What is a Periodontist?

A periodontist is a dentist that treats the different diseases that affect the gum and bone surrounding your teeth. Gum disease is now the leading cause of tooth loss in the adult population and as such we place a strong emphasis on its detection and treatment.

A periodontist also provides cosmetic periodontal treatments. We can therefore also offer a number of cosmetic gum treatment options including:

• Recession coverage to cover exposed tooth root surfaces
• Crown lengthening to increase the length of teeth and reduce a “gummy” smile
• Gum recontouring to correct irregularities and give a balanced, symmetrical smile.
• Regeneration of dental tissues lost to periodontal disease

What is periodontal disease?

Often referred to as “gum” disease, periodontal disease is an inflammatory disease of the gums that results in the gradual and progressive destruction of the bone and ligament that hold the tooth in the jaw. It is caused by bacteria in plaque both above and below the gum line. If left untreated it can lead to the teeth becoming loose and having to be removed, or even falling out.

Periodontal diseases are usually slow in progressing and it can take a number of years for enough bone loss to occur for the teeth to become loose. However, the severity of the disease can vary from one person to another.

Treatment becomes more difficult as it progresses but it can be very successfully treated in the earlier stages. The initial treatment is carried out by the periodontist with help from the hygienist but the day to day care of your gums is up to you. The visits to our hygienists and their advice will help you maintain your teeth.

Regular removal of the plaque and calculus that causes gum disease will greatly reduce the risk of developing the destructive form of gum disease.

Who gets periodontal disease?

15% of the population are highly susceptible to developing destructive gum disease, whilst another 15% are highly resistant. The remaining 70% of the population have the potential to develop destructive gum disease.By the age of 40 around 70% of the population has some stage of the disease.

The factors below are the most common seen in patients with gum disease. However, we often see people with few of the causative factors who still have advanced disease. This is why regular follow-up visits with the dentist and the hygienist are so important.

Smoking

Smoking has been identified as a true risk factor for periodontal disease. Smokers tend to have more severe tissue destruction and lose more teeth as a result of periodontal disease than non-smokers.

We also know that periodontal therapy works better in non-smokers than in smokers and that smokers are at significantly higher risk of experiencing further periods of disease progression later in life, even after previously successful periodontal treatment. Stopping smoking will be extremely beneficial for achieving and maintaining gum health and keeping your teeth in the long term.

Please consider stopping smoking or even just reducing your daily tobacco consumption as part of getting started on your way to healthy and beautiful teeth and gums.Of course, your general health will benefit hugely from this, too, and so we do hope that you will give this some thought. If your require information and support, please ask your General Practitioner or any member of staff at Flint and Flint Dental Surgeons who will be happy to provide you with information of where to find help locally.

• Smoking
• Genetics
• Pregnancy
• Stresses
• Medications
• Diabetes
• Poor nutrition
• Other systemic diseases

How do I know if I have gum disease?

The signs of periodontal disease can be difficult for a patient to detect, but may include:

• Bleeding gums or bad breath (“halitosis”)
• Teeth becoming loose, or gaps appearing between the teeth
• Receding gums
• Red, sore or swollen gums
• Recurrent infections in the mouth.

It is important to note that smoking increases the rate of bone destruction in periodontal disease, but also masks these signs. This may mean that the disease progresses to an advanced stage without the patient knowing that there is a problem. At your consultation, your gum health will be assessed and discussed with you.

How is periodontal disease detected?

First, you will have a detailed consultation with our Periodontist assessing how your teeth are affected by periodontal disease. This will include gentle measurements on your gums (6-point periodontal pocket chart) and x-ray examinations. You will receive information about how gum disease develops, which factors may contribute to it in your case and what you can do to get actively involved in the treatment. We will also make a note of your specific expectations and preferences.

Following this, we will be able to provide you with a detailed written report, proposed treatment plan and estimate detailing the timescale and cost of treatment. In advanced cases which include planning for replacement of missing teeth, further planning appointments may be required to be able to provide a definitive treatment plan.

How is periodontal disease treated?

Periodontal therapy is best carried out in systematic treatment phases:

• The Hygienic Phase of Therapy

The initial Hygienic phase of therapy is aimed at arresting disease, resolving inflammation and reducing number and depths of pockets. This meticulous deep cleaning of the gums will be carried under local anaesthetic on sections of the mouth at a time either by our Dental Hygienist or by the treating dentist. We will also suggest some minor modifications to your home care, since your own cleaning is of fundamental importance in achieving periodontal (gum) health. At the Flint and Flint Dental Surgeons, we use state-of-the art piezon-electronic equipment which causes minimal trauma to the gums and replaces the main part of traditional `scraping’ with sonic scaling.

Treatment can result in a small amount of discomfort and slight increase in sensitivity which usually lasts only a short time. You may also notice a slight increase in recession of the gums as the swollen and inflamed tissues heal. This shrinkage of the tissues may show in form of longer teeth or so called “black triangles” between your teeth. We will explain to you how much this shrinkage would affect your personal situation.

