Q. What is the difference between a general dentist and a periodontist?
A. When dentists graduate from dental school, they are qualified to practice general dentistry. When a dentist wants to specialize in a certain field, they are required to graduate from additional study in that area, including a residency period in the specialty. Periodontology is one of the specializations dentists can study. Periodontists diagnose and treat diseases of the gums and bone that support the teeth, and they work with patients to modify habits and work toward preventing these periodontal diseases from arising again. They are also qualified to place dental implants and monitor implants after surgery to assess their health and ensure their continued function, and they can perform various cosmetic procedures that restore the appearance of the gums. In many of these cases, periodontists work as part of a team of dental health professionals that collaborate with a patient to develop and implement a plan that will lead to long-term oral health and an attractive and healthy smile.
Q. What are the symptoms of periodontal disease?
A. In its earlier stages, periodontal disease might not have any symptoms at all and can only be detected by a dentist or dental hygienist during a clinical examination. When it is detected early, periodontal disease can often be reversed, and the gums and other oral tissues can be restored to health. When symptoms do appear, the disease may have advanced, and it’s important to see your dentist for a checkup. Common symptoms can include swelling or tenderness in the gums, bleeding during brushing or flossing, visibly receding gums, loose teeth, a bad smell or taste in the mouth, pus at the gum line, pain or sores in the mouth, or problems with the bite. If you already have a periodontist and are experiencing any of these symptoms, see your periodontist; if you don’t, see your dentist for an exam and a referral. The sooner you address the symptoms, the more likely you and your periodontist will be able to save your teeth.
Q. What are the different types of periodontal disease?
A. Gingivitis, the earliest form of gum disease, is a common condition that affects more than half of adults in the US. It is characterized by inflammation in the gum tissue, which becomes swollen and red and can bleed more easily than usual. With effective professional treatment and improved oral hygiene practices, gingivitis can often be reversed and the oral tissues can be restored to health. When left untreated, gingivitis can advance and develop into periodontitis. Periodontal disease is caused by an excessive amount of bacterial plaque and tartar on the teeth and along the gum line. While plaque can be removed with regular brushing and flossing, it’s easy to miss a spot here or there, and when plaque remains on the teeth, it calcifies and turns into dental calculus, also known as tartar. Dental calculus can only be removed by a dentist or dental hygienist, who will use a specialized tool to safely yet effectively scrape this hard substance from the teeth.When plaque and calculus aren’t effectively removed, they spread, and bacteria are allowed to flourish under the gums, releasing toxins that introduce continued inflammation throughout the tissues of the gums and bone in the mouth. When the ligament that attaches the teeth to the gums and bone separates from these surfaces, pockets form; these pockets characterize periodontitis, which can be treated effectively but cannot be completely reversed. When periodontitis is not addressed, the periodontal pockets that form collect more bacteria and become infected, deepening and continuing to loosen the attachment between the gum tissue and the teeth. As the bacteria and toxins spread, they continue to destroy the gum tissue and begin to destroy the bone tissue as well, gradually leading to loss of the natural teeth. Gingivitis can be diagnosed with routine clinical examinations, and periodontitis can be diagnosed by a periodontist.
Q. What is a comprehensive periodontal evaluation?
A. A yearly comprehensive periodontal evaluation is recommended by the American Academy of Periodontology. The comprehensive periodontal evaluation, or CPE, is a clinical assessment that can identify periodontal disease and gauge the overall health of the periodontal tissues through an examination of your teeth, the composition of your plaque, your bite, your gums, and your bone characteristics, and with an assessment of your risk factors. When it is performed annually, the CPE provides periodontists with benchmarks and measurements that can indicate the characteristics of disease when compared longitudinally. Observing the health of the oral cavity over time can help your dentist notice changes that can indicate periodontal disease and can suggest effective long-term treatment options.
Q. What are my non-surgical options for treatment if I have periodontitis?
A. Some periodontal treatment options are non-surgical, though in some cases, surgery is necessary to repair the damage caused by periodontal disease. A common non-surgical treatment option is the dental scaling and root planing procedure. In a scaling and root planing treatment, your periodontist cleans the surfaces of the roots of the teeth, using a specialized instrument to scrape beneath the gum line and remove plaque, dead tissue, and bacteria from periodontal pockets. If the roots of the teeth are rough, your periodontist can plane them, smoothing their surfaces so that plaque is less able to adhere to them in the future. Scaling and root planing is sufficient treatment for many patients, though a significant number of patients with periodontitis require consistent maintenance to keep the disease in control. Laser treatment can also be an effective non-surgical option, though laser treatments should only be administered by experienced medical professionals, to prevent damage to the periodontal tissues. Tray delivery systems use impressions of the teeth to make trays that consistently deliver medication to the gums. While tray delivery systems have been approved by the FDA, they have not been shown to be effective in treating gum disease.
