Periodontology / gums
Periodontology is a specialisation within the field of dentistry which focuses on the supporting structures of the teeth: the jawbone, the gums and the periodontal ligament. The word “periodontology” is derived from the Greek words peri (around) and odontos (tooth). In periodontology, the dentist treats inflamed gums (gingivitis) and other tissues around the tooth (periodontitis), corrects of any damage caused by them and encourages the healing process.
Gingivitis is gingival inflammation (‘itis’) of the gingiva, or gums. Gingivitis or gingival inflammation is caused by the accumulation of dental plaque and tartar around the teeth. It is characterized by red and swollen gums which can quickly begin to bleed when irritated. Gingivitis can heal through good oral hygiene. Typically, gingivitis has all the features of a nonspecific chronic inflammation, but in some situations gingivitis can be acute, such as in the cases of pregnancy gingivitis, acute streptococcal gingivitis or the so-called NUG or necrotising ulcerative gingivitis.
If the inflammation includes more tissue than just the gums, we use the term periodontitis. Periodontitis is a dentistry term stemming from the Greek words peri (around), odontos (tooth) and itis (inflammation); or the inflammation of tissues around the tooth. It is a bacterial infectious disease resulting from inflamed gums or gingivitis. In an advanced stage, the jawbone can be affected, resulting in the loss of teeth.
Where gingivitis is caused by the amount of dental plaque (i.e., by all bacteria types), periodontitis is due to specific bacteria, such as actinobacillus actinomycetemcomitans, treponema denticola, porphyromonas gingivalis and prevotella intermedia. Several other factors also play a role, such as: smoking, systemic diseases such as diabetes and genetic factors. Periodontal research groups have classified the following periodontopathies:
- Chronic adult periodontitis
- Refractory periodontitis
- Localised juvenile periodontitis (LJP)
- Rapid progressive periodontitis (RPP)
- Chronic adolescent periodontitis
Chronic adult periodontitis is the most common form of periodontitis in adults over 30 years old. This form of periodontitis progresses very slowly. Periods of chronic inflammation can alternate with periods where inflammation hardly develops. There may also be short periods of inflammation, possibly accompanied by pain and swelling. However, this is rare.
Over time, the tooth will gradually become loose as it is not longer well anchored into place; when gums bleeds the pockets in which the teeth site increase in size by around 3-5 mm and bone decomposition begins around the affected teeth. Adult periodontitis can occur anywhere in the mouth (generalised adult periodontitis) or be localised at the molars and/or front teeth (local adult periodontitis).
Periodontitis increases the risk of coronary heart disease, stroke, pregnancy complications and local infection. Periodontitis may be accompanied by bad breath, otherwise known as halitosis.
Treatment of periodontitis is carried out in accordance with the perio-protocol. Treatment can be done at the dentist’s own practice, at the oral hygienist or at the periodontologist. Since the protocol includes a number of important controls, many dentists prefer to send periodontitis patients to specific treatment centres. This is much preferred in resistant/severe forms of periodontitis.
The protocol is based upon the following:
- Initial treatment
- After care
- Possible specific treatments
Treatment can involve one or more of the following:
- scaling & root planing: remove plaque under the gum and in the pockets
- corrections at bone level: for problems surrounding the teeth
- gingivectomy: removal of a part of the gum to reduce the risk of infection or because of irregular growth/regrowth
- flap: surgical method to reach the root when scaling and root planing or to place graft tissue
- graft tissue for furcation defects (bone loss): when two or more roots meet, bone can break down due to the presence of plaque. Fillers using materials such as calf bone can fill this up.
- gingival recession treatment: for receding gums, connective tissue grafts, pedicle flap techniques or free mucosal grafts can be placed.
- crown lengthening
Periodontal treatment is conducted in accordance with the perio-protocol, a proved treatment protocol. Your dentist will refer you to the prevention assistant if you suffer from gingivitis. The prevention assistant will work together with you to learn techniques to prevent the gingivitis from worsening and becoming periodontitis. In the case of mild periodontitis, the dentist will refer you to the oral hygienist; more severe forms mean you will be referred to the periodontologist. They will measure your teeth according to the “perio protocol” and start the correct treatment to make your teeth healthy again.
Finally, looking after the roots is essential for keeping rest of the teeth healthy. Without healthy roots, we can not make crowns and/or bridges!
Types of Periodontitis
Refractory periodontitis is periodontitis that returns after it has been treated. This form is not recognised by some as a separate type of periodontitis, but as the previous therapy’s failure. However, the inflammation is often caused by different bacteria. Bacteroides forsythus is more common in refractory periodontitis than in the more classic forms of juvenile or adult periodontitis.
Because refractory inflammation may mean there is some resistance to less intensive treatment, periodontal surgery otherwise known as scaling and root planing may be your best option. This a total cleanse and smoothing of the roots which require the gums to be cut open.
Although the above condition often follows gingivitis, this is not always the case. Localised juvenile periodontitis (accompanied by severe bone breakdown around the incisors and the first permanent teeth), which occur around puberty, does not always involve gingivitis. It is therefore extremely important that pocket depth is measured at a young age.
In about 10-20% of cases, the progress of periodontitis is very quick. This means the inflammation is usually due to a specific and aggressive bacterial which takes over other bacterial types within the plaque. In these circumstances we speak of rapid progressive periodontitis (RPP). This form also occurs in young people (under the age of 20). We then call it juvenile periodontitis. The aggressive form of periodontitis can occur locally, but can affect all teeth.
PPeri-implantitis happens when bone surrounding an implant is broken down through chronic inflammation, causing the implant to come loose. This is on the whole due to inadequate oral hygiene, smoking and/or the presence of large numbers of periopathogenic microorganisms, together with a genetic predisposition. Gums can attach to teeth (epithelial adhesion), but not to an implant. The gums just sit around the implant, without growing onto it. This means bacteria can easily get under the gum and grow around the implant. Which is why people with dental implants need to observe high standards of dental hygiene.