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Periodontics

Gum disease is one of the main causes of tooth loss and is highly prevalent; people are often unaware they have it because it is not painful and doesn’t affect their daily life, but if left untreated the impact can be serious, damaging the bone and tissue that support the teeth.

Periodontology is the dental specialism that deals with the treatment of gum disease which begins with plaque, a biofilm of bacteria that grows in the mouth every day and which, if allowed to build up, forms tartar, or calculus, which gathers at the junction where the teeth come through the gums and can only be removed by a dentist.

Gum disease is present in 83 per cent of adults and gets more common with older age; it is the biggest cause of tooth loss in over-40's. Symptoms include bleeding gums, gums that have come away from the teeth, persistent bad breath or bad taste in the mouth, and teeth that are loose or changing position. The simplest form of gum disease is gingivitis, which with the proper dental treatment is a reversible condition. If untreated, it can develop into periodontitis, which can result in tooth loss.

Bacteria in the body can also get into the blood stream through the mouth and gradually contribute to health problems such as heart disease, if gum disease is left untreated. Seeing a hygienist every three months stops this bacterial build up, preventing gum problems, bad breath, tooth decay and helping to protect systemic health. Occasionally, even in a relatively healthy mouth, gums may become sore and infected, producing an unpleasant metallic taste. This is acute gingivitis and requires urgent treatment.

As the tissue starts to break down, pockets form in the gum around the teeth which allow more plaque to form. This is known as chronic periodontitis and has been linked to increased inflammation in the body, which may lead to increased risk of stroke or heart disease.

The first stage in the treatment of periodontitis is a non-surgical cleaning of the pockets below the gum line. This is known as scaling or debridement. In deeper areas a treatment called root planing or deep scaling is used which cleans deep pockets and removes plaque and tartar from the tooth roots. This procedure may require local anaesthetic and several visits to the practice.

In addition to initial periodontic treatment it may also be necessary to adjust the bite, or occlusion, to prevent excessive force on teeth that have reduced bone support.

Studies have shown that non-surgical scaling and root planing is usually successful if the periodontal pockets are shallower than 4-5mm. It is necessary for the dentist or hygienist to perform a re-evaluation four to six weeks after the initial scaling and root planning to determine if the patient’s oral hygiene has improved and inflammation has regressed. Pocket depths of greater than 5-6mm which remain after initial therapy, with bleeding upon probing, indicate continued active disease and will likely lead to further bone loss.

This is especially true in molar tooth sites where areas between the roots have been exposed. If non-surgical therapy is unsuccessful, periodontal surgery may be needed to stop progressive bone loss and regenerate lost bone where possible.

There are many surgical approaches used in the treatment of advanced periodontitis and the periodontist at Harley Street Dental and Implant Clinic will discuss these with the patient.

Long term studies have shown that in moderate to advanced periodontitis, surgically treated cases often have less further breakdown over time and when coupled with a regular post treatment maintenance regimen are successful in halting tooth loss in nearly 85 per cent of patients. This involves regular check-ups and detailed cleanings every three months to prevent repopulation of periodontitis-causing micro-organisms, and to closely monitor affected teeth so that early treatment can be given if disease recurs.

The hygienists at Harley Street Dental and Implant Clinic help patients create effective oral hygiene regimes that encompass the best type of tooth brush for them, brushing technique, flossing and use of a medicated mouthwash. Diet and frequency of eating is also a factor which can affect oral health because regular snacks and drinks can strip the teeth of their protective minerals, accelerating decay.

Even with a good tooth brushing technique, most people miss parts of their mouth regularly. Harley Street Dental and Implant Clinic recommends a dental check-up twice a year to detect and treat early signs of gum disease and a hygienist appointment every quarter to remove calculus.

If you are experiencing bleeding gums, gums that have come away from the teeth, persistent bad breath or bad taste or teeth that are loose or changing position, book an appointment with a periodontist at Harley Street Dental and Implant Clinic.