Q. What are the surgical treatment options for periodontal disease?
A. Periodontists are trained specialists who address the health of the gum tissue and the bones that support the teeth. Sometimes, surgery is necessary when treating periodontal disease and addressing its destructive effects. Periodontists undergo additional education and training, including a residency period, that qualifies them to perform complex surgical procedures on the tissues of the mouth and also allows them to administer sedation and anesthesia. Periodontists perform a number of different kinds of surgical procedures. Gum graft surgery can help cover roots that have been exposed due to gum recession, protecting them from bone loss and protecting the gingival tissue from further recession. Periodontists can also perform procedures to help regenerate bone that has been destroyed by the effects of periodontal disease, using bone grafts, growth-stimulating proteins, and guided tissue regeneration membranes to stimulate and manage the body’s own inclination to repair itself and regenerate lost tissue and bone. These regenerative procedures can be crucial to the future success of dental implants. When periodontal pockets are present, periodontists can reduce the depth of the pockets with a periodontal pocket procedure. Your periodontist will fold back your gum tissue and clean out bacteria and infected tissue, then securing the remaining gum tissue back in place. If the exposed surfaces of bone are rough or irregular, your periodontist will also smooth these rough areas to discourage the accumulation of future bacteria.
Q. When I smile, my gums are more prominently visible than my teeth, and I hate it. Is there anything I can do?
A. If you have a gummy smile and it makes you feel self-conscious, a crown lengthening procedure could provide you with a solution. Your periodontist can assess your situation and determine whether the appearance of your smile could be improved by removing some of the excess gum tissue that’s covering your teeth and reshaping the gum line to expose a greater proportion of the natural tooth. Crown lengthening can be done on one tooth or on a whole row of teeth, and it may be recommended as a preparatory procedure for cosmetic restorations. For example, some people with gummy smiles have other issues with their teeth that make veneers or dental crowns the best restoration option for them, and a crown lengthening procedure can increase the amount of available tooth, thereby increasing the durability of the restoration and improving its aesthetic effects.
Q. What can I do to reduce my risk of periodontal disease?
A. Effective oral hygiene habits are instrumental in the fight against periodontal disease. The American Dental Association recommends brushing the teeth at least twice daily, using a soft-bristled brush and fluoride toothpaste and brushing in a gentle circular motion with a careful focus on cleaning the gum line. The ADA also advises that people should clean between the teeth, either with dental floss or another approved interdental cleaning tool, at least once a day, as well as any time noticeable debris remains between the teeth. Finally, effective oral hygiene includes regular visits to the dentist for routine examinations and professional cleanings; unless you have been advised otherwise by your dentist, make appointments for checkups and cleanings every six months. You and your dentist will review your medical history; if you have any new medical conditions or start a medication, be sure to tell your dentist, as some conditions and medications can exacerbate periodontal disease. If you smoke, your dentist may recommend smoking cessation programs to help you quit; smoking and excessive alcohol consumption are linked to increased risk of periodontal disease. Maintaining a balanced diet and staying hydrated also contribute to the health of the oral cavity.
Q. How can I ensure that my children don’t get periodontal disease?
A. While periodontal disease is not common in children, children who don’t learn effective oral hygiene habits are more likely to develop periodontal disease later in their lives. Teach your children proper brushing and flossing habits early on, and instill in them the importance of establishing and maintaining these daily habits; don’t be afraid to rely on their pediatric dentist to help you with this. If your children display any symptoms of gum disease, like swelling, redness, or bleeding in the gums, or if they have chronic bad breath, contact your periodontist so your child can get an early diagnosis and treatment; while uncommon, juvenile periodontal disease can happen, and early treatment is key.
Q. Are dental implants as great as people say they are? I hear a lot about them, but I don’t really understand them!
A. A dental implant is a tiny cylindrical post, usually made of titanium, that is surgically implanted in the jaw and serves as an artificial root for a prosthetic tooth or other dental restoration, though people often use the term to describe the implants and the restorations they support. Implant posts are fitted with abutments that attach the dental restoration to the implant, providing a stable, permanent dental restoration for people who seek to replace one or more of their natural teeth and prefer not to wear conventional dentures. You might be a good candidate for dental implants if you have a sufficient amount of healthy bone and healthy gum tissue to support implants and if you are in overall good health. Your periodontist can help determine whether dental implants could provide you with a permanent solution for missing teeth, and, if additional procedures are necessary to prepare the mouth for effective implant surgery, your periodontist can initiate these procedures. Your dental implant treatment plan will be designed specifically for your clinical needs and aesthetic goals and could consist of a single tooth implant, a multiple tooth implant, or full mouth dental implants, as well as sinus augmentation, ridge modification, or bone grafts if needed.
You and your periodontist will review each procedure as you plan, and you’ll discuss your healing timeline and requirements for aftercare. Periodic visits to the periodontist will be a required part of healing and will help to guarantee the long life and success of your dental implants, and keeping your implant clean with effective home care and professional cleanings will also help ensure a lifetime of satisfaction with your dental implants.