Periodontics

 

What is Periodontal Disease?

What is Periodontitis?

Periodontitis is a form of gum disease that destroys the ligaments and bone that hold your teeth in the jaw.
It is a “quiet” disease that you may not know you have unless your dentist examines you very carefully.
It presents with some or all of the following features:

  • Bleeding gums (e.g. when you brush your teeth)

  • Gum recession (shrinkage)

  • “Pocketing” (this is the development of a deep space between your teeth and gums)

  • Mobility of teeth (teeth move excessively)

  • Drifting of teeth (spaces appear between teeth) and / or

  • Pus, swelling and abscess around some of your teeth

  • Bone loss (this can only be seen on x-rays)

Does Periodontitis affect everyone?

Many studies show that severe periodontitis only affects about 10% of the adult population, but it can start in your teenage years. There is also a very aggressive form of the disease which affects between 0.1% (Caucasians) and 2% (Afro-Caribbeans) of younger patients.

Why do I suffer from Periodontitis?

Historically, it was believed that the accumulation of plaque (due to poor oral hygiene) was sufficient to initiate periodontitis in all individuals. However, research shows that 10% of people are resistant to getting periodontitis even if their oral hygiene is poor. 10% are highly susceptible and will develop disease even with quite good oral hygiene and most of the remainder will develop the disease eventually (by 65 years-of-age) if they have average oral hygiene.

Susceptible patients develop the disease because their immune system over-reacts to the presence of plaque at the gum margin and especially between the teeth. These patients are “at risk” of early tooth loss because they possess, or have been exposed to “risk factors”.

What are the risk factors?

Risk factors are circumstances that increase your chances of getting the disease; they do not necessarily cause the disease. The following are the main risk factors:

  • Genetics

  • Stress

  • Smoking

  • Drugs

  • Diabetes

  • Pregnancy

Genetics Studies of twins have taught us that about 50% of periodontitis is due to your genetic make up and you cannot change this. In these patients it is vital they have meticulous oral hygiene.

Smoking

Smoking is the largest “modifiable” risk factor for periodontitis. It reduces the blood supply to your gums, and therefore you do not heal properly after treatment. Treatment does not work as well in smokers and the disease is often impossible to control. Stopping smoking is the only sure way of improving treatment outcomes; even then it may take several years before you heal as well as a person who has never smoked. Research has shown the following features in relation to smoking:

  • Specific bacteria responsible for periodontitis are 2-3 times higher in smokers

  • Smokers accumulate more tooth stain and calculus (tartar), making cleaning harder

  • Smokers lose bone twice as much as non-smokers in periodontal disease

  • Smokers are prone to persistent treatment failure

  • Smokers receiving treatment for periodontitis are twice as likely to lose teeth as non-smokers

Stress

If you are stressed, the body has a reduced ability to fight against periodontal infection. It may also affect your ability to brush your teeth effectively. It is important to speak to your doctor if you are stressed and they can find the right people to help you.

Diabetes

Diabetes sufferers have an increased risk of having periodontitis. Periodontitis makes it harder for diabetes patients to control their blood sugar levels. Poorly controlled diabetes has the following adverse effects on periodontitis:

  • Reduced ability of the body’s defence cells to fight properly against the bacterial plaque.

  • Increased damage caused by certain types of immune defence cells in your body.

  • Poor healing following periodontal treatment.If periodontitis is treated, it improves the control of blood sugar and lipid (fat) levels in diabetics. Therefore it is important to treat and regularly maintain the health of your periodontal tissues. It is important to speak to your doctor to check your sugar levels if you have a history of diabetes in the family.

Drugs

Some drugs, taken for certain medical problems, are associated with overgrowth of the gums in a small number of patients, which can make oral hygiene more difficult. Examples include: drugs used to control blood pressure like nifedipine, felodipine, amlodipine; the anti-epilepsy drug Phenytoin and the immunosuppressant Ciclosporin.

Pregnancy

If you are pregnant, you may experience bleeding and / or overgrowth of your gums. This is due to the hormonal changes in your body. It is vital that you increase the time you spend brushing your teeth regularly to prevent plaque from accumulating under the gums. In most cases, the gums stop bleeding after child-birth and the overgrowth reduces. However, severe bone loss can occur during pregnancy. Extra attention to tooth brushing is recommended during pregnancy. We also recommend you also see a hygienist every 3 months during your pregnancy.

I am concerned, what can I do next?

Periodontitis cannot be cured, but it can be stopped and held at bay so that you keep your teeth for much longer, if not for life. The most important thing you can do is to learn how to achieve the highest standard of oral hygiene possible. Like diabetes, patients have to monitor their blood glucose levels and be careful with their diet, you have to monitor your plaque levels and be careful with your oral hygiene.

