%namePeriodontology – what is it?

Periodontal disease is, right after caries, the second most common cause of tooth loss. Development of this disease is primarily affected by poor hygiene, but also genetic predisposition, immune system disorders, general diseases and so-called modifiable factors: nicotine dependency, obesity or chronic stress. The periodontologist’s task is to accurately diagnose the causes of the disease and to plan comprehensive treatment.

Periodontics – types of treatments

Periodontological treatment can be divided into non-surgical treatment and periodontal surgery. The first group of treatments includes mainly the so-called subgingival scaling and curettage: cleaning the tooth surface (both crown and root) from bacterial plaque, which is the direct cause of gingivitis or periodontitis. Scaling is performed using manual or ultrasonic tools, adapted to individual tooth surfaces. The treatment is supplemented with antiseptics, and in exceptional cases antibiotics administered to control the infection.

Periodontological surgery can be divided into resection, regeneration and plastic surgery. The first group includes procedures for removing overgrown gums or epulis, as well as open curettage, during which the doctor can cleanse the infected root surface, seeing it. Regenerative treatment is an extremely dynamically developing branch of periodontology. It uses bone substitutes for reconstruction of the bones disappeared as a result of periodontitis. In regenerative surgery we use special techniques to restore the connection of the gingiva with the tooth. Periodontological plastic surgery aims to improve the aesthetics of a smile by shaping the gums. For example, the aim of treatments can be: to cover the recession (exposed necks), reconstruction of the gum between teeth, covering of exposed roots of molars, correction of frenulum and reconstruction of the gum width (to prevent a recession). Most periodontologists may perform the majority of surgical procedures in cooperation with a dental surgeon.

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The periodontologist is also a specialist in the field of mucous membrane diseases. It recognizes and treats such changes as oral mycosis, recurrent aphthous stomatitis, as well as more serious ones, such as lichen planus or leukoplakia. Typically, the treatment is pharmacological and involves the use of medications in the oral cavity, but sometimes a periodontologist can use a laser method or photodynamic therapy. Both methods involve light exposure of changes to reduce them. Small changes can be removed surgically as well as using cryotherapy.

Periodontology – the course of the procedure

Professional periodontal treatment is carried out according to a defined scheme, consisting of several phases. The first stage is hygienisation – removal of plaque and tartar – usually done in the office of dental prophylaxis in our clinic. Then we perform also supragingival scaling and polishing of the tooth surface (see: dental prophylaxis). At this stage, caries treatment is also performed (see: conservative dentistry) and removal of unfit teeth (see: oral surgery). At subsequent visits, the periodontologist performs subgingival scaling and curettage procedures, always under local anesthesia, so that the patient feels comfortable.

periodontologia wroclawAfter completing this phase, the patient comes for control after 4 – 6 weeks. Then the effects of treatment are assessed. If the patient and the dentist are not satisfied, surgical treatment is performed. Under a local anesthesia the periodontologist performs the appropriate procedures, usually completed by sewing the wounds. The patient receives post-treatment recommendations, which must be strictly followed. At the next visit, after about a week, sutures are removed, and the patient gets schedule of follow-up visits to monitor the healing of the treatment site. The subsequent phases of the comprehensive periodontal treatment include orthodontic or prosthetic treatment, under the supervision of appropriate specialists.

Treatment of the mucosa lesions with the use of laser or photodynamic therapy consists of irradiating them for several minutes with a special light. It is a completely painless method and stimulates the body to remove diseased cells, thanks to which the change reduces its size. Surgical removal is always performed under local anesthesia. For every suspicious change, the doctor takes a slice and sends it for histopathological examination to check it for cancer.


Periodontology – indications and contraindications

All patients who have problems with chronic gingivostomatitis, exposed tooth necks or have loose teeth should report to the periodontologist. Indications for surgical periodontal treatment include subgingival margins that do not shrink after hygienization, gingival hypertrophy, abnormal frenum (eg upper lip frenulum causing diastema: separation of the incisors), and gingival recessions (exposed tooth necks). This treatment is also indicated before the prosthetic treatment, for example to extend the tooth crown (by cutting the gum) when it is damaged and it is impossible to put on the prosthetic crown or bridge. Periodontologist can also work with an orthodontist, increasing the width of the gums by surgical procedures, when the front teeth (especially lower ones) should be moved forward and there is a risk of a recession.
The first phase of periodontal treatment is hygienisation, ie the removal of plague and tartar. After hygienisation, the patient receives recommendations regarding home hygiene. Hygiene is assessed at the control visit and if it is unsatisfactory, the periodontologist cannot go to the next phase. This means that the basic contraindication to professional periodontal treatment, including periodontal surgery, is the inability to maintain proper oral hygiene by the patient. Sometimes it results from physical or mental disability. Then we can proceed with so-called palliative care, which is based on regular hygienic visits, and its goal is to keep the patient’s teeth as long as possible. Other contraindications for surgical procedures are general diseases affecting healing, e.g. diabetes or blood diseases, as well as taking anticoagulants. If they occur, the treating physician has to prepare the patient for treatment.

Periodontics – frequently asked questions

What is the goal of next periodic visits to the periodontologist, while I do not see any changes?

Periodontal disease is multifactorial and chronic, and this means that it is influenced by various conditions contributing to its recurrence. These are both genetic and immune disorders, as well as smoking, obesity, stress or infection with specific bacteria. The basis of treatment is constant monitoring of the course of the disease and rapid response when it gets worse. It is extremely important to eliminate the so-called modifiable factors named above – patients with periodontal disease should quit smoking as soon as possible, prevent obesity development and maintain excellent oral hygiene.

I brush my teeth after eating, I use mouth rinses, and yet the doctor still says that my hygiene is not enough. What should I do?

Very often, patients seem to take excellent care of their teeth. Unfortunately, research shows that most people brush their teeth for about 30 seconds (it should be done for 2 minutes), mainly cleaning the front teeth. There are often paradoxical situations when the surfaces of the front teeth are worn away from too intensive brushing and there is plaque on other teeth. Rinses should only be an addition, yet and many patients use them several times a day, paying less attention to the mechanical removal of plaque. To improve oral hygiene, use, for example, dental plaque coloring preparations. This allows you to visualize the rough spots that you need to brush thoroughly. It is also important to floss the interdental spaces, and sometimes you can reach for interdental brushes, as recommended by your doctor.