For many patients deep cleaning in conjunction with the appropriate maintenance care will be sufficient to control the disease. However, in advanced cases of periodontal disease with a large number of deep pockets, the improvement after deep cleaning alone may not be enough. A second phase of therapy may include minor surgery to gain access to deep areas for cleaning and reshaping.

• The Corrective Phase of Therapy

This phase of therapy aims at treating teeth with residual deep pockets or problematic situations following the Hygienic phase. We now aim at restoring your function and aesthetics.

The decision regarding what type of further periodontal therapy may be needed, and on how many sites, should be made after the effect of the initial phase of therapy has been evaluated. The time lapse between finishing the initial phase of therapy and this evaluation may vary from 1-6 months.

Periodontal surgery is aimed at reducing the pockets further and achieving a situation which allows you to clean between the teeth more easily. There may be a small amount of discomfort following surgery, which in few patients can amount to facial swelling and bruising for a few days. There will be sutures for around 1 week.

At Flint and Flint Dental Surgeons we adopt a minimally invasive approach. This means that we aim to limit and tailor any further treatment to specific sites that have been identified as needing further correction.

After completion of periodontal therapy, we can now carry out any final cosmetic improvements or replacement of missing teeth. This may include any type of restoration (including dental implants). Ideally, removable dentures should be avoided since they lead to further plaque retention and an increased risk of recurrence of gum disease.

What should I do if I think I have a gum problem?

All patients should be regularly screened for the early signs of periodontal disease but if you feel that you have a specific gum problem or you have any of the risk factors listed above, then we recommend a consultation with the Specialist Periodontist.

What if I get gum recession or tooth sensitivity after treatment?

Recession of the gums is an unavoidable side effect of periodontal treatment (see also: Hygienic phase of therapy). In fact, it is a sign of a healing tissue. In gum disease the tissues are usually red and swollen as a result of the bacterial inflammation.

After removal of the bacteria, the tissue will heal back to its former firm texture and pale pink colour. However, the final outline of the gums is determined by the underlying bone and this depends on the amount of bone loss that has taken place prior to treatment.

In advanced cases, this may lead to noticeably longer teeth which can also become quite sensitive to cold. The sensitivity is usually temporary and can be treated with fluoride applications if necessary. The shrinkage of the gum, however, is permanent. There are methods by which unsightly gaps between the front teeth can be disguised (e.g. tooth coloured fillings or veneers to adjust the shape of the teeth to the new gum outline).

In any case, we will advise you about the implications and possibilities affecting your dentition prior to carrying out any treatment. Cosmetic gum surgery is also possible.

Cosmetic gum surgery is also possible.

There are a number of cosmetic concerns that can be addressed successfully with periodontal (gum) plastic surgery. Situations that may require such correction are:

•The approach to solve such defects can vary widely and requires careful examination and treatment planning. Often a combined approach, taking care of the gums but also planning for new fillings, crowns (caps), bridges or dental implants is needed. In this case, collaboration with the other Specialists may be required.

•Gummy smile

•Extremely worn down teeth

• Gum recession defects (isolated or multiple)

• Gum recession prevention in conjunction with orthodontic therapy

What does the Hygienist do?

Our experienced hygienists provide the following services.

The basis for a healthy mouth is healthy gums. The absence of gum disease and tooth decay will help you maintain your teeth for life. The hygienist works with the periodontist to establish and maintain a programme tailored to meet your specific needs.

Good home-care is important if gum disease and tooth decay are not to progress to more serious problems. Remember more teeth are lost due to gum disease than tooth decay.

Our Hygienists are trained to help prevent dental disease by providing preventive dental treatment, helping you care for your teeth and gums by giving advice on oral hygiene techniques and advising on diet.

• Preventive Clinical Treatment
• Oral Hygiene Instruction
• Dietary Advice

Why do I need to see the hygienist regularly?

For what is known as Maintenance Care (or Supportive Periodontal Therapy). Excellent maintenance of periodontal health after treatment can be achieved over many years. However, the key to success is the attendance for recall visits at regular intervals (generally 3-4 months) involving the Dental Hygienist and periodic reviews with your dentist.

At these recall intervals a continuous risk assessment will be carried out in conjunction with the appropriate therapy. It is important that you update us regarding changes to your medical status, medications and circumstances, as these may affect your risk of disease recurrence.

Your home care plaque control is of fundamental importance in maintaining periodontal (gum) health. The maintenance regime that Flint and Flint Dental Surgeons operates is derived from clinical studies, and has been shown to be an effective way of helping patients to keep their teeth and gums healthy.

Whilst we aim to help our patients keep their teeth for as long as possible, we also recognise that an attractive smile and fresh breath is important to many people. We provide the most up to date techniques to help our patients achieve this. At Flint and Flint Dental Surgeons we take the time to understand your needs and expectations.