Periodontics
Periodontology is the specialty of dentistry that studies supporting structures of teeth, as well as diseases and conditions that affect them. A periodontist is a dentist who specializes in the prevention, diagnosis, and treatment of periodontal disease. Periodontists are also experts in the treatment of oral inflammation.
Periodontal Disease
Swollen and bleeding gums are early signs that your gums are infected with bacteria. If nothing is done, the infection can spread. It can destroy the structures that support your teeth in your jawbone. Eventually, your teeth can become so loose that they have to be extracted. "Peri" means around, and "odontal" refers to teeth. Periodontal diseases are infections of the structures around the teeth. These include the gums, the cementum that covers the root, the periodontal ligament and the alveolar bone. In the earliest stage of periodontal disease, gingivitis, the infection affects only the gums. In more severe forms of the disease, all of the supporting tissues are involved. For many years scientists have been trying to figure out what causes periodontal disease. It is now well accepted that bacteria in dental plaque are the major villains.
Gingivitis and Periodontitis
Gingivitis (gum inflammation) usually precedes periodontitis (gum disease). However, it is important to know that not all gingivitis progresses to periodontitis. In the early stage of gingivitis, bacteria in plaque build up, causing the gums to become inflamed and to easily bleed during tooth brushing. Although the gums may be irritated, the teeth are still firmly planted in their sockets. No irreversible bone or other tissue damage has occurred at this stage.
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When gingivitis is left untreated, it can advance to periodontitis. In a person with periodontitis, the inner layer of the gum and bone pull away from the teeth and form pockets. These small spaces between teeth and gums collect debris and can become infected. The body's immune system fights the bacteria as the plaque spreads and grows below the gum line.


How Can Gum Diseases Be Prevented?
Gum disease can be reversed in nearly all cases when proper plaque control is practiced. Proper plaque control consists of professional cleanings at least twice a year and daily brushing and flossing. Brushing eliminates plaque from the surfaces of the teeth that can be reached; flossing removes food particles and plaque from in between the teeth and under the gum line. Antibacterial mouth rinses can reduce bacteria that cause plaque and gum disease, according to the American Dental Association.
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Other health and lifestyle changes that will decrease the risk, severity, and speed of gum disease development include:
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Stop smoking - Tobacco use is a significant risk factor for development of periodontitis. Smokers are seven times more likely to get gum disease than nonsmokers, and smoking can lower the chances of success of some treatments.
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Reduce stress - Stress may make it difficult for your body's immune system to fight off infection.
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Maintain a well-balanced diet - Proper nutrition helps your immune system fight infection. Eating foods with antioxidant properties -- for example, those containing vitamin E ( vegetable oils, nuts, green leafy vegetables) and vitamin C (citrus fruits, broccoli, potatoes) -- can help your body repair damaged tissue.
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Avoid clenching and grinding your teeth - These actions may put excess force on the supporting tissues of the teeth and could increase the rate at which these tissues are destroyed.
Despite following good oral hygiene practices and making other healthy lifestyle choices, the American Academy of Periodontology says that up to 30% of Americans may be genetically susceptible to gum disease. And those who are genetically predisposed may be up to six times more likely to develop some form of gum disease. If anyone in your family has gum disease, it may mean that you are at greater risk, as well. If you are more susceptible to gum disease, your dentist or periodontist may recommend more frequent check-ups, cleanings, and treatments to better manage the condition.
Treatments for Gum Disease
There are a variety of treatments for gum disease depending on the stage of disease, how you may have responded to earlier treatments, and your overall health. Treatments range from nonsurgical therapies that control bacterial growth to surgery to restore supportive tissues.
• Non-surgical Treatments for Gum Disease
Treatments for gum disease that don't involve surgery include:
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Professional dental cleaning. During a typical checkup your dentist or dental hygienist will remove the plaque and tartar (plaque that builds up and hardens on the tooth surface and can only be removed with professional cleaning) from above and below the gum line of all teeth. If you have some signs of gum disease, your dentist may recommend professional dental cleaning more than twice-a-year. Dental cleanings are not a treatment for active gum disease. They are, though, an important preventive measure that can help you stave off its development.
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Scaling and root planing. This is a deep-cleaning, nonsurgical procedure, done under a local anesthetic, whereby plaque and tartar from above and below the gum line are scraped away (scaling) and rough spots on the tooth root are made smooth (planing). Smoothing the rough spots removes bacteria and provides a clean surface for the gums to reattach to the teeth. Scaling and root planing is done if your dentist or periodontist determines that you have plaque and calculus (hardened plaque, also called tartar) under the gums that needs to be removed.
• Surgical Treatments for Gum Disease
Some treatments for gum disease are surgical. Some examples are:
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Flap surgery/pocket reduction surgery. During this procedure the gums are lifted back and the tarter is removed. In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. The gums are then placed so that the tissue fits snugly around the tooth. This method reduces the size of the space between the gum and tooth, thereby decreasing the areas where harmful bacteria can grow and decreasing the chance of serious health problems associated with periodontal disease.
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Bone grafts. This procedure involves using fragments of your own bone, synthetic bone, or donated bone to replace bone destroyed by gum disease. The grafts serve as a platform for the regrowth of bone, which restores stability to teeth. New technology, called tissue engineering, encourages your own body to regenerate bone and tissue at an accelerated rate.
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Soft tissue grafts. This procedure reinforces thin gums or fills in places where gums have receded. Grafted tissue, most often taken from the roof of the mouth, is stitched in place, adding tissue to the affected area.
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Guided tissue regeneration. Performed when the bone supporting your teeth has been destroyed, this procedure stimulates bone and gum tissue growth. Done in combination with flap surgery, a small piece of mesh-like fabric is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow to better support the teeth.
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Bone surgery. Smoothes shallow craters in the bone due to moderate and advanced bone loss. Following flap surgery, the bone around the tooth is reshaped to decrease the craters. This makes it harder for bacteria to collect and grow.