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Periodontal Treatment

Periodontology is the study of diseases affecting the structures that support the teeth. These consist of the gingivae (gums), the outer surface of the root of the tooth called cementum, the ligament and the bone.

Gingivitis is the mildest form of periodontal disease. The gums become red, swollen and bleed easily. There is usually little or no discomfort and unfortunately patients are usually unaware they have gingivitis. 90% of the population have gingivitis.

Periodontitis occurs when gingivitis progresses. Because the gum becomes puffy and looser, bacteria can progress under the gum line and the toxins that they produce stimulate an inflammatory response which attacks the ligament and bone support of the teeth. The gums separate from the teeth to form pockets which may contain millions of bacteria. As disease progresses, pockets deepen and bone is lost around the teeth. 90% of adults have periodontitis at some stage of their life and 15% will have an aggressive type which, if untreated, leads to loss of teeth early in adulthood. Most patients have mild symptoms only, which they may not consider abnormal. Patients are not usually aware of loose teeth until they have lost over 50% of the bone support, by which stage the disease is advanced.

Symptoms of gum disease:

  • Red, swollen, tender gums
  • Bleeding gums
  • Loose teeth
  • gaps between teeth getting bigger
  • Sensitive teeth
  • Bad breath (halitosis)
  • Altered bite
  • Drifting teeth
  • Gum recession
  • Discoloured teeth
  • Loss of taste/bad taste
  • Pus / abscesses of the gums

Smokers usually have much worse gum disease than non-smokers and because smocking severely compromises the blood supply to the gums, inflammation is masked and they are often unaware of the problem. They also respond much less well to treatment.

What to expect during assesment
We will carefully review your complete medical history and need to know any medications you may be taking. Medical conditions may have a strong relationship with periodontal disease.

A lifestyle assessment will be made as factors such as a family history of periodontitis, an existing or previous smoking habit, nutritional factors, hydration, stress, exercise and sleep may be involved in the manifestation of disease.

The gums will be assessed visually and a small measuring instrument called a periodontal probe will be placed around the teeth to determine the separation between the gum and the deeper supporting structures i.e. the depth of the pockets. Assessments of plaque, calculus (tartar), staining, mobility (looseness) and gum recession are made. Careful examination of the bite is also undertaken.

Radiographs (x-rays) are an important part of diagnosis of periodontitis and of monitoring periodontal therapy over time, as they show the bone level around the teeth.

Treatment:
Since the main cause of periodontal disease is plaque, most therapy is aimed at its consistent, effective removal on a daily basis. Usually two or three half hour sessions of education and training will result in substantial reductions in inflammation through patient-performed procedures, starting off the healing process.

When the gum tissues are sufficiently healthy, subgingival debridement (deep cleaning of the roots) using specially designed instruments to clean and thoroughly smooth the teeth, is undertaken in two longer sessions.

A reassessment is undertaken 2-3 months later when the decision is taken whether further ‘active’ treatment is required or whether the maintenance programme should commence.

Advanced periodontal procedures
Most patients will respond very successfully to treatment. However, in aggressive periodontitis, occasionally a course of adjunctive antibiotics may be used. It is also possible that the anatomy (shape) of some periodontal problems will not allow adequate healing and periodontal surgery may be necessary.
Surgery may be required if there is a combined root canal (endodontic) problem.

Periodontitis and general health
Although it is important to treat periodontal disease to enjoy a comfortable, pleasant and healthy mouth with which to chew, speak and smile with confidence, there are other very important health benefits to periodontal therapy.

  • Pregnant women with periodontal disease are more likely to have a baby born too soon or too small.
  • Middle-aged men and post-menopausal women with periodontal disease have an increased risk of heart disease, including heart attacks and strokes.
  • Poorly controlled diabetics have increased risk of periodontal disease.
  • Patients with periodontitis have an increased risk of developing type II diabetes.
  • Patients with periodontitis have increased risk of repeated bouts of infection if they have respiratory disease due to aspirating bacteria into the airways.
  • Patients with osteoporosis or a family history of osteoporosis may have a more aggressive periodontitis, leading to early tooth loss.

Periodontal therapy has been shown to be highly cost-effective in the USA in reducing general health costs. Clearly there is a substantial benefit in quality of life.

Visit our patient information page for Gum Disease to help tackle the problem at home


YOUR personal dental practice
77 Penn Hill Avenue | Lower Parkstone | Poole | Dorset | BH14 9LY | Tel: 01202 746557 | Email: info@pennhilldental.co.uk