Periodontics is one of the nine dental specialties recognized by the American Dental Association. It focuses on treatment of the soft tissue and bone that support the teeth and jaw.
Periodontal disease, also known as gum disease, often begins as a buildup of plaque on the surface of teeth near the gum line. If not removed by regular brushing and flossing, the plaque can harden into tartar. Eventually the gums will become red, swollen, and irritated. This is known as gingivitis.
If left untreated, gingivitis can worsen into periodontal disease. If that is not treated, it can contribute to heart disease, diabetes, and other health problems. Periodontal disease during pregnancy has been linked to premature birth or low birth weight.
Risk factors for periodontal disease
You may be at risk of periodontal disease if you smoke or use tobacco products, do not regularly brush your teeth and floss, have health conditions such as diabetes, heart disease, or osteoporosis, or have family members that have had gum disease. In some cases, it can be genetic. If you observe any of the symptoms of gum disease, schedule an appointment with your dentist, who can determine if treatment is necessary.
If you’ve been diagnosed with gum disease, treatment options will depend on the particulars of your situation and the severity of the problem. We always start with the least invasive options, which are non-surgical.
The first line of defense against gum disease is a cleaning technique known as “scaling and root planing.” An ultrasonic cleaning device is used to remove plaque and tartar (also called “calculus”) from your teeth where regular cleaning devices can’t reach. Scaling the root will remove bacterial toxins that create gum disease. Then the rough surface of the tooth and the root are smoothed out (planed). This creates a healthy, clean surface that makes it easier for gum tissue to reattach to the tooth.
As with any dental procedure, after-care is vital. In order to prevent recurrences of gum disease, you must brush and floss daily, eat a healthy diet, avoid tobacco use, and schedule regular dental checkups. Even after a successful scaling and root planing, if you don’t attend to your teeth, you are likely to develop gum disease again.
When gingivitis goes untreated, gum disease will cause the gums to pull away from the teeth, leaving deep pockets where bacteria can grow and damage the bone. If your dentist has diagnosed you with gingivitis or periodontal disease, it is important to notice if:
- You have sensitivity to hot or cold temperatures, or even to sweet, spicy, or sour foods
- Your teeth appear longer than normal
- Spaces between your teeth seem to grow
- The roots of your teeth begin to show
Gum tissue grafting
Depending on your situation, the periodontist will perform one of three types of gum tissue grafts.
- Connective tissue graft — Tissue from under the skin of the roof of your mouth, called sub-epithelial connective tissue, is removed and stitched to the gum tissue around the exposed root. This is the most common method.
- Free gingival graft — Instead of making a flap and removing tissue from under it, a small amount of tissue is removed directly from the roof of the mouth and then attached to the gum area. This method is preferred for people who have especially thin gums and need additional tissue to enlarge them.
- Pedicle graft — Instead of the roof of the mouth, tissue is grafted from gum around or near the tooth that needs repair. The flap, called a pedicle, is only partially cut away so that one edge remains attached. The gum is then pulled over or down to cover the exposed root and sewn into place. This procedure can only be done if the patient has plenty of gum tissue near the tooth.
Also called regenerative surgery, a bone graft is used to rebuild bone and soft supporting tissues lost due to periodontitis. In order to avoid extractions, your periodontist may recommend regrowing the lost bone with a graft.
First, the periodontist will separate your gums from the teeth in order to get access to the roots and bone. The roots will be thoroughly cleaned, and the holes in the bone will be filled with a graft material that usually consists of your own bone. Then your periodontist will put the gums back in place and stitch them together. Over the next few months, the grafted material will be encouraged to grow, and fill in for lost bone and soft tissue.
Bone grafting is often used for ridge augmentation. After the loss of one or more teeth, your gums and jawbone may become indented where the tooth or teeth used to be. Not only does the indentation look unnatural, it also causes the replacement tooth to look too long compared to the adjacent teeth, and may create an area that is difficult to clean. Ridge augmentation can recapture the natural contour of your gums and jaw.
If gum disease has resulted in a loss of bone, bone regeneration may be a good option to rebuild jawbone and bone tissue in order to correct the damage. It can also benefit patients who are missing teeth and don’t qualify for dental implants, which require a significant amount of jawbone in order to be successful.
Your periodontist will place a biocompatible membrane between the gum and bone, to act as a barrier against downgrowth of the gum into the underlying bone as it heals. Sometimes a bone graft or tissue-stimulating proteins may be placed under the membrane to encourage your body to regenerate bone and tissue. Membranes around teeth are designed to dissolve or reabsorb after a few weeks.
Crown lengthening improves the aesthetics of your smile by exposing more of your teeth. The periodontist removes excess gum tissue around the upper teeth to make them look longer. If the gum line is uneven, crown lengthening can also sculpt it to produce a more symmetrical, balanced smile. This procedure may be done for dental care and medical reasons as well as cosmetic ones.
If your periodontist finds decay or fracture under the gum line, for example, crown lengthening can help expose more of the tooth’s crown in order to support a filling or restoration. Usually, a follow-up appointment will be needed to check the healing process and remove any stitches.
Osseous surgery, also known as “pocket depth reduction,” is a surgical procedure to fix pockets that form around the teeth because of periodontal disease. These pockets may become too deep to clean with daily at-home oral hygiene, providing a space for bacteria to live, and leading to bone and tissue loss.
During osseous surgery, your periodontist will fold back the gum tissue and remove the bacteria before securing the tissue back into place. If the underlying bone has been damaged, the irregular surface will be smoothed out to limit areas where disease-causing bacteria can hide. This will also allow your gum tissue to reattach to healthy bone more effectively.