PERIODONTAL DISEASE:

The two most common diseases in the mouth are dental caries (tooth decay) & periodontal disease. Over the age of 30, periodontal disease becomes more common than caries & is second only to cold & flu as the most common of human diseases. Periodontal disease occurs in two forms:

1. GINGIVITIS:

This is the first & a reversible stage of periodontal disease. It can be very localized or it can affect the entire mouth depending on how one cleans the gum. Areas left unclean, results in plaque build-up on tooth surfaces, between teeth & under the gum line, thus causing inflammation–, & bleeding of the gums when plaque bacteria produce toxins that irritate gum tissue. The gums gradually become red, swollen (spongy) & move away from the teeth forming pockets. Generally the condition is painless. By removing the cause, PLAQUE, it will clear up within a few days. Please note that prescribing antibiotics will only help to treat the symptoms & not the disease! If left untreated, Gingivitis will often progress to result in Periodontitis.

2. PERIODONTITIS:

The terminal stage of this disease was once referred to as "Pyorrhea". Periodontal disease is a slowly progressing chronic inflammation that affects approximately 34% of the population over 30 by affecting the structures supporting the teeth (gums & periodontal ligament). In most cases, periodontal disease can start–, develop– & progress to the loss of some or all of the teeth without the patient experiencing any pain whatsoever! Even though bleeding of the gums is an early warning sign, bleeding may disappear as the disease progresses giving the false impression that the disease is no longer present!

Dentists need to consider the severity of the condition & be aware of the limitations of non-surgical therapy. Over emphasis on non-surgical therapy may lead to patients not being referred to a Periodontist for special care in a timely fashion, or may not be receiving adequate initial periodontal therapy in general dental practices.

More importantly, after patients are successfully treated, they need to be monitored & re–evaluated periodically to determine if disease in progression has occurred.

WHY TREAT PERIODONTAL DISEASE?

The main reason for treating periodontal disease is to preserve the natural teeth (without treatment there is a continuation of the destruction of the supporting tissues of the teeth resulting in tooth loss).
Researchers have found that people with periodontal disease are almost twice as likely to suffer from coronary artery disease (heart disease), as those without periodontal disease. Several theories exist to explain this link: Periodontal bacteria can enter the blood stream & travel to major organs to begin new infections. The heart is one of the most susceptible organs.
Some existing heart conditions can put people at risk for infective endocarditis which is characterized by the inflammation of the lining of the heart & heart valves.
A number of studies have reported that the clinical signs of periodontitis may be associated with cardiovascular events. Cardiovascular disease is the top cause of death & carries with it considerable morbidity. As a result of this link with cardiovascular disease, interest in periodontal disease prevention– & treatment is likely to intensify in the private– & public health sectors & in the general public.
Periodontal disease also has been linked to other significant health problems, including respiratory diseases, diabetes, osteoporosis, premature & underweight births.
The increased prevalence of periodontal disease in patients with diabetes is likely due to the adverse effects of hyperglycemia & possible insulin resistance. The complications of diabetes on cardiovascular disease & potential effect of periodontal therapy on glycemic control, have important public health & economic implications. Both conditions are common chronic diseases. New treatment for periodontal disease in diabetes patients can improve oral health & may also improve diabetes & other systemic disorders in these patients, thus leading to a dramatic reduction in health care costs.

TREATMENT:

In order to assess the state of health in your mouth, your Periodontist must perform a detailed clinical examination consisting of the inspection of the gum tissue, measurements of the extent of gum destruction around the entire mouth & taking of a set of full mouth radiographs.

Treatment usually consists of:

Learning of an effective oral hygiene technique.
Having your teeth scaled & polished.
Root planning & or periodontal flap surgery (non-surgical / surgical periodontal therapy)

1. Root planning: (non–surgical)

Limitations of non–surgical periodontal therapy:

Non–surgical therapy is limited to:

Individuals where pocket depths is less than 5mm
Medically compromised patients with uncontrolled or poorly controlled systemic disease

2. Periodontal flap surgery (surgical periodontal therapy):

Where the condition is advanced, minor surgical procedures may be necessary to gain access to the roots, as well as to correct any major bone changes. When tartar deposits are found under the gums, it is necessary to first lift the gums away from the tooth & the bone. By lifting/deflecting the gum the root surface is exposed thus ensuring efficient cleaning (the depth of the pocket is reduced).

Surgical therapy in indicated in cases where:

pocket depths > 5mm area inaccessible for debridement
areas with irregular bony contours or deep vertical osseous defects,
in cases of grade II or grade III furcation involvement,
infra–bony pockets in distal areas of last molars,
persistent inflammation in areas with moderate to deep periodontal pockets,

What happens when treatment has been completed?

You will be scheduled to commence a periodontal maintenance programme which will usually consist of six monthly visits to your Periodontist & Oral Hygienist. With regular maintenance therapy screening will be carried out to ensure that your oral hygiene technique remains efficient & to detect & treat any recurrence of the disease as early as possible.