Periodontist as the Primary Care provider for periodontal health and dental implants.

In the evolution of health care in Medicine and Dentistry there has been an explosion of knowledge, new developments in biotechnology, and new and improved treatment methods and techniques.  Along with this there has been an increasing shift to more specialized treatment.  For example, in our parents’ generation most medical diagnosis and treatment was initially provided by the “Marcus Welby, MD” practitioner (“the family doctor”) and at some point you would be referred to a specialist whereas today, if you have a heart problem you see a Cardiologist, a bone or joint problem you see an Orthopedist (bone specialist) or if your child becomes ill you take them to a Pediatrician.  Likewise in Dentistry, today, you take your child to the Pediatric Dentist, you have a broken jaw you see an Oral Surgeon.  Thus it stands to reason that if you think you have a gum problem, pain or soreness in the jaw or an infection in the mouth that causes your teeth to loosen, shift or be lost that you would seek a Periodontist, the person who specializes in the diagnosis and treatment of those conditions. 

A periodontist is a dentist specializing in the prevention, diagnosis and treatment of infections and diseases in the soft tissues surrounding the teeth, and the jawbone to which the teeth are anchored.  Periodontists have to train an additional three years beyond the four years of regular dental school, and are familiar with the most advanced techniques necessary to treat periodontal disease and place dental implants.  Periodontists also perform a vast range of cosmetic procedures to enhance the smile to its fullest extent.

Periodontal disease begins when the toxins found in plaque start to attack the soft or gingival tissue surrounding the teeth.  This bacterium embeds itself in the gum and rapidly breeds, causing a bacterial infection.  As the infection progresses, it starts to burrow deeper into the tissue causing inflammation or irritation between the teeth and gums.  The response of the body is to destroy the infected tissue, which is why the gums appear to recede.  The resulting pockets between the teeth deepen and if no treatment is sought, the tissue which makes up the jawbone also recedes causing unstable teeth and tooth loss.   The earlier the recognition of the signs and symptoms of periodontal disease the more conservative the treatment that will be necessary to return to a healthy mouth. 

Self Referral and Referrals from General Dentists

There are several ways treatment from a periodontist may be sought.  Many people recognize signs and symptoms of periodontal disease and self refer or are referred by a friend or family member who have had treatment for similar conditions.  Also, in the course of a regular dental check up, if the general dentist or hygienist finds symptoms of gingivitis, gum recession or "deep pockets" resulting from progressive periodontal disease, a consultation with a periodontist would be recommended.  However, a referral is not necessary for a periodontal consultation if the patient.

If you experience any of these signs and symptoms, it is important that you schedule an appointment with a periodontist without delay:

• Bleeding while eating or brushing – Unexplained bleeding while consuming food or during the course of daily cleaning is one of the most common signs of periodontal infection.
• Bad breath – Continued halitosis (bad breath) which persists even when a rigorous oral hygiene program is in place, can be indicative of periodontitis, gingivitis or the beginnings of an infection in the gum tissues.
• Loose teeth and gum recession – Longer looking teeth can signal recession of the gums and bone loss due to periodontal disease.  As this disease progresses and attacks the jawbone, (the anchor holding the teeth in place) the teeth may become loose or be lost alltogher.
• Gangrene in the tissues – Gangrene is hard to self diagnose but the general dentist and periodontist will check for its presence in the soft tissues, alveolar bone and periodontal ligament.
• Related health conditions – Heart disease, diabetes, osteopenia and osteoporosis are highly correlated with periodontitis and periodontal infections.  The bacteria infection can spread through the blood stream and affect other parts of the body.

Diagnosis and Treatment

Before initiating any dental treatment, the periodontist must extensively examine the gums, jawbone and general condition of the teeth.  When gingivitis or periodontal disease is officially diagnosed, the periodontist has a number of surgical and non surgical options available to treat the underlying infection, halt the recession of the soft tissue, and restructure or replace teeth which may be missing.

• Gingivitis/mild periodontal disease – When the gum pockets exceed 4mm in depth, the periodontist or hygienist may perform scaling and root planing to remove debris from the pockets and allow them to heal.  Education and advice will be provided on an effective cleaning regime thereafter.
• Moderate periodontal disease – If the gum pockets reach 4-6mm in length a more extensive scaling and root planning cleaning might be required.  This cleaning is usually performed under local anesthetic.
• Advanced periodontal disease – Gum pockets in excess of 6-7mm are usually accompanied by bone loss and gum recession.  Scaling and root planning will always be performed as the initial nonsurgical treatment.  In addition to tose nonsurgical treatments, the periodontist may recommend surgical treatment to reduce pocket depth.
• Tooth loss – Where one or several teeth are missing due to periodontal disease, dental implants are an effective option.  If the bone is strong enough to provide a suitable anchor for the prosthetic tooth, the implant can be placed.  However, if the bone is severely eroded, bone grafts may be performed by the periodontist to provide a suitable anchor for the new tooth/teeth.

Ask your periodontist if you have questions about periodontal disease, periodontal treatment or dental implants.