This is the specialty of dentistry that deals with the management of the diseased tissues supporting the teeth known as the periodontium, which includes the gum (gingiva), alveolar bone, periodontal ligament and cementum (the outer covering of the root of the tooth).
Periodontal diseases are common in any population where the etiological factors could be local or systemic.
The process of periodontal disease is initiated with the formation of dental plaque and then the accumulation of calculus or tartar combined with an inflammatory mechanism which leads to the destruction of the supporting bone around natural teeth. Untreated this leads to a host of symptoms beginning with halitosis or bad breath, bleeding and / or swollen gums, pus discharge from the gingiva, loosening of the teeth and then bone loss ultimately leading to tooth loss.
Periodontal disease is the leading cause of tooth loss in adults.
The normal colour of the gums or gingiva is coral pink. Change in colour to a red hue accompanied by swelling and bleeding from the gums are sure early indications that your gums are in a state of inflammation or gingivitis. If at this stage if remedial action is not taken then this bacterial infection can spread to the other supporting structures of the teeth namely the cementum, periodontal ligament and the alveolar bone ( the complete periodontium) ending in Chronic Destructive Periodontitis (CDP).
Periodontal disease is caused by micro organisms and dental plaque. Plaque is the sticky substance that forms on your teeth after meals. The bacteria attach on the plaque and produce an acidic environment leading to gradual accumulation of calculus and gum inflammation. The build up of plaque below the gum line causes the gums to become inflamed. As the gums swell they detach from the tooth. This process forms a space or pocket between the tooth and the gum. Bacteria grow rapidly in these pockets further advancing the process of destruction.
The primary reason of brushing after meals is to remove plaque promptly that over time has become hardened or calcified and turns into calculus. This is commonly called tartar.
Among the common treatment modalities carried out are
Scaling and root planning
Cosmetic gum Surgery
Alveolar bone Surgery
SCALING is the process by which plaque and other deposits are removed from the tooth's surface both from above and below the gum margin. The primary aim of scaling is to restore the gingival health by completely removing from the tooth's surface all the irritants provoke inflammation and further destruction of the gum.
The modern method is the use of the ultra-sonic hand scaling equipment which has vibratory forces to dislodge the hard deposits and stains present on the tooth surface.
Ultra-sonic scaling is recommended twice a year.
CURETTAGE is the procedure where granulation tissue from the periodontal pockets is removed with the help of special instruments known as curettes. The result is that the detached periodontal tissues re-attach to the tooth surface. The procedure is done local anesthesia.
Among the gingival surgeries the two common procedures are GINGIVECTOMY is done when the gums are excessively swollen and the affected is removed under local anesthesia to get the normal contours. GINIVEOPLASTY is the surgical procedure used to improve the appearance of the gum. Periodontal dressing is placed after surgery.
COSMETIC GUM SURGERY
Gingival graphs are designed to replace or enhance the amount of gum surrounding the tooth. These surgeries are indicated when there are exposed root surfaces due to recession or denudation of the root surface.
GINGIVAL FLAP SURGERY
Gingival flap surgery is required when the periodontal pockets are very deep and do not heal with conservative therapy. The depths of the pockets do not allow adequate cleaning and elimination of infection. Bone loss is of varying degree and the gum attachment is lost. Surgical correction is required to eliminate chronic infection. By using a flap procedure excess is gained to the root surface. Bony defects are corrected and inflamed tissue is removed.
ALVEOLAR BONE SURGERY
Osseous surgery is used to modify and re-shape deformities in the supporting bone around the teeth and is used when periodontal disease is advanced in nature. Either natural freeze dried bone or synthetic periodontal alveolar bone particles are used as fillers to replenish the loss of bone.