No matter what we do for you, unless you are cleaning meticulously and conscientiously on a daily basis at home, our treatment will fail.

If you feel you need help with any of the above issues, please inform our reception team and we will be happy to see you for a consultation and recommend a customised plan to help control your gum disease.

For advice on what your role is, in managing your periodontitis, please ask for a separate leaflet.

It is also recommended that you get your family members, including parents, siblings and/or children to see a dentist regularly and to detect gum disease early.

 

Healthy Gums

Your gums are like cushions for your teeth; they surround the tooth from its crown to its root in the jaw and help to support a healthy mouth. Looking after your gums is just as important as looking after your teeth, and without routine cleaning gum disease can occur. These are the stages of gum disease:

  1. Red and swollen gums that bleed when you brush them are a sign of a type of gum disease, gingivitis.

  2. When gingivitis is left untreated it can develop further into a type of infection known as periodontitis, which affects the entire area surrounding the tooth, causing discomfort and difficulty when eating

  3. Eventually this kind of infection can lead to tooth loss and may require invasive procedures to replace the missing tooth.

Your gums are like cushions for your teeth; they surround the tooth from its crown to its root in the jaw and help to support a healthy mouth. Looking after your gums is just as important as looking after your teeth, and without routine cleaning gum disease can occur. These are the stages of gum disease:

Life Benefits

  • Minimised risk of tooth loss.

  • Reduced risk of developing tooth decay and need for fillings.

  • Fresh, minty breath.

 

Sensitive Teeth

Your gums are like cushions for your teeth; they surround the tooth from its crown to its root in the jaw and help to support a healthy mouth. Looking after your gums is just as important as looking after your teeth, and without routine cleaning gum disease can occur. These are the stages of gum disease:

  1. Temporary pain can be experienced after tooth whitening procedures and is treated with over the counter painkillers.

  2. Dental erosion, or the loss of tooth enamel, can also cause sensitivity. Enamel is the hard outer coating of a tooth that protects the sensitive dentine underneath. If enamel is worn away or eroded, this dentine is exposed which can lead to pain and sensitivity, which can be worsened with extreme temperatures.

  3. Erosion can be caused by your diet (frequent consumption of high sugar or high acid food or drink), tooth brushing habits (brushing too hard), tooth grinding, certain medical conditions and eating disorders.

For top tips on protecting your enamel and for effective treatment of tooth sensitivity, come to the practice for a check-up and we will create an individualised care plan for you.

Life Benefits

  • Being able to consume hot and cold drinks and food.

  • Pain-free mouth.

  • Reduced risk of further tooth wear.

 

Children’s Teeth

For top tips on protecting your enamel and for effective treatment of tooth sensitivity, come to the practice for a check-up and we will create an individualised care plan for you.

  1. Fluoride applications are a safe and effective way to safeguard your child’s growing teeth from developing decay. The fluoride is painted onto the surface of the teeth, helping to mineralise them.

  2. Tooth-coloured fissure sealants are applied to the biting surfaces of children’s teeth to prevent decay.

  3. Studies have shown that the younger your child is when attending their first dental appointment, even if just for a check-up, the more likely they are to have a positive experience and to grow up unafraid of the dentist. Our team will take special care of your child to make them feel safe and cared for.

  4. Treating a child from a young age also allows the dentist to spot early signs of underbites, cross bites or overbites developing. As with most dental problems, the sooner you can start to treat it, the quicker it can be resolved.

Prevention is always better than cure, so call the practice today to make an appointment for your child.

Life Benefits

  • Healthy teeth and gums for life.

  • Reduced risk of developing tooth decay and reduced need for fillings.

  • No fears or phobias of the dentist.

 

Gum recession

Gingival (gum) recession is not uncommon and can occur suddenly in isolated sites in healthy mouths OR as a consequence of gum disease.

It can be scary and occasionally painful to have receding gums, but you don’t need to worry. There are several steps you can take at home that may serve as effective treatment for receding gums, depending on the severity of the problem.

Causes of Gum Recession

  1. Overly aggressive brushing or flossing. It’s great to be enthusiastic about oral care, but you should make sure that you’re brushing, not scrubbing! Be gentle on your teeth, and remember that taking care of them isn’t supposed to hurt. Seeking advice from your dentist, hygienist and/or Periodontist (gum specialist) is an important aspect of preventative advice.

  2. Genetics. Your gums’ characteristics are determined by your genetics, just as the rest of your body is. Generally, this is seen in areas where the gum quality is thin and fragile.

  3. Abnormal tooth positioning. If your teeth are not in alignment to one another, gum recession can occur in this situation.

