Periodontics
Periodontology is "the branch of dentistry that studies the supporting structures of the teeth and the diseases and conditions that affect them."
The supporting structures are together know as the periodontium and comprise the gingiva, alveolar bone, cementum and periodontal ligament. Periodontitis is the name given to diseases of the periodontium which, if allowed to progress sufficiently, will lead to loss of the underlying bone, with movement of the teeth leading to spacing between teeth and increasing mobility, until the teeth are lost. It is caused by the accumulation of sufficient numbers of specific bacteria in a susceptible individual and its treatment is initially geared at reducing the levels of plaque bacteria on a regular basis, both by dental professionals (dentist, therapist or hygienist) and, most importantly, the patient themself.
The result of poor oral hygiene in a susceptible individual
Advanced Periodontal Disease.
Effect of poor oral hygiene on the gums and teeth.
Gross Calculus Deposits.
OPG. Note the loss of bone around the roots.
The treatment of gum disease relies chiefly on the removal of the bacterial deposit, plaque, and the mineralised form of this, calculus, that acts as a niche for further bacterial accumulation. This in turn removes the causes of the inflammatory reaction that in itself can damage the underlying supporting tissues. The body's attempts to fight off the effects of these bacteria results in swelling, spontaneous bleeding and a loss of the underlying bone that supports the roots in the sockets. This results in loss of gum height and normal architecture, recession, increased looseness of the teeth, opening up of spaces betwen teeth until, ultimately, they fall out.
Treatment initially is non surgical. Through thorough cleaning, generally by a hygienist, and instruction in day to day cleaning methods and tools the majority of gum problems can be stabilised and the disease progress halted.
Primary Periodontal Treatment
Untreated disease. Calculus build up on lower incisors.
After initial periodontal treatment. Cleaned tooth surfaces.
Occasionally surgical intervention is required. Where bone loss has created walled defects, these can respond to guided tissue regenerative techniques with the craeation of new bone and periodontal ligament attachment. Where recession has exposed root dentine, connective tissue grafts, taken from the palate, can be used to re-create the original gum contour.
Connective Tissue Grafting
Pre-operative View. Note the thin tissues and recession around the lateral incisor
Post-operative View. Good bulk of tissue now covering the root
Crown Lengthening Surgery
Where wear or a reaction to certain drugs has caused a loss of height of visible tooth, crown lengthening procedures can be carried out to improve the aesthetics or to facilitate the placement of a restoration that might otherwise have insufficient retention.
Pre-operative view. Gum overgrowth.
Post-operative view. One week after surgery.