The Specialist

How a periodontist manages the different types of gum disease

A periodontist is defined as a dentist who specializes in the prevention, diagnosis and treatment of periodontal disease, and in the placement of dental implants. Periodontists receive extensive training in oral inflammation, including three additional years of education beyond dental school. We are familiar with the latest techniques for diagnosing and treating periodontal diseases and skilled in cosmetic periodontal procedures.

Periodontics is a dental specialty which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes. It includes the maintenance of the health, function and esthetics of these structures and tissues.

It is one of 10 specialties in dentistry recognized by the Bahamas Dental Council and The National Commission on Recognition of Dental Specialties and Certifying Boards (USA).

Dental specialties are recognized to protect the public, nurture the art and science of dentistry, and improve the quality of care. The other nine specialties will be addressed in later issues.

The word “periodontal” comes from two words, perio (around) and dont (tooth). If we are looking at periodontal problems, we are looking at areas around the tooth or on the outside of the tooth.

What is on the outside of the tooth? Well, if you look under the gum line you observe:

• Root.

• Bone anchoring the root.

• Fibers connecting the root to the bone called ligaments and cementum.

Inside the tooth:

• Pulp.

• Canal that houses the blood vessels and nerve supply.

Types of periodontal diseases

Gingivitis: The non-painful swelling of the gum tissue without any underlying bone or ligament damage. The gums become red and bleed easily. Gingivitis is often caused by inadequate oral hygiene. This condition is completely reversible with professional treatment and good oral home care.

Factors that may contribute to gingivitis include: diabetes, smoking, aging, genetic predisposition, systemic diseases and conditions, stress, inadequate nutrition, puberty, hormonal changes, pregnancy, substance abuse, HIV infection, and the usage of certain medications.

Aggressive periodontitis: Occurs in patients who are generally healthy. Common features include rapid attachment and bone destruction. What is usually unique about these patients is the distinct genetic predisposition that is inherited from parent(s) to their child.

Chronic periodontitis: Is the most frequent form of periodontal disease. It is the loss of the ligament and bone support anchoring the tooth. It creates a pocket that is occupied by bacterial plaque and calculus. There is usually some recession of the gums in many of these patients. Although common in adults, it can occur at any age. This is usually not reversible, however it can be managed by a periodontist.

Periodontitis, as a manifestation of systemic diseases, often begins at a young age. Systemic conditions such as heart disease, respiratory ailments and diabetes are also associated with this form of the disease.

Necrotizing periodontitis: A painful infection of the gum tissue characterized by a rotting effect of the gingival tissues and bone. These lesions are most commonly observed in individuals with systemic conditions such as HIV infection, malnutrition and immunosuppression.

Treating periodontal diseases

When considering treatment choices for periodontal diseases, the dentist should be patient-centered, least invasive and most cost-effective. Today, we are best able to achieve this through non-surgical means. Non-surgical periodontal treatment does have its limitations, however. When it does not achieve the desired result, surgery may be indicated to restore periodontal health.

The following are possible procedures a periodontist may perform in managing periodontal ailments:

Nonsurgical treatment (scaling and root planing)

• Dental implants.

• Laser treatment.

• Regenerative procedures.

• Dental crown lengthening.

• Pocket reduction procedures.

• Gum grafting procedures.

• Plastic surgery procedures.

The most commonly performed non-surgical treatment to fight gum disease:

Scaling and root planing: The procedure referred to as scaling and root planing is a careful deep cleaning of the root surfaces to remove plaque and calculus [tartar] from periodontal pockets and to smooth the tooth’s root to remove bacterial toxins. Scaling and root planing sometimes are followed by additional therapy such as local delivery (below the gum) antimicrobials and systemic antibiotics as needed on a case-by-case basis.

Most periodontists would agree that after scaling and root planing, many patients do not require any further active treatment. However, the majority of patients will require ongoing maintenance and recalls (special cleanings) to sustain their great results.

Tray delivery system: A tray delivery system consists of a custom-fitting tray made from an impression of the patient’s mouth. Patients would use the tray at home. The tray is similar to a bite guard or orthodontic retainer tray and it delivers special medication in the tray directly into the pockets. These trays have been proven to be a safe and effective way to treat gum disease.

Periodontal diseases are extremely common among the Bahamian population. Despite its prevalence, with proper and prompt treatment along with follow-up care, patients are able to retain their teeth for a lifetime.

Unfortunately, many Bahamians are unaware of their gum conditions because they have not visited a dentist or were never told they suffered from periodontal disease. Since the disease is mostly chronic, which means it is painless, many patients are unaware of the signs and symptoms unless they are diagnosed by a dentist.

Remember this – proper diagnosis requires the measurement of pockets using a periodontal probe, x-rays, then appropriate treatment. The skills and experience of your dentist certainly matters in predicting successful outcomes.

The most recent addition to our non-surgical approach to treatment is the tray delivery therapy.

We live is an exciting time in dentistry! For most of the patients who suffer from or are concerned about periodontal disease, today we are able to predictably apply these painless treatment choices with promising results.

Next issue: Nutrition and periodontal disease

• Dr. Kendal V. O. Major is founder and CEO of Center for Specialized Dentistry, a comprehensive family dental practice operating in New Providence and Grand Bahama. He is the first Bahamian specialist in gum diseases and dental implants since 1989. He is also a certified Fastbraces provider. His practice is located at 89 Collins Avenue; he can be reached at telephone (242) 325-5165 or

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