Periodontology
What is periodontics?
Periodontology is the specialty of dental medicine responsible for the diagnosis and treatment of diseases related to the tooth’s supporting tissues – gum and bone. This specialty’s goal is to maintain these tissues healthy, avoiding tooth loss. The main periodontal diseases are gingivitis and periodontitis.
Health
Once periodontal disease is established, besides the increased probability of tooth loss and all the associated symptoms, it is now known that periodontitis is a risk factor for heart diseases, chronic obstructive pulmonary disease, diabetes mellitus, premature births, among other pathologies.
Aesthetics
Periodontal disease often results in undesirable dental aesthetic consequences, due to loss of teeth, gums and bone which occurs when the disease is out of control. However, nowadays there are several ways to recover the lost structures and recover an harmonious smile.
Diagnosis
The diagnosis of periodontal diseases is made simply through clinical observation and radiographic examination. However, if the patient does not schedule frequent visits to the dentist, the patient often only notices that something is wrong already at an advanced stage of the pathology, when the gums start to disappear and the teeth start to “wobble”. This happens because such diseases develop without very relevant or painful initial symptoms, which makes it hard to detect and make a diagnosis. On the other hand, the majority of the population thinks that having a bleeding gum is normal, which is incorrect.
Step-by-Step
In the first Periodontics appointment, it is fundamental to make a diagnosis through clinical observation where the control and accumulation of bacterial plaque is evaluated, as well as the amount of gum bleeding.
It is also explained to the patient that the gum is not fully adhered to the tooth, and that there is a space between these two structures where food debris accumulates, which, together with saliva and bacteria in the area, build up plaque. Not removing or incorrectly removing this bacterial plaque causes an expansion of this space, which is then called a pocket. Therefore, the identification and characterization of the location and size of these periodontal pockets is also done in this first appointment, using a specific measuring instrument.
If in the clinical data collected there are signs that bone loss already exists, a radiographic examination is performed.
Faced with a diagnosis of gingivitis (inflammation of the gums without bone loss) or periodontitis (inflammation of the gums with bone loss) the first phase of treatment (called “non-surgical treatment”) consists of thorough cleaning/oral hygiene and the elimination of all tartar deposits and plaque (which cause the disease) from all surfaces of the teeth, so that the gums can be healthy again. In addition, it is also essential to teach specific oral hygiene techniques to the patient and to adapt the instruments necessary for this task, in order to reduce and prevent the accumulation of disease-causing plaque.
In cases of more advanced periodontitis where non-surgical treatment is not fully effective due to the existence of pockets that are too deep and/or difficult to reach, it may be necessary to undergo a surgical treatment to remove the remaining plaque, eliminate the pockets, and control the degree of destruction caused by the periodontitis.
In both cases, the goal of the various phases of periodontal disease treatment is to stop the progression of the disease and prevent even greater loss of gum and bone, in order to begin a maintenance phase later on. This phase corresponds to monitoring/routine appointments to be defined according to the severity of the disease and risk factors of each patient in order to avoid new foci of activity, since periodontitis is a chronic disease and can develop again throughout the patient’s life.
Responsible team
Dr. Pedro Freitas
Frequent Questions
What is gingivitis?
Gingivitis is a persistent inflammation of the gums, caused by plaque accumulation and improper hygiene of the oral cavity.. This inflammation is reversible when treated early with the help of the dentist, and by adopting/learning how to perform correct daily oral hygiene.
What is periodontitis?
Periodontitis is a chronic disease which evolves from a previously untreated gingivitis. Nevertheless, in this case, there is already destruction of the structures supporting the teeth: gum and bone. The evolution of this disease can cause tooth mobility and subsequent tooth loss in more advanced stages. Other factors also contribute to the appearance of this disease, such as genetics (family history), smoking, systemic diseases (such as diabetes, when not under control), hormonal changes (in case of pregnancy or menopause), stress situations, among others.
What are the main symptoms?
- Bleeding gums.
- Inflammation of the gums.
- Gum with increased volume.
- Bad breath.
- Gingival recession (loss of part of the gum around the tooth, making it seem like the teeth increased in size).
- Sensitive teeth or pain, especially to cold and touch.
- Wobbling teeth.
- Teeth loss.
Can patients with periodontitis get implants?
Once periodontal disease has been treated and controlled, patients who have lost teeth due to this pathology can and should get implants to replace them and be able to chew, smile, and speak properly again. The important thing is to continue having the same oral hygiene care that you would have with your teeth, but adapted to the implants.
Can patients with periodontitis get braces?
Patients with a history of periodontal disease who have misaligned teeth can and should correct this problem as soon as the pathology is stabilized, and as long as the remaining supporting bone of each tooth allows it. This requires prior evaluation by an alignment specialist (orthodontist).
Is having periodontitis a sign of heart-related health problems?
Patients with active periodontal disease have bacteria in their oral cavity that are harmful to the oral and overall health. Although this is an unknown fact to most of the population, the reality is that our mouth has a privileged line of communication with the heart through numerous blood vessels. Therefore, bacteria found in the mouth can easily be carried to the heart, causing possible heart problems.
Does having periodontitis mean that i will lose all my teeth?
In a case of untreated periodontitis, we can have extreme bone loss around the teeth, making it impossible to keep them in the mouth and requiring extraction. This can occur in a generalized way with all teeth or in a more restricted way, affecting only some teeth. However, having periodontitis does not automatically mean that you will lose all your teeth. When detected early and treated properly, periodontal disease can be stopped and tooth loss prevented or reduced.
Is periodontitis contagious?
No, periodontitis is not transmitted from person to person, not even through saliva. The primary factor for its development is excessive plaque accumulation.
How can i prevent periodontal diseases?
In two ways, both of which are crucial:
– Scheduling scaling (cleaning) appointments at the dentist at least every 6 months
– At home, by brushing your teeth properly (at least twice a day) and complementing this with flossing (at least once a day) or other cleaning device which better suits your situation, such as brushes
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