A periodontist is a dentist specializing in the prevention, diagnosis and treatment of infections and diseases in the soft tissues surrounding the teeth, and the jawbone to which the teeth are anchored.
Periodontists have an additional three years beyond the four years of regular dental school, and are familiar with the most advanced techniques necessary to treat periodontal disease and place dental implants. Periodontists also perform a vast range of cosmetic procedures to enhance the smile to its fullest extent.
Periodontal disease begins when the bacteria found in plaque start to attack the soft or gingival tissue surrounding the teeth. These bacterium or toxins, embed in the gum tissue and rapidly breeds, causing a bacterial infection. As the infection progresses, it starts to penetrate deeper into the tissue causing inflammation or irritation between the teeth and gums. The response of the body is to destroy the infected tissue, which is why the gums may bleed, swell, appear red or begin to recede. The pockets between the teeth and gums deepen and if no treatment is sought, tooth loss will occur.
Referrals from General Dentist and Self Referral
In the course of regular dental check-ups, there are several ways treatment from a periodontist may be sought. If the general dentist or hygienist finds symptoms of gingivitis or progressing periodontal disease, a consultation with a periodontist may be recommended. However, a referral is not necessary for a periodontal consultation.
If you experience any of these signs and symptoms, it is important that you schedule an appointment with a periodontist without delay:
Bleeding while eating or brushing – Unexplained bleeding while consuming food or during the course of daily cleaning is one of the most common signs of periodontal infection.
Bad breath – Continued halitosis (bad breath) which persists even when a rigorous oral hygiene program is in place, can be indicative of periodontitis, gingivitis or the beginnings of an infection in the gum tissues.
Loose teeth and gum recession – Longer looking teeth can signal recession of the gums and bone loss due to periodontal disease. As this disease progresses and attacks the jawbone, (the anchor holding the teeth in place) the teeth may become loose or be lost all together.
Gangrene in the tissues – Gangrene is hard to self diagnose but the general dentist and periodontist will check for its presence in the soft tissues, alveolar bone and periodontal ligament.
Related health conditions – Heart disease, diabetes, osteopenia and osteoporosis are highly correlated with periodontitis and periodontal infections. Pre-term low birth weight babies may be the result of an untreated periodontal condition. The bacterial infection can spread through the blood stream and affect other parts of the body.
Diagnosis and Treatment
Before initiating any dental treatment, the periodontist must extensively examine the gums, bone and general condition of the teeth. When gingivitis or periodontal disease is officially diagnosed, the periodontist has a number of surgical and non surgical options available to treat the underlying infection, halt the recession of the soft tissue, and restructure or replace teeth which may be missing.
Gingivitis/mild periodontal disease – When the gum pockets exceed 4mm in depth, the periodontist or hygienist may perform isolated scaling and root planing to remove debris from the pockets and allow them to heal. Education and advice will be provided on an effective cleaning regime thereafter.
Moderate periodontal disease – If the gum pockets reach 4-6mm in depth, a more extensive scaling and root planning cleaning might be required. This cleaning is usually performed under local anesthetic. As an adjunct to scaling and root planing, a non surgical option is the placement of a locally administered antiobiotic (LAA) which is placed in the deep pocket.
Advanced periodontal disease – Gum pockets in excess of 6-7mm are usually accompanied by bone loss and gum recession. Scaling and root planning will usually be performed as the initial nonsurgical treatment. In addition to those nonsurgical treatments, the periodontist may recommend surgical treatment to reduce pocket depth.
Tooth loss – When one or several teeth are missing due to periodontal disease, dental implants are an effective option. If the bone is strong enough to provide a suitable anchor for the prosthetic tooth, the implant can be placed. However, if the bone is severely eroded, bone grafts must be performed by the periodontist to provide a suitable anchor for the new tooth/teeth.