What is Periodontics?

Periodontics is a specialty of dentistry that is devoted to the health of the supporting structures of the teeth which are the soft tissues or gums and the supporting bone.  Periodontics is concerned with the diagnosis and treatment of gum disease and the maintenance of these supporting structures once health has been achieved.  The specialty of periodontics also involves the placement of dental implants and regenerative plastic surgical procedures for both the gum tissue and bone.

What is a Periodontist?

A periodontist is a dentist who after four years of dental school has completed additional training at a university or post graduate specialty program in periodontics.  Periodontal specialty programs are an additional three years of training.  A periodontal residency program includes training in oral medicine, oral pathology, hospital training in general anesthesia, treatment of TMJ disorders, and all related implant and periodontal surgical procedures.

Why should I see a Periodontist?

The three primary reasons a patient is asked to see a periodontist are:

• You have been referred by your dentist or hygienist for the evaluation of periodontal disease.       
• To evaluate the health of the supporting structures of the teeth which is the gum tissue and bone and to determine if bone loss is occurring due to inflammatory periodontal disease.
• For periodontal plastic surgical procedures which include esthetic smile enhancement and soft tissue grafts to cover areas of exposed root surfaces following gum recession.
• To regenerate or develop new bone in areas that are to receive dental implants in the future.
• To replace missing teeth with dental implants or evaluate teeth which require extraction to be replaced by dental implants.

My teeth feel fine, do I still need to see a Periodontist?

One of the most common reasons a patient is referred to a periodontist by their dentist or hygienist is to evaluate loss of supporting bone or gum pocketing around the teeth. Periodontal disease is a low grade inflammatory process caused by oral bacteria or plaque.  The inflammatory process gradually destroys soft tissue and supporting bone.  As the bone levels recede closer to the root tips, the gum tissue that was formerly attached around the neck of the tooth separates creating the so-called "periodontal pocket". The hallmark of periodontal disease is that it does not cause pain until the end stages. A patient may suffer significant destruction of the supporting bone with increased pocket depth and be totally unaware this process is taking place. 

It has been well documented that you the patient can only clean approximately 2-3mm within the gum tissue pocket.  Pocket depths can only be determined by a periodontal probing.  If you have pocket depths greater than 3mm it may be impossible for you, your hygienist or even the dentist to clean the plaque away completely.  This is what causes periodontal disease.  Plaque begins to grow back almost immediately after removal.  It is essential that plaque is removed completely at least twice a day by flossing and brushing.  Unfortunately when there are pockets greater than 3mm this may be impossible.  The process of periodontal disease is usually slow and will not cause pain or even an awareness by the patient until there is tooth mobility or an abscess.  Another sign of advanced periodontal disease is bad breath and bleeding gum tissue when brushing or flossing.

What is Periodontal disease?

Periodontal disease is classified as gingivitis or periodontitis.  Gingivitis is the inflammation of the gum tissue (red, bleeding gums).  Gingivitis is reversible by appointments with the dental hygienist and your own thorough brushing and flossing.  Periodontitis is the destruction of bone and loss of attachment of the tooth with the bone. 

The objective of successful periodontal treatment is to arrest the bone destruction process and reduce pocketing.  Pocket reduction is done to give the patient the opportunity to remove plaque on a daily basis.  Thorough daily plaque removal is the best way to prevent bone loss and the reoccurance of periodontal disease.  The objective of plaque removal is to limit the inflammatory process and stop additional destruction of gum tissue and the supporting jaw bone.

My teeth look too long, what can be done to make them look normal?

There are a variety of soft tissue grafting procedures that can be done to cover areas of exposed root surface caused by gum tissue recession. These procedures can restore the normal length of the tooth which reduces root sensitivity and makes your smile more attractive.

My teeth look to short, square or I show too much gum tissue when I smile.

Short teeth and excessive display of gum tissue (gummy smile) or a smile that just does not look right are common concerns that many patients have. There are several procedures that allow the periodontist to restore normal proportions and symmetry to produce a more pleasing smile by exposing tooth structure which is hidden by too much gum tissue.  This procedure is called smile enhancement or esthetic crown lengthening surgery.  Often after orthodontic treatment is completed, your orthodontist may refer you for smile enhancement surgery.  Dramatic improvements in your smile can be made in one or two hours' time.

I need a tooth extracted, who should take it out?

If it is your intention or hope to have your tooth replaced by a dental implant, the extraction of a failing tooth is the first critical step. It is my preference to extract a failed tooth myself to ensure that all residual infection has been removed and that every effort has been made to preserve as much supporting bone following the extraction as possible. It is essential to create the best possible environment for the eventual placement of your implant once the extraction site has healed.

In many situations it is possible to place the implant when the tooth is removed.  An examination must be done to advise you if immediate implant placement at the time your tooth is removed is best for your clinical situation.  Appropriate dental x-rays and a CT Scan is usually required when evaluating a site for implant placement or for implant surgery. Generally when a tooth is removed it is important to add bone graft into the extraction site to prevent the collapse of the bone and gum tissue after removing the tooth. This is true even if the implant can be placed at the same appointment the tooth is removed.  Allowing the periodontist who will be placing the implant to extract the tooth will ensure the best possible functional and esthetic result once the implant is placed and the restoration is complete.