Periodontal Health

Periodontics is a specialized branch of dentistry that focuses on the diagnosis, prevention, and treatment of diseases and conditions that affect the supporting structures of the teeth. This includes the gums (gingiva), the bone that surrounds and supports the teeth, and the periodontal ligaments that anchor teeth to the bone.

Dulwich Dental Office is a world-class periodontics centre in London. We have performed over 10,000 periodontal treatments that have helped improve our patients’ teeth, periodontal health and avoid extractions.

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Criteria of Healthy Periodontal Tissue

Periodontal health is evident during diagnosis when the gum, bone, and periodontal attachment appear normal during examination. The criteria for healthy periodontal tissue include:

• Thin and scalloped gum margins.
• Coral pink colour gums with an orange peel appearance.
• Firm gum attachment without recession.
• No bleeding on probing.
• No pockets detected. The normal pocket depth is 1-3 mm.
• No evident bone loss during radiographic examination.

The Most Common Periodontal Diseases

1. Gingivitis

This term is used to describe periodontal diseases confined to the gums only. This is the initial form of periodontal disease, where a causative factor, mainly plaque, causes gum inflammation. Gum inflammation is expressed as bleeding during brushing, red, and swollen gums.

2. Periodontitis

If gingivitis goes untreated, the inflammation will progress to affect other components of the periodontal tissue. Periodontitis leads to significant tissue destruction, including bone resorption, the migration of the gum attachment to a lower level, resulting in pocket formation, gum recession, and root exposure, which may ultimately lead to tooth loss.

The Main Factors that May Endanger Periodontal Health

Dental plaque

Dental plaque is the primary cause of periodontal diseases. Normally, bacteria cannot adhere to the smooth surface of teeth; however, plaque provides a surface for bacteria to attach and release toxins and byproducts near the teeth and gums. Plaque is a sticky film that forms due to inadequate oral hygiene. If plaque is not removed within 24 hours, it is crucial to schedule a professional hygiene visit to thoroughly clean your teeth and eliminate the accumulated plaque.

Smoking and alcohol

Several studies have proved beyond doubt that smoking and alcohol consumption increase the risk for the development of periodontal diseases and increase their severity.

Uncontrolled diabetes

Diabetes can only affect the periodontal health when the blood sugar level is uncontrolled. This leads to weakening of the immune system, delayed healing, and a high risk of developing severe periodontal diseases.

The Importance of Periodontal Health

It is essential to maintain your periodontal health, as it affects not only your dental health but also your systemic health.

Dental Health:

Periodontal diseases, such as gingivitis and periodontitis, are prevalent conditions that affect the gums. Left untreated, they can lead to severe oral health issues, including gum recession, tooth mobility, and tooth loss.

Systemic Health:

Scientific research has demonstrated a significant connection between gum disease and systemic health conditions such as heart disease, diabetes, and respiratory problems. Maintaining optimal periodontal health is crucial for both your smile and overall well-being.

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When to See Our Specialist Periodontist

We recommend scheduling an appointment with our specialist periodontist if you experience any of the following symptoms:

• Gum bleeding, especially during brushing or flossing.
• Persistent bad breath or a foul taste in your mouth.
• Gum recession, leading to tooth sensitivity or the appearance of elongated teeth.
• Loose or shifting teeth.
• Changes in the fit of dentures or dental appliances.
• Formation of pockets or gaps between your teeth and gums.
• A family history of gum disease.

 

1. Scaling and Root Planning

Scaling and root planning, often referred to as a deep cleaning, is a common periodontal procedure performed by our specialist periodontists to treat gum disease. It is the first periodontal therapy step to remove plaque, control, and prevent further damage.

This process includes the following steps:

• Step 1: Assessment: Our periodontist begins by assessing the extent of gum disease through a comprehensive examination, which may involve probing or measuring pocket depth and taking X-rays to evaluate the bone level and if there is bone resorption.
• Step 2: Scaling: Using specialised instruments, our periodontists remove plaque and calculus (tartar) deposits from tooth surfaces and below the gumline.
• Step 3: Root Planning: The tooth roots are meticulously smoothed (planed) to eliminate rough areas where bacteria can accumulate. This promotes gum reattachment to the tooth’s surface.
• Step 4: Antibacterial Agents: In certain cases, our surgeons may apply antimicrobial agents or antibiotics to treated areas for further infection control.
• Step 5: Follow-Up: Periodic follow-up appointments are scheduled to monitor healing progress and address residual pockets or concerns.

2. Periodontal Surgery

When gum disease reaches an advanced stage or if more complex treatment is needed, our specialist periodontists may recommend periodontal surgery to reverse the damage that occurred and provide better conditions for healing. Common procedures include:

• Gingival Flap Surgery

Indications: Gingival flap surgery, also known as pocket reduction surgery or osseous surgery, is typically recommended for individuals with moderate to advanced periodontitis, where gum pockets have formed, and bone loss has occurred.

Procedure Overview:

Anaesthesia:Before commencing the surgery, local anaesthesia is administered to ensure the patient’s comfort during the procedure.

Incisions: The surgeon makes precise incisions in the gum tissue to create a flap, which is gently lifted away from the teeth and underlying bone. This provides access to the root surfaces and allows for thorough cleaning.