  4. Trauma to gum tissue. The gum tissue may recede when a traumatic injury has occurred on a tooth or teeth.

  5. Poor oral health. If your oral health habits are questionable, gum recession may be a result of periodontitis.

  6. Muscle activity. The muscle attachments in certain areas of the chin are high and tension on the gums can aggravate recession.

  7. Previous history of orthodontic treatment where tooth movement can result in recession of the gums

In most cases, a number of the above factors work in combination to cause the recession.

Receding Gums Treatment

There are a number of different treatment modalities, depending on the cause and symptoms experienced.

The following treatments are generally available:

  1. Tooth brushing advice

  2. Application of topical desensitisers where you experience sensitivity

  3. Oral hygiene instructions on how to keep the gums clean

  4. Use of gingival veneers

  5. Gum grafting surgery to:

  • Either increase the thickness of the tissues to prevent further recession in the future (but not cover the recession); and/or

  • Root coverage plastic surgery procedures including connective tissue grafting or using alternative modalities like Alloderm

We recommend you see our Periodontist (gum specialist) for a consultation to provide you with the advice needed for prevention and management of the recession.

Taking care of your oral health is very important. Your mouth is a great indicator of your general wellness, and an oral infection can affect your whole body. Be gentle with your teeth, and see our periodontist if you have any persistent discomfort.

 

Bone Grafting for gum disease

Periodontal Regenerative Surgery (bone grafting in gum disease)

What Is It?

A bone graft is used to recreate bone and soft supporting tissues lost due to gum disease. It’s also called regenerative surgery.

What It’s Used For

Regenerative surgery is a treatment for the gum disease. People with periodontitis lose gum coverage and bone support around their teeth.


Regenerative surgery can be used in certain types of defects to regrow the lost tissues. This usually involved a minor surgical procedure under local anesthesia to achieve the end result.

Preparation

Before your surgery, you need to have basic periodontal treatment called scaling and root planing. You also must be taking good care of your teeth. You should brush twice a day and floss daily. A local anesthetic is used to numb the area for surgery. During the next six to nine months, your body fills in the area with new bone and soft tissue. In effect, this reattaches the tooth to your jaw.

How It’s Done

The goal of this surgery is to coax the body into rebuilding the bone and other structures that attach a tooth to the jaw. The holes (defects) in the bone will be filled in with a graft material. Then they will be covered with a physical barrier.

Bone grafting materials commonly used include bits of:

  1. Your own bone

  2. Cadaver bone

  3. Cow bone

  4. Synthetic glasses

Barriers are used to cover the grafting material in the early stages of healing. They also prevent the gums from growing into the bony defect. Barriers are made from human skin, cow / pig skin or synthetic materials.
The choice of materials can be discussed with the periodontist (gum specialist) and if you have specific preferences / restrictions on types of materials used, there are always alternatives.
We recommend you discuss this with our Periodontist during your consultation.

Ridge Preservation

An alveolar ridge augmentation after tooth extraction, or “ridge augmentation,” involves placing Bone Graft material directly into the empty socket where a tooth’s roots used to be, to help create the natural shape of the gums and jaw that may have been lost following tooth extraction.
Patients usually need a ridge augmentation procedure after losing one or more teeth, to prepare for future dental restorations or placement of dental implants.

Sinus lift

 

A sinus lift (sinus augmentation) is surgery that adds bone to your upper jaw in the area of your molars and premolars. If you’ve lost bone in that area due to reasons such as periodontal disease or tooth loss, you may be left without enough bone to place implants. 

 

Sinus lift surgery can help correct this problem by raising the sinus floor and developing bone for the placement of dental implants. A CT scan is usually required in the planning stages of the surgery.

The bone is added between your jaw and the maxillary sinuses. Undergoing sinus lift surgery has been shown to greatly increase your chances for successful implants that can last for years to come.

The procedure can be carried out in most cases under local anesthesia. Alternatively oral or intravenous sedation may also be considered if you are anxious about this procedure. The periodontist in our practice can explain your options for graft materials, which can regenerate the lost bone and tissue.

In the upper jaw, near the premolars and molar teeth, the sinuses may enlarge and reduce the amount of bone available to place implants.

Sinus augmentation procedures are done either:

  • as a stand alone procedure when there is less than 4mm bone height, to increase the bone available. The site needs to heal for a period of 9 months before an implant can be placed. OR,

  • If there is >4mm bone available, sinus augmentation and implant placement can be done at the same time.

UL3 distal Combinatiom Regeneration with Bio-Oss and Emdogain at 2 years follow up. Radiograph shows complete bone infill; no periodontal pockets pockets >3mm.

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