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Periodontology

What is Periodontology?

Periodontology is the specialisation that deals with treating and preventing diseases of the hard and soft tissues (bones and gums) that support the teeth and keep them in position in the jaws.

In addition to supporting the teeth, the gums and jawbone have some essential functions, such as:

  • Acting as a shock absorber during biting and chewing, helping to prevent damage to the teeth caused by excessive forces;
  • Keeping the teeth in position to work together efficiently and comfortably during chewing.

Through this speciality of dentistry, which literally means “around the tooth”, it is also possible to treat gum disharmonies, whether due to an excess or a lack of gum.

 

What are periodontal diseases, and how do they manifest themselves?

Periodontal diseases can be divided into 2 main groups: gingivitis and periodontitis. Both consist of inflammations or infections of the tissues around the teeth as a result of bacterial accumulation. But while gingivitis is limited to the gums, periodontitis is the advanced stage of periodontal disease, which moves from the gums to the bone.

Gingivitis

A mild gingivitis causes little or no pain and may even be unnoticeable. Initially, the bacteria only causes inflammation of the gums, so gingivitis is a reversible condition.

However, if left untreated, gingivitis can become severe. Some possible symptoms are swelling of the gums – when they become red, sensitive or bleed – receding or pulling away from the teeth, bad breath, bad taste in the mouth and loose teeth.

If this initial situation is not resolved, the bacteria can reach the bone, causing periodontitis.

Periodontitis

The symptoms of periodontitis are similar to those of gingivitis, but in addition, there is tooth sensitivity and pain when chewing. This leads to a lack of support for the tooth, causing mobility and, in more severe cases, tooth loss.

Stress, smoking, genetic factors or diseases such as diabetes increase the risk of periodontitis.

Periodontitis affects more than half of the population and is responsible for most tooth loss in adult patients. Therefore, periodontal diseases should not be ignored but treated as soon as possible to avoid more serious oral problems.

Mucositis and peri-implantitis

The same sequence and severity of disease apply to patients with dental implants. However, in these cases, the pathologies have the names of mucositis (corresponding to gingivitis) and peri-implantitis (corresponding to periodontitis).

 

Curiosities about periodontitis

Please note that periodontitis:

  • It affects a large proportion of the population and is responsible for most tooth loss in adult patients;
  • It can affect and harm the whole body. For example, it can lead to cardiovascular problems and lower blood glucose levels in people with diabetes;
  • It is perfectly curable, but recovering the lost bone is difficult, so time is always an essential factor to consider;
  • Early treatment is always a simpler treatment.

 

Treating periodontal diseases

Although there is treatment for these conditions, their seriousness should not be ignored. Therefore, the sooner you consult with a periodontologist or oral hygienist, the more effective the treatment will be.

A detailed clinical and radiographic examination provides the necessary information to develop a specific and effective treatment. Once gingivitis or periodontitis has been diagnosed, treatment is carried out to decontaminate the roots and eliminate plaque and tartar.

The patient is also taught the best method for brushing the teeth and removing interproximal plaque (contact area between the teeth), using dental floss and brushes. It is essential that the patient learns how to perform correct oral hygiene and then maintains it.

In more advanced situations, it may be necessary to perform minor surgical procedures to access the surface of the roots below the gums’ level. New surgical techniques allow for a more precise, conservative and regenerative treatment. Ultimately, the healing process and elimination of the disease are faster and more effective.

 

Other periodontal treatments

In addition to gingivitis and periodontitis, surgical techniques are used to treat gum disharmony.

Gingival smile

This is characterised by excessive exposure of the gums when smiling, with short teeth often hidden by gum tissue. Most people dislike this type of smile, impacting their self-esteem and self-confidence.

A “gummy smile” can be corrected through aesthetic crown lengthening (gingivectomy), resulting in natural teeth exposure.

A cosmetic coronal lengthening can also be carried out in cases where the teeth’ gingival margins are not aligned to level them out, making the smile more harmonious.

Gingival recession

Also known as gingival retraction, this is a common condition characterised by the shrinking of the portion of gum covering the tooth, exposing its root.

Root coverage surgery, using a gum graft, can help repair the gum defect, prevent further progression of the recession and prevent the development of tooth decay. The gum graft will permanently cover the exposed root, reducing discomfort and restoring gum health.

In other situations, in patients with gingival recessions associated with thinner gums, it may be beneficial to increase the thickness of the gums through periodontal plastic surgery.

 

The step-by-step process of periodontal treatment

Did you know that the health of your gums reflects the state of your general health? That’s why we are so meticulous in treating periodontal disease.

  1. Diagnosis

A detailed clinical and radiographic examination is carried out at the first appointment. This enables us to understand the distribution and severity of the disease so that a correct diagnosis can be made and the best treatment plan drawn up.

  1. Non-surgical treatment

The first treatment approach is always non-surgical, eliminating all bacterial deposits (plaque and tartar) attached to the tooth and root surfaces.

The patient is also motivated and instructed in appropriate oral hygiene techniques.

  1. Re-evaluation

The re-evaluation appointment takes place about 2 months after the first treatment phase. It allows us to evaluate the effectiveness of the treatment and define new action strategies when necessary.

  1. Maintenance

Once the active treatment has been completed, the patient moves on to a maintenance phase. Maintenance appointments aim to reduce the probability of the disease progressing through regular monitoring, the regularity of which is adapted to each case.

References

  • Slots J (2013). Periodontology: past, present, perspectives. Periodontol 2000, 62(1): 7-19.
  • Kwon T, Lamster I, Levin L (2021). Current concepts in the management of periodontitis. Int Dent J, 71(6): 462-76.
  • Manresa C, Sanz-Miralles E, Twigg J, Bravo M (2018). Supportive periodontal therapy (SPT) for maintaining the dentition in adults treated for periodontitis. Cochrane Database Syst Rev, 1(1): CD009376.
  • Shangae S, Mohangi G, Hassam-Essa S, Wodd N (2013). The association between periodontitis and systemic health: an overview. SADJ, 68(1): 8-12.
  • Merijohn G (2016). Management and prevention of gingival recession. Periodontol 2000; 71(1): 228-42.
  • Aroni M, Pigossi S, Pichotano E et al. (2019) Esthetic crown lengthening in the treatment of the gummy smile. Int J Esthet Dent, 14(4): 370-82.
  • https://www.efp.org/