Periodontics is one of the nine dental specialties recognized by the American Dental Association. It focuses on the study and treatment of the soft tissue and bone that support the teeth and jaw.
Who Is a Periodontist?
A periodontist is a dental specialist who has the training and experience required by the American Dental Association to diagnose, treat, and prevent various forms of periodontal/gum disease.
What Is Periodontal Disease?
Periodontal disease, also known as gum disease, often begins as a buildup of plaque on the surface of the tooth near the gum line. If this plaque is not removed by brushing and flossing regularly, it can harden into what your dentist calls tartar.
Plaque will continue to build up over the tartar, and eventually cause the gums to become red, swollen, and irritated. This is known as gingivitis and is the first stage of periodontal disease. If left untreated, gingivitis can turn into periodontal disease.
What are the common signs and symptoms of periodontal disease?
Periodontal disease is often silent, meaning symptoms- particularly pain- may not appear until an advanced stage of the disease. However, you should still be on the lookout for the signs and symptoms, which include:
Is Periodontal Disease Treatable?
Gum disease is both preventable and treatable. Today’s periodontal treatments offer a variety of options that are gentle, safe, and effective. If you have been diagnosed with gingivitis or gum disease, our office can help you determine which treatment best meets your needs. Periodontal treatments include:
Am I At Risk Of Having Periodontal Disease?
You may be at risk of having periodontal disease if you smoke or use tobacco products, do not brush your teeth and floss regularly, have health conditions such as diabetes, heart disease, or osteoporosis, or several of your family members have had gum disease since it can, in some cases, be genetic. If you are experiencing any of the symptoms of gum disease, schedule an appointment with your dentist, who can determine whether treatment is necessary.
Will My Insurance Cover My Periodontal Treatment?
Many insurance plans will provide assistance for periodontal treatment. Our practice understands how important your dental health is, and we want you to get the most out of any dental treatment you receive. We will help you work with your insurance provider to make sure your treatment is easy on your budget, and your peace of mind.
Is periodontal disease contagious?
Research has shown that periodontal disease is caused by the inflammatory reaction to bacteria under the gums, so periodontal disease technically may not be contagious. However, the bacteria that cause the inflammatory reaction can be spread through saliva. This means that if one of your family members has periodontal disease, it’s a good idea to avoid contact with their saliva by not sharing eating utensils or oral health equipment. If you notice that your spouse or a family member has the warning signs of a possible periodontal problem (bleeding, red and swollen gums, or bad breath) you may want to suggest that they see the periodontist for an exam. It may help to protect the oral health of everyone in the family.
What are the consequences of missing teeth?
There are actually several negative consequences of missing some or all of your teeth. First, missing teeth will affect the aesthetics of your face. Not only will your smile be affected by the gaps from missing teeth, but if you’re missing too many teeth, the skin around your mouth won’t be supported properly and will start to sag, making you appear older than you are. Additionally, missing teeth will make it more difficult to chew your food properly and may even affect the way you speak. Finally, missing even one tooth may have emotional consequences; many people feel less confident about their smile when they are missing teeth. If you are currently missing any of your teeth, consider replacing them with dental implants, which can look and feel just like natural teeth.
What are dental implants?
A dental implant by itself is not a tooth! A dental implant is a prosthesis used to replace missing teeth. Essentially, it is a small titanium post/fixture that is inserted into the jawbone, on top of which a single crown (cap), a fixed bridge, a partial denture, or full denture can be attached. Once the implant integrates to your bone, a structure called an abutment is connected to the implant and then the artificial tooth/teeth are attached. Therefore, there are 3 parts to an “implant tooth”: the dental implant itself, the abutment, and the artificial tooth.
Who is a good candidate for dental implants?
Almost anyone who is missing a single tooth, multiple teeth, or all teeth are candidates for dental implants.
What are the advantages of dental implants?
Humans are “blessed” with 2 sets of teeth (baby teeth and adult/permanent teeth). When a single permanent tooth or multiple teeth are lost due to dental decay or gum disease, dental implants can now replace them as the 3rd set of fixed teeth! Dental implants can last a lifetime and can improve your appearance, your confidence, and your ability to eat the foods you like, and participate in an active lifestyle, without worrying about your teeth. Dental implants are made of titanium and can never get dental decay!
