Periodontal Disease:

Healthy Gums are robust tissues that are usually a little pink in colour, with slight stippling. This stippling will usually disappear if the tissues are swollen or inflamed. They should not normally bleed under normal stress, such as brushing off the teeth. Periodontal Disease is group of diseases that affect the gums (Periodontium). Although there are 8 broad categories, the two most common forms are gingivitis and  periodontitis.

Gingivitis
Gingivitis is a reversible disease of the gums [gingival]. Although very common, it is reversible and good brushing will usually prevent it. The signs and symptoms include swollen gums and bleeding. Your dentist can review and treat gingivitis.

Periodontitis
Periodontitis is the body's response to plaque (known as biofilm). It is found in 10-15% of the population and results in irreversible bone loss. Although it was formerly known as pyorrhea, it is a chronic disease with many sufferers not being aware they have it.

The result of the disease is that patients will loose bone around their teeth and this is reflected clinically as recession (long in the tooth) or an increase in pockets depths. These pockets depths can only be measure by a periodontal probe. It is important that your dentist measures your periodontal pockets to see if you have periodontal disease on a regular basis.

Periodontal disease is similar to getting a splinter under your skin. Whilst some people will get very little reaction, others will get an area around the splinter that is red and swollen. The splinter is very much like plaque. The body’s response to this splinter is mediated by the immune system. Whilst some people will tolerate the splinter, others will respond in an inappropriate manner. As a result the inflammation will result in bone being lost around the tooth. The diagrams illustrate the process of health, gingivitis and periodontitis.
 

There are two parts to the disease process and this illustrated below:

Periodontal disease is all about the host response to the plaque (biofilm). The plaque is determined how well the patient's clean and how well it is professionally cleaned.

The host response is mainly determined by genetics and it is modified by smoking and diabetes. This is the reason that you will be asked about your parents teeth and if you smoke or are a diabetic.

Patients/ Periodontal disease/ treatment

Using the splinter analogy above, the infection will only get better if the splinter is removed. This is the basis of periodontal treatment, which reduces the biofilm to a level that the body can accept. The removal of the biofilm is known as debridement. This is were the dentist scraps of the calculus (tartar) and biofilm of the root surface. This is usually done under local anesthetic in the initial stage (cause related) for patient comfort.

Although most people respond to treatment, periodontal disease is never “cured” as the immune system has not been changed; hence the disease process is hopefully controlled (similar to diabetes). In most cases, we aim to maximise outcomes, which is assisted by the patients oral hygiene and regular maintenance. An important aspect to this is that regular maintenance allows the monitoring of the disease and the ability to identify any areas before they become a problem.

Diagnosis of periodontitis is usually done after a thorough exam and consultation, which includes a medical history, a complete dental history and charting, probing of pockets depths and a review of x-rays (usually an OPG).

A complete treatment plan can then be discussed, which will include debridement sessions. In most cases a closed debridement is recommended but in some cases an open debridement can be an option in deeper pockets. Open debridement is also known as a surgical approach and this is often recommended when regeneration is required.

Following treatment there will several changes that will occur and may include some positive and negative aspects. These include:

Less bleeding and more pale “tight gums”, recession and sensitivity.

A summary of treatment is shown below.

• Consultation/Examination.

• Closed Debridement (Cause related)

• Review

Further sessions of Closed/Open debridement, Extraction of teeth, or a Maintenance (SPT) program may be recommended.

Further information can be found at this website: www.anzap.org.au

Patients/ Implants

Implants

Dental implants are small screws that are surgically placed into jaws, that bind to the bone. They allow crowns to be placed on the dental implants to help restore function and improve aesthetics.

Further information can be found at this website: www.aos.org.au

Image provided courtesy of Straumann

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