Periodontics

WHY THESE TISSUES MATTER

A tooth is only as secure as what holds it.

The crown of a tooth can be rebuilt, crowned, veneered or replaced. The attachment underneath cannot be manufactured. Once the bone around a root has gone, it does not return on its own — which is why periodontics is more concerned with early detection and prevention than almost any other area of dentistry.

It is also why a periodontal examination comes before cosmetic or restorative work rather than after it. Crowns, veneers and implants placed on unstable foundations fail, and they fail expensively.

 

WHAT A PERIODONTIST TREATS

Gum disease at every stage — from inflammation of the gum alone, through to advanced bone loss. The stages, signs and treatment are set out on our gum disease treatment page.

Gum recession, where the gum has pulled back and exposed part of the root, causing sensitivity, a higher risk of decay on the root surface, and often concern about appearance. Where appropriate, this is treated with grafting to cover the exposed root.

Crown lengthening, reshaping gum and bone either to expose enough of a damaged tooth for it to be restored, or to correct a gum line that makes the teeth look short.

Gummy smile and uneven gum levels, where the cause lies in the gum and bone rather than in the teeth.

Bone grafting and sinus lifting, rebuilding bone volume where it has been lost.

Dental implants, which sit within periodontics because an implant depends entirely on the health of the bone and gum around it.

Peri-implant disease, the equivalent of gum disease around an implant rather than a natural tooth. It is increasingly common as more implants have been in place for longer, and it needs recognising and treating early.

Problems of the gum from other causes — reactions to medication that cause the gum to overgrow, oral conditions affecting the gums, and the effects of smoking.

 

HOW THE GUMS ARE ASSESSED

Periodontal health is measured, not estimated from appearance.

A fine probe is used to measure the depth of the space between gum and tooth at several points around every tooth. Those measurements are recorded as a chart, along with where the gum bleeds on gentle probing, where the gum has receded and where teeth are mobile.

X-rays show the level of the bone around each root, which is the other half of the picture.

Together these form a baseline. Repeating them later is how it is known whether a condition is stable, improving or progressing — which cannot be judged by how the gums look on the day.

 

PREVENTION AND MAINTENANCE

Periodontal conditions are chronic. They are controlled rather than cured, and the long-term result depends as much on what happens after treatment as during it.

Patients who have been treated for periodontitis are reviewed and professionally cleaned at intervals set by their individual risk — often every three or four months rather than every six. This is the single best-established factor in whether treatment holds over the years that follow.

Daily cleaning between the teeth matters as much as brushing, because a toothbrush reaches only part of each tooth and gum disease begins where it does not.

Where a patient smokes, stopping has a greater effect on the outcome than any treatment that can be provided.

 

PERIODONTICS AND IMPLANTS

An implant has no attachment fibres of the kind that surround a natural tooth, and the seal between gum and implant is different. That makes an implant in some respects more vulnerable to inflammation, not less.

Peri-implant mucositis — inflammation of the gum around an implant — can progress to peri-implantitis, where bone around the implant is lost. Early recognition matters, because the treatment is far more straightforward at the first stage than the second.

For this reason, patients with implants need the same structured monitoring as patients who have had gum disease, and those who have previously had periodontitis need it particularly.

 

WHEN SOMEONE IS REFERRED TO A PERIODONTIST

Not every patient with gum problems needs a specialist. Gingivitis and early periodontitis are treated routinely in general practice.

A referral is more likely where the condition is advanced or progressing despite treatment, where it has appeared at an unusually young age, where there is severe recession to be grafted, where surgery is being considered, or where complex implant work is planned in a mouth with a history of periodontal disease.

 

QUESTIONS PATIENTS ASK

What is the difference between a dentist and a periodontist? A periodontist is a dentist with several years of additional specialist training in the gums, the supporting bone and implants. General dentists and hygienists treat the majority of gum problems; periodontists deal with the more advanced and the surgical.

 

Can lost gum and bone be regenerated? Some specific shapes of bone defect can be partially regenerated with grafting techniques. Generalised bone loss cannot be regrown, and recession can be covered by grafting the gum rather than by regrowing it.

 

Is periodontal treatment painful? Treatment below the gum is carried out under local anaesthetic where needed. Tenderness and sensitivity for a short period afterwards are common.

 

I have no pain. Can I still have gum disease? Yes. Periodontitis is usually painless until it is advanced, which is why it is diagnosed by measurement rather than by symptoms.

 

Does gum disease run in families? Susceptibility does vary genetically, which is part of why two people with similar habits can have very different outcomes. It does not mean the disease is inevitable or untreatable.

 

Can I have implants if I have had periodontitis? In many cases yes, provided the disease has been treated and is stable, and provided maintenance continues afterwards. The history does raise the risk of problems around implants, so it changes how closely they are monitored rather than ruling them out.

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