Root Debridement: Once the tooth roots are exposed, our surgeon meticulously removes plaque, calculus (tartar), and any infected tissue from the tooth surfaces. Special instruments are used for this purpose.

Smoothing of Bone: In cases where there is an irregular or damaged bone due to periodontal disease, the surgeon may perform bone reshaping or recontouring. This process helps eliminate areas where bacteria can hide and supports the reattachment of healthy gum tissue.

Flap Repositioning: After the cleaning and bone reshaping, the gum flap is repositioned and sutured back into place. The sutures used are often dissolvable and will naturally dissolve as the gums heal.

Postoperative Care: Patients receive detailed postoperative care instructions, including guidelines on oral hygiene, diet, and using prescribed medications.

Benefits: Gingival flap surgery aims to reduce pocket depths, promote gum reattachment to the tooth surfaces, and halt the progression of periodontal disease. It can help preserve teeth that might otherwise be lost to advanced gum disease.

• Bone and soft tissue Grafting

Advanced periodontal diseases can lead to bone resorption and gum recession, which can be corrected using bone and soft tissue grafting.

Bone grafts involve the stimulation of bone cells to form new bone. It aims to restore tooth stability and improve overall oral health.

Soft tissue grafts are used to augment and thicken gum tissue in areas where it has receded, helping protect tooth roots and enhancing smile aesthetics.

Procedure Overview:

Graft Collection: Bone grafts may have multiple sources, such as grafts collected from another site in the patient’s mouth, grafts from another donor, bovine grafts, and synthetic bone-like material. The bone graft collected from the same person is the best time because of the reduced risk for rejection. However, it requires a second surgical site.

Gum graft is collected from another site of the oral cavity with healthy, thickened soft tissue, most commonly the hard palate.

Local Anaesthesia: Anaesthesia is applied for your comfort during the whole procedure.

Securing the graft: The graft is secured in place and attached to healthy tissue all around to ensure success.

Post-operative care and follow-up: It is essential to follow the instructions of our expert periodontists to ensure the hygiene of the graft site, to ensure proper healing, and to avoid graft rejection.

• Crown Lengthening

Indications:

Crown lengthening is recommended when there is excessive gum tissue covering the tooth crowns, affecting your smile appearance, or the ability to place restorations like dental crowns.

Procedure Overview:

Anaesthesia: Local anaesthesia is administered to ensure patient comfort.

Gum Tissue Removal: The surgeon carefully removes excess gum tissue to expose more of the tooth crowns. In some cases, bone may also be reshaped to achieve the desired gumline.

Suture Placement: The gum tissue is sutured into its new position to facilitate healing.

Postoperative Care: Patients receive postoperative instructions and may need to follow a soft-food diet while the gums heal.

Benefits

Crown lengthening improves the balance between gum and tooth exposure, enhancing the aesthetics of the smile and allowing for the placement of dental restorations.

• Guided Tissue Regeneration

Indications:

Guided tissue regeneration is employed to stimulate the growth of selective tissue types, such as bone, in areas affected by periodontal disease using a barrier membrane.

Procedure Overview:

Anaesthesia: Local anaesthesia is administered for patient comfort.

Barrier Membrane Placement: A biocompatible barrier membrane is placed over the affected area. This membrane prevents unwanted tissue (such as gum tissue) from invading the healing area, allowing bone and other tissues to regenerate.

Suture Placement: The barrier membrane is secured in place with sutures.

Healing and Regeneration: Over time, the barrier membrane guides the growth of new bone and soft tissue, promoting proper healing.

Postoperative Care: Patients receive postoperative instructions and may need to follow specific guidelines for oral hygiene and diet during the healing process.

Benefits:

Guided tissue regeneration helps regenerate bone and soft tissue in areas affected by periodontal disease, improving the health of the supporting structures of the teeth.

How To Maintain Your Periodontal Health

It is essential to maintain your periodontal health to enjoy general and oral health. Our expert periodontists and hygienists provide detailed instructions and tips to help you during your daily oral hygiene practices. These are our experts’ top picks to maintain periodontal health:

1. Brush your teeth at least twice and floss at least once daily.
2. Use medium or soft-bristle toothbrushes and avoid the hard ones, as they may injure your gums and cause teeth wear.
3. Avoid vigorous brushing and use the correct brushing technique explained by our experts.
4. Change your toothbrush every 4 months.
5. Maintain regular hygiene visits every 6 months or as advised by our experts.
6. Maintain a healthy diet rich in fiber and reduce sugar consumption.
7. Quit smoking and reduce alcohol intake.
8. If you are a diabetic patient, make sure to control your blood sugar level within the normal range.

Conclusion

At Dulwich Dental Office, our specialist periodontists play a crucial role in preserving and enhancing your periodontal health. Whether you require treatment for gum disease, periodontal surgery, or dental implants, our skilled surgeons provide exceptional care and ensure your oral health and smile remain in optimal condition. If you have any questions or wish to schedule a consultation with our specialist periodontists, please do not hesitate to contact us. Your periodontal health is our priority, and we are here to assist you every step of the way.