What is the success rate of dental implants?
It varies from individual to individual and with health and habits. For a healthy individual with good oral hygiene and good health, dental implants are predictably successful with reported success rates above 90-95 percent.
Do dental implants last?
Unlike natural teeth, dental implants are not susceptible to dental disease such as decay; however, the health of the gums is vital to maintaining lasting implant success. Conscientious home care by the patient and regular professional cleanings and check-ups are essential elements for dental implant sustainability. Each patient is different, and success relies upon diagnosis and planning, medical history, and a variety of other factors.
I have big gums and short teeth, so when I smile you can almost only see my gums. I don’t smile very often anymore because I am so self-conscious of my gums. Is there a way to improve my smile?
Yes, there may be a way to enhance your smile. It’s a good idea to discuss your options with a periodontist first. He or she can explain the best way to create the smile you want, as well as answer any questions that you may have. For example, one procedure that can remove excess gum tissue is called crown lengthening. After the excess gum tissue is removed, the gum line is then reshaped in order to create the right proportion between the gum tissue and tooth surface. Your general dentist and periodontist may also work together to coordinate additional treatments such as veneers or crowns. However, your periodontist and general dentist will recommend the best procedure to improve your smile.
I was recently diagnosed with periodontal disease. How often should I see my periodontist for an examination?
Regular examinations are very important to keep track of the present status of your disease and any disease progression over time. Your periodontist will work with you to create a maintenance schedule depending on how advanced your periodontal disease is at that time. Based on many variable factors such as your overall health, the severity of bone loss, and risk factors such as smoking and genetics, your periodontist will constantly tailor your care so your periodontal disease does not progress further. He or she may recommend exams every six months for mild periodontal disease, or every few months for more advanced stages.
I was recently diagnosed with periodontal disease. My periodontist mentioned that laser surgery would be an appropriate option for my treatment course. Is laser surgery safe?
Is it as effective as traditional treatment courses?
There seem to be a lot of mixed messages when it comes to the use of lasers in periodontal treatment. Currently, there is insufficient evidence to suggest that any specific laser wavelength is superior to the traditional treatment methods for common periodontal diseases, such as periodontitis. Therefore, it is always in your best interest to talk with your individual periodontist about the particular laser or therapy he or she plans on using, and why he or she feels that it is the best course of treatment for your particular case.
I have heard there is a connection between gum disease and heart disease. Is this true?
Where can I find more information?
The connection between gum disease and heart disease is a very hot topic in the field of periodontics right now! Several research studies have indicated that heart disease and gum disease may be linked, and researchers suspect that inflammation may be the basis for this relationship. If you are at risk for heart disease, it is a good idea to mention this to your periodontist, since gum disease may increase this risk.
Both of my parents have periodontal disease, and I’m worried that it may be genetic. Is there a way to determine my risk for developing gum disease?
First of all, congratulations on being proactive about your health! Recent research has shown that genetics may be involved in a person’s risk for gum disease, but there are a variety of other factors that also play a role. The American Academy of Periodontology has an online risk assessment tool that you can use to determine your risk level for gum disease. The test only takes a few minutes to take, and you should discuss the results with your periodontist. Take the gum disease risk assessment test.
What can I do at home to prevent periodontal disease?
The best way to prevent periodontal disease is to take good care of your teeth and gums at home. This includes brushing your teeth after every meal and before bedtime, flossing at least once each day, and seeing your dentist or periodontist for regular exams twice a year. Spending a few minutes a day on preventative measures may save you the time and money of treating periodontal disease!
Other than diagnosing and treating gum disease, what else have periodontists been trained to do?
Most periodontists spend the majority of their time diagnosing and treating gum disease, but there are a variety of other procedures that they are able to perform. Periodontists place dental implants when natural teeth cannot be saved. They also monitor the implants to make sure that they’re properly doing their job. Periodontists may also correct gum recession and cover up exposed root surfaces which can be unsightly as well as sensitive to hot and cold. These procedures are often used to lay the foundation for additional cosmetic procedures to help create a beautiful smile. Finally, periodontists can be integral in the comprehensive planning of your oral care, along with your general dentist or other dental professionals.
