Periodontics is the branch of dentistry that is concerned with the treatment of gum diseases. One who has specialized in this particular branch is called a Periodontist.
A tooth has got two parts; a crown and a root. The portion that can be seen outside is called the crown. The part that is within the gums is called the root. Just like a good building needs a strong foundation, the root portion of a healthy tooth must be strongly anchored within the tooth socket, which is a part of the jaw bones. The healthy gums form a tight covering or curtain over the root and the surrounding bone.
Gum diseases are caused by the absence of proper oral hygiene. Improper/inadequate brushing will lead to the formation of tooth deposits, which mainly are of two types. The initially formed deposits are thin, soft, yellowish white in color, and cannot be easily seen with the naked eye. This is called dental plaque. Even though dental plaque forms very rapidly, proper brushing on a regular basis (twice a day) can remove most of it and can protect the gums. Dental plaque, over a period of time will harden to form another type of deposit known as tartar or dental calculus. Calculus cannot be removed by brushing, instead requires professional removal. Plaque and calculus are initially formed on the tooth surface outside the gums. In course of time, these will extend under the gums. The action of the harmful bacteria present in these deposits will lead to the infection of the gums.
Gum diseases are of two main types. Initially gum diseases are confined only to the gums without affecting the underlying bone. This is called gingivitis. The most common symptoms of gingivitis are bleeding from the gums especially while brushing or biting on hard food, bright red color of the gums, and mild swelling of the gums.
If gingivitis is not treated in time, it will lead to the detachment of the gums from the tooth thereby creating a space between the gums and the tooth known as a pocket. A pocket can be detected only by your doctor with the help of special instruments. Bacteria can easily grow inside this pocket. The action of these bacteria will lead to the destruction of the bone that supports the tooth root. This stage of the disease is called pyorrhea or periodontitis. The common symptoms of periodontitis are shaking teeth, pus discharge from the gums, foul taste in the mouth, foul smell of the mouth, itching sensation in the gums, food getting stuck between the gums and the teeth, sudden appearance of gaps between the teeth or change in the normal position of the teeth. In some cases, the gums will recede from the teeth resulting in the exposure of the root portion. This may lead to sensitivity of the teeth especially while taking cold food or drinks. In severe cases, there will be occurrence of painful swellings on the gums frequently (abscess formation).
X-rays are often required to determine the extent of the disease. Depending on the number of teeth affected, either small x-rays of individual teeth or a big x-ray including all the teeth (OPG) might be required.
If not treated, the disease can progress to such an extent that the tooth will fall off itself.
Although poor oral hygiene is the primary cause of gum diseases, certain other conditions can aggravate gum diseases. They include chronic smoking, diabetes, and hormonal variations associated with pregnancy. The chronic use of certain drugs (medicines for hypertension and epilepsy) can result in gum enlargement. Although gum diseases usually manifest above the age of 35 years, a hereditary type of severe form of gum disease is seen in young people less than 30 years of age.
The basic treatment for any type of gum disease starts with professional tooth cleaning called scaling which may require multiple visits depending on the amount of deposits on the teeth. Initial stages of gum diseases (gingivitis) can be treated most of the times by proper scaling alone.
In more advanced cases, scaling has to be followed by deep scaling (scaling under the gums). This will often require the use of local anesthesia.
In cases where there are deep pockets and considerable loss of tooth supporting bone, a procedure called flap surgery is done. This is done in the dental clinic itself under local anesthesia. Here the gums are surgically reflected from the tooth and the infected tissue inside is removed and the root surfaces are thoroughly cleaned. In certain situations, artificial bone graft materials are placed in areas where natural bone has been destroyed due to disease. Afterwards, the gums are stitched back in place. The stitches can be removed within 10 – 14 days after surgery.
In the case of shaking teeth, a procedure called splinting can be done. Here, the loose teeth are attached to the adjacent firm teeth with the help of certain materials.
These are surgical procedures of the gums done for improvement of the esthetic appearance of the patients. These are usually indicated for people with gummy smile (excessive display of gums while smiling) and also for teeth with receded gums.
No medicine can completely cure gum diseases as long as the deposits are present on the tooth surface. In acute stages of the disease and following surgical treatment certain antibiotics and antiseptic mouthwashes may be required to control the disease and prevent infection.
Treatment of gum diseases is quite predictable and good results are obtained most of the times. However, the long-term success of the treatment depends a lot on co-operation of the patient. Following treatment, the patient has to maintain his/her oral hygiene properly. Along with this regular dental check ups once in 3-4 months is also needed.
Recent studies have shown that chronic gum infections can aggravate many other diseases like diabetes, heart diseases, respiratory diseases, gastro-intestinal diseases etc. A significant finding is that severe gum infections in pregnant women can result in premature delivery and birth of underweight babies.
The only effective method to prevent the development of gum diseases is to maintain a good oral hygiene. For this, proper brushing of the teeth must be done at least twice a day. Any dentist will demonstrate you the correct method of brushing. Also a dental visit at least once in every six months is mandatory. Remember, in initial stages of gum diseases, there won’t be much pain or discomfort. Therefore, only a thorough dental examination by a dentist can identify your gum problem at the initial stages.