What is a periodontist?
A periodontist is a highly specialised dentist. They specialise in the prevention, diagnosis, and treatment of periodontal (gum) disease and are experts in the placement of dental implants, cosmetic periodontal procedures, and treatment of oral inflammation. Periodontists receive extensive training including three years of specialised education beyond general dental school.
What do periodontists do?
Periodontists often treat more problematic periodontal cases, such as people with severe gum disease or a complex medical history. After examination and diagnosis, they can offer a wide range of treatments, such as scaling and root planing (cleaning the infected surface of the root), or root surface debridement (removal of damaged tissue). For more serious cases, they perform surgical procedures to treat severe periodontal problems.
Some periodontal needs can be met by a general dentist. However, anyone who has moderate to severe periodontal disease, has a complex medical history, or is looking for dental implants or cosmetic procedures should consult a periodontist as well.
What is periodontal disease?
Periodontal disease (gum disease) is an infection of the structures supporting your teeth in your jawbone.
In the earliest stage – gingivitis – the infection affects the gums. As the disease becomes more severe, the alveolar bone (tooth sockets) and the periodontal ligament (the connection between the teeth and tooth sockets) become infected.
If nothing is done, the infection destroys these structures to the point where your teeth become loose and have to be extracted.
What causes periodontal disease?
The main cause of periodontal disease is the bacteria in plaque – the sticky substance that constantly forms on your teeth. In an effort to eliminate the bacteria, your body releases substances that combat bacteria but also cause inflammation and destruction of the gums and surrounding tissues.
Certain people are at higher risk of getting gum disease, but insufficient tooth care will lead to plaque build-up and, ultimately, severe periodontal problems.
What are the symptoms of periodontal disease?
Gum disease often doesn’t present visible symptoms until advanced stages. However, warning signs include:
- Red, swollen, or tender gums or other pain in your mouth
- Bleeding while brushing, flossing, or eating hard food
- Bad breath that won’t go away
- Gums that are receding or pulling away from the teeth, causing the teeth to look longer than before.
- Loose or separating teeth
- Sensitive teeth
- A change in the way your teeth fit together when you bite
- Pus between your gums and teeth
- Sores in your mouth
- A change in the fit of partial dentures.
What is the link between diabetes and gum disease?
People with diabetes are more likely to develop periodontal disease as they are more susceptible to infections. In fact, periodontal disease is often considered a complication of diabetes.
The relationship between gum disease and diabetes also goes the other way – severe periodontal issues can increase blood sugar, in turn increasing diabetic complications.
Is gum disease a strong factor in getting heart disease?
Although a cause-and-effect relationship has not yet been proven, studies show a link between periodontal disease and heart disease.
There are several possible reasons for this. One theory is that the bacteria that cause gum disease also travel to blood vessels elsewhere in the body, causing blood vessel inflammation and damage such as blood clots or, in more severe cases, heart attacks. Another theory is that the body’s immune response – inflammation – causes vascular damage throughout the body, including the heart.
There may, in fact, be no direct connection between gum disease and cardiovascular disease. They may often occur together due to a shared risk factor. Several lifestyle choices (such as smoking or poor nutrition) and medical conditions are risk factors for both diseases.
What will happen during my first visit to a periodontist?
During the first visit, the periodontist will review your medical and dental history to ensure you are receiving the best personalised treatment. They will examine your gums, check for any gum-line recession, assess how your teeth fit together when biting, and check whether any of your teeth are loose.
The periodontist will also use small dental instruments (probes) to help assess the health of your gums and may also take x-rays to look for bone damage and any other problems below the gum line.
What is a dental implant?
A dental implant is a titanium screw that is surgically placed into the upper or lower jawbone as an anchor for a natural-looking crown. Implants match the appearance, function, and strength of natural teeth, and with proper maintenance they can last a lifetime.
Dental implants are a quick, easy, and relatively pain-free way to replace broken or missing teeth. They are also the only permanent solution to tooth loss.
How do I know if I need dental implants?
Dental implants are the best solution if:
- You have a severely cracked or broken tooth
- You are missing one or more of your natural teeth
- You have loose-fitting partials or a loose-fitting denture
- You are starting to experience bone loss in the jaw area
- You notice your teeth aren’t functioning properly when eating or speaking
- You have a severely infected tooth
The ideal candidate for a dental implant is in good general and oral health. Adequate bone in your jaw is needed to support the implant.
How are dental implants placed and who places them?
Depending on your specific condition and the type of implant chosen, your periodontist will create a treatment plan tailored to your needs.
The most common type of implant is an endosteal (in the bone) placement. Screws, cylinders, or blades holding prosthetic teeth are surgically placed into the jawbone.
A subperiosteal placement (on the bone) is used for patients who have minimal bone height. These are placed on top of the jaw with the metal framework’s posts protruding through the gum to hold the prosthesis.
If necessary, augmentations to the bone can be done to ensure both structurally and cosmetically correct placement.
Because dental implants are intimately connected with the gum tissues and underlying bone in the mouth, expertise in this particular area is crucial – that’s why periodontists place implants and can do it to such a high standard.
What type of post-treatment care will I require after a dental implant?
Your periodontist will provide detailed after-care instructions. As your body heals following surgery, the bone in your jaw will begin to fuse to your implant(s). Once this process has taken place, your implants will be fixed and immovable, just like natural teeth.
After placement, we will schedule periodic follow-up visits to monitor your implants, teeth, and periodontal health. As with natural teeth, proper oral hygiene will help keep your new implants in great condition.
How and why is bone lost when teeth are lost?
Bone loss in the jaw is a common consequence of loss of teeth and periodontal disease.
In the case of gum disease, the bacteria gradually eats away at the underlying jawbone and the ligaments that connect teeth to the bone.
Jawbone is preserved through the pressure and stimulus of chewing. So, if teeth are lost and left unreplaced, and the stimulus is gone, the bone reabsorbs into the body. In the first year after tooth loss, 25% of the bone is lost, and this is ongoing.
Replacing teeth with full or partial dentures doesn’t solve the problem, as dentures exert a small amount of chewing pressure on the bone compared with natural teeth. Implants, however, function as natural teeth and so retain the bone.