What is a periodontal disease?
Periodontal diseases are inflammatory diseases that affect the parts of the mouth that support a tooth. This includes the gums and bone around the teeth. Once periodontal disease has started, the supporting tissues of the tooth and the function of the gums can be compromised. Initially, the inflammation may be confined only to the gums, but in more advanced disease, the bone that supports the tooth can dissolve away and ultimately the tooth may become so loose, that it falls out, due to the lack of support.
What causes periodontal disease?
The primary cause of periodontal disease is dental plaque. This is the soft, yellowish-white build up that occurs naturally around teeth. It consists of bacteria and the by-products they excrete. Although bacteria are naturally found in all mouths and play an important role in keeping out more harmful types of bacteria, if they are allowed to proliferate, the body defends itself in a process called inflammation. Frequently the inflammation is limited to only the gums (gingivitis) and is sufficient to prevent any further damage. However, in some people, an exaggerated inflammatory response occurs, and this poorly controlled inflammation leads to breakdown of the supporting structures for the tooth, such as the periodontal ligament and the surrounding bone.
What is gingivitis?
When plaque is allowed to accumulate on teeth, the body mounts a defensive process called inflammation. This results in the gum becoming red and swollen as the blood vessels enlarge and allow defensive white blood cells into the area to prevent bacteria entering the body. We call this gingivitis. Common symptoms include bleeding when brushing or flossing and even spontaneous blood while sleeping. The condition is not generally painful and is quickly reversible by removing sufficient plaque to a level the body can handle. This is usually achieved with a toothbrush and cleaning between the teeth with either floss and/or small brushes. In people that are susceptible to periodontitis, gingivitis is the first step towards further breakdown of the tooth’s supporting structures and needs to be controlled if there is any hope of also controlling the periodontitis.
What is Periodontitis?
Periodontitis is a disease caused by plaque bacteria that leads to an exaggerated inflammatory response in some people. The inflammation that occurs in these people, instead of leading to gingivitis alone, progresses to the other supporting structures of the teeth. This results in decreased support for the tooth, loss of bone around the teeth and if left untreated, may result in loss of the tooth. Although only some teeth may be affected, it is more common for most of the teeth in the mouth to be involved to differing extents. The condition is not usually painful and is very common, being one of the most common chronic (ongoing over a long period) bacterial conditions in humans. Periodontitis, if managed early enough, can usually be arrested, preventing the further loss of support. Professional intervention is required to manage the condition as homecare alone will not stop the progression of the disease. Treatment is centred around reducing the number of harmful bacteria and controlling factors that increase the inflammatory response (e.g., cigarette smoking and Diabetes). Occasionally, it may be possible to regenerate some of the lost supporting tissues around certain teeth. As the type of inflammatory response is often genetically determined, even when successfully controlled, the disease requires an ongoing level of maintenance care, to prevent further breakdown.
What is a Periodontist?
A Periodontist is a Dentist who has then studied for a higher University degree over several years to specialise in treating conditions affecting the tissues that support the teeth (and their substitutes e.g., dental implants). By the very nature of their work, Periodontists usually have a wide array of specialist equipment for managing diseases of the gums and supporting structures as well as the specialised knowledge and skill of when and how to apply them. In Australia, Periodontists are registered by the AHPRA (Australian Health Practitioner Regulation Agency) and in New Zealand by the New Zealand Dental Council.
What do dental implants do?
Dental implants are artificial tooth substitutes. They are not the same as teeth but can, when restored, undertake many of the functions of teeth. Implants are surgically placed into the jaw-bone and fuse to it. In some cases, it may not be possible to place an implant if there is insufficient bone. Part of the implant will come through the gum and can then be restored either with a crown or as part of a larger restoration that may replace multiple teeth. Implants can also be used to support a removable denture. Because the implant is fixed to the bone, it does not have the same small degree of movement or sensation that a natural tooth has. As some of the supporting structures for teeth are lost, when a tooth is extracted, it is critical that the implant be kept very clean with good homecare. It is possible for implants to lose bone and support in a manner like periodontitis (gum disease); this is particularly the case in people who have already had periodontitis.