Can children be at risk for developing periodontal disease?
Periodontal disease is rarely found in children, and only sometimes found in adolescents. However, children should still learn the importance of keeping their teeth and gums healthy to prevent periodontal disease in the future. Children should brush their teeth twice a day and learn how to floss properly- if children learn how to floss at an early age, they will be more likely to make it a lifetime habit. These two simple acts will help protect their teeth and gums from periodontal disease.
As a parent, you should also be aware of the warning signs of periodontal disease, which include red, swollen, bleeding gums or bad breath that won’t go away. If your child develops any of these symptoms, tell your dental professional right away. It’s also a good idea to ensure your dental professional knows your complete family history, as genetics can play an important role in the early development of periodontal disease.
Bone grafting is a procedure where bone substitutes are placed next to the existing alveolar bone and the implant fixture, in order to promote new bone growth in these areas where the bone is needed. The bone substitutes, otherwise known as bone graft materials, can be synthetic, sterilized human donor bone, or derived from an animal source (commonly bovine). The bone graft is also usually covered by a collagen membrane, and stitches are placed over the grafted site. After a period of time (depending on the amount that is grafted as well as the type of graft used), new bone will be generated!
Although it sounds quite terrifying, the procedure is done under local anesthetic and has been described as being more comfortable than wisdom tooth surgery. After the grafting procedure, some mild discomfort and swelling are expected, but these are easily managed with some painkillers.
There are 4 methods of placing an implant, based on the timing of the procedure:
Immediate implants are only suitable for selected cases where tooth removal is followed immediately by the placement of the implant into the extraction socket. This reduces the waiting time; however, you will still not have a tooth yet as the implant needs to be left undisturbed under the gum for at least 3 months before a crown can be fabricated. Bone grafting is also almost certainly needed as the socket shape is never the same shape as the implant itself, and these voids will need to be filled up with graft material.
Early implant placement is done usually within 4 to 8 weeks of tooth extraction. The reason for this is to allow for some soft tissue or gum healing to take place first before the implant surgery, to ensure sufficient gum will be present for better outcomes. Delayed placement, on the other hand, is done 12 to 16 weeks after tooth extraction to allow for both gum healing and partial bone healing before implant surgery.
Late placement is done at least 6 months after tooth extraction to allow for complete bone healing, but this protocol is less favored today as evidence has shown that there will be significant bone loss if the implant surgery is delayed for so long unless grafting had been done.
As mentioned earlier, after the implant fixture is placed into the jaw bone, there is normally a minimum waiting time of at least 3 months before the implant can be loaded – in other words, to have a tooth, bridge or denture connected to the implant fixture. Those requiring bone grafts have a longer waiting time, sometimes extending to 6-12 months, especially in cases with extensive grafting, in order to allow sufficient time for the implant site to “stabilize”.
Additionally, if your implant is submerged, you will need another additional visit to expose the implant via a minor gum surgery. This is known as 2 stage implant surgery. The advantage of submerging the implant is to allow better healing and stronger integration with the bone, and this is often indicated where bone quality is compromised or when significant grafting has been done. Once the implant is exposed and a healing abutment is placed, a short wait of 2 weeks is sufficient for the gums to heal before proceeding to the final restoration of the implant.
A submerged implant (with a cover screw) requires an additional minor gum surgery to expose the implant and have a healing abutment which allows the gums to heal around it.
Which protocol is most suitable for your case, as well as whether a single or 2-stage surgery is appropriate, has to be determined by the dentist examining and treating you, as there are many factors to be considered. At times, the patient has to wear a temporary denture while waiting for their implants to be completed, especially if the front tooth is involved. But as the saying goes, “Good things come to those who wait,” and this is particularly true where implant surgery is concerned. Rushing the whole implant process may lead to compromised results and poorer long-term success.
A simplified flowchart illustrating the sequence of the implant procedure