starts with what is known as initial phase therapy – a thorough cleaning of the teeth to remove tartar (calculus) and plaque.  This is usually performed under local anaesthetic.

More advanced treatments can include periodontal surgery to treat gum disease; these include tissue regeneration where bone grafts for the regeneration of bone are used, pocket reduction therapy, reducing the space between the teeth and gums, and gingival or gum tissue grafts. Your periodontal specialist will advise you if these are required.

Prevention
Prevention of periodontal disease is important to avoid potential tooth loss and other complications in the future. There are various risk factors that should be avoided to prevent the development of gum disease. These risk factors include smoking or chewing tobacco, certain medications, defective fillings. Other risks include diabetes, poorly fitting bridges, and teeth that are not straight and make cleaning and brushing difficult. The easiest way to prevent periodontal disease and subsequent surgery is to practice good oral hygiene by brushing (at least twice per day) and flossing regularly. It is also important to visit a dentist regularly and maintain a healthy diet, too. Many patients find flossing difficult, you might want to consider different ways of brushing between your teeth, such as TePe brushes. Some patients will also benefit from anti-tartar (calculus) toothpastes.
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The Training of a Periodontist
In order to be considered a specialist in the United Kingdom, individuals must have qualified as a dentist first by having a degree in dentistry (BDS or BChD), then complete a post-graduate certificate specialising in this subject after at least 3 years of professional training.  Individuals will hold the MRD RCS examination of one of the Royal Colleges and will be on the appropriate specialist list at the GDC.

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Important terms

Periodontium – these are the structures securing your tooth in place including the bone – when it becomes diseased it can lead to tooth mobility and ultimately tooth loss.

Pocket – this a gap between the tooth and its supporting structures caused by periodontal disease.  As the disease progresses, the pocket deepens making the tooth loose (mobile) and more difficult to clean.

Root planing – this is the treatment that most periodontists will start with – a thorough cleaning, usually under anaesthetic of the root surfaces of teeth to remove calculus.

Grafting – gum recession can lead to exposed root surfaces that may be sensitive. There are several treatment for this, but sometimes piece of gum tissue is removed from elsewhere in your mouth and placed over a defect.

Tartar – or calculus is a hard deposit that occurs when plaque becomes mineralised.  Its hard to remove and is usually cleaned off by dentists or hygienists during a dental cleaning, or scale and polish.