Periodontology, or periodontics, is the branch of dentistry which studies the supporting structures of teeth, known as the periodontium, which includes the gingiva (gums), alveolar bone, cementum, and the periodontal ligaments. The word comes from the Greek words peri meaning around and odons meaning tooth. Literally taken, it means study of that which is "around the tooth".
A periodontist is a dentist that specialises in treating diseases of the periodontium .
Periodontal diseases take on many different forms, but is usually a result of bacterial infection of the gums. Untreated, it often leads to tooth loss and alveolar bone loss.
A. Scaling ( cleaning)
This involves cleaning the root surface of the tooth to remove plaque and calculus. This may be above the gum line or in shallow pockets below the gum line. Cleaning calculus is done with sharp instruments called "scalers" or sometimes with an ultrasonic cleaner
B. Gingival Surgery
A tooth is surrounded by two types of tissue. The first is gingiva (gum), which is pink, thick and dense. It is also called keratinized tissue. Gingiva forms a tight seal around the tooth which serves as a barrier against the penetration of bacteria to the underlying bone. The gingiva also helps to withstand trauma from brushing, eating, etc. The other type of tissue, mucosa, found directly below the gingiva, is red, thin and loose or elastic. It does not seal tightly around the tooth, nor does it withstand trauma well (as shown by how easily you can "scratch" the floor of the mouth).
When gum recession occurs, the body loses a natural defense against both bacterial penetration and trauma. When there is only minor recession, some healthy gingiva often remains and protects the tooth, so that no treatment other than gentle oral hygiene is necessary. Recession can be caused by genetically thin bone and gum, overscrubbing or toothbrush bristles that are too stiff, or by clenching and grinding habits.
When recession reaches the mucosa, the first line of defense against bacterial penetration is lost. No matter how meticulously the patient tries to control the bacteria, there is a greater chance of it penetrating and affecting the underlying supporting bone. In addition, gum recession may result in root sensitivity as well as an unsightly appearance to the gum and tooth.
Some people genetically have extremely thin gingiva and require grafting to prevent recession before it starts. This is quite common when orthodontic tooth movement is planned.
A gingival graft is designed to solve these problems. A thin piece of tissue is taken from the roof of the mouth, or moved over from adjacent areas, to provide a stable band of dense gingiva around the tooth. There is also a new skin graft product that eliminates taking gum from the roof of the mouth
Curettage is the removal of dead inner tissue from a gum pocket. In dentistry there are different types of curettage procedures and these are outlined below.
Types of Curettage
Gingival curettage: This is the removal with a curet (a spoon-shaped instrument for removing material from the wall of a cavity or other surface) of the inflamed tissue wall of a periodontal (area surrounding a tooth) pocket.
Periapical curettage: This is the removal, with a curet, of diseased soft tissues in the bony area surrounding a tooth root apex and smoothing of the top surface of a tooth without excision of the tooth tip.
Subgingival curettage: This is a slightly different form of gingival curettage.
Surgical curettage: This is a flap procedure to remove an inflamed periodontal pocket wall and the connective tissue attachment, followed by reattachment of the flap to the teeth.
Ultrasonic curettage: This is the removal of inflamed tissue from the tooth surface and wall of the gingival fissure with an ultrasonic scaler.
Patient is usually unaware of the presence of disease, though some may report bleeding gums, loose teeth, spreading of the teeth with appearance of spaces where none feeling in gums, relieved by digging with a tooth pick; There may also be pain of varied types and durations, including constant, dull, gunning pain, dull pain after eating, deep vadrating pain in jaws acute throbbing pain, sensitivity when cleaning gums, sensitivity of heat & cold, burning sensation in gums, and extreme sensitivity to unheated air. Usually what happens is that these symptoms appear at a very later stage of the disease and till that the poor patient, even being very keen about the health of his teeth, does not even get to know that this silent disease has already gone to its worse phase.
The problem which appears is that the disease which could have been reverted & health with just a bit of enhanced care & effort, is so much spread in the month, that patient is left with only fewer, more complicated, more extensive and expensive T/r options to save his teeth. Treatment for periodontal diseases do exist, and have miraculous results, but intervention vary according to the stage of disease at which the patient presents to the doctor.
1. Initial Stage: Therapy is simple, non surgical and less extensive and the disease too is totally reversible mostly at this stage professional oral proplytaxis i.e. scaling and polishing will suffice; along with enhanced maintenance and hygiene care on the part of patient.
2. Moderate Stage : A little more extensive procedure generally known as gingeral curellage or deep scaling can be helpful and these are good chances of healing of tissues to their stage of health.
3. Advanced Stage : At this stage, T/r has to be surgical, along with basic phase of scaling, polishing & maintenance. Many periodontal surgical procedures depending on the type of disease are available.
a. Ginginectomy : A minor surgery done under local anesthesia for enlarged and malformed gums to enchance health and beauty of smile.
b. Flap Surgery: A minor surgical procedure where tooth root is cleaned of all the infectious material and diseased tissues after raising a small part of overlying gums under LA.
d. Guided Tissue Regenerations: Where in some artificial barrier marenals are used with purpose of stimulating bone growth in a guided manner.
e. Muco gingival surgeries (perso plastic procedure) : These surgical procedures are aimed at either enhancing the esthetics of mouth by enlarging tooth root coverage etc. or to enhance the successful outcome of rest of periodontal surgical procedure.
4. Terminal Stage : It is the stage, where tooth is diseased beyond the limits and support has weakened to such an extent that it can no longer survive in the existing bone. Here comes the last resort of extraction of the tooth, which will be replaced by Dental Implant.