FAQs
Frequently Asked Questions
• What is periodontitis (Gum Disease)? Periodontitis is inflammation of the tissues that support the teeth, that is the gums and the supporting bone. Peri- means around, -odont- means tooth and -itis means inflammation. In susceptible individuals, this inflammation leads to a loss of the supporting bone and subsequent gum recession. The gum recession leads to spaces opening between the teeth and the teeth appear longer as the root surfaces are exposed. Significant aesthetic problems often arise if the disease is not treated in the early stages and kept stable with ongoing maintenance treatment. Eventually, without early and appropriate treatment, including long term regular maintenance treatment, Periodontitis may lead to tooth loss and significant damage to the soft tissues (gums) and supporting bone. The damage to the supporting tissues can then limit the options to replace missing teeth or make replacement significantly more complex and challenging.
• What are the symptoms of Periodontal Disease? In the early stages, symptoms are usually vague and not recognised by most patients. The early form of periodontal disease, Gingivitis, is characterised by inflammation that is restricted to the soft tissues (gums) alone, without involvement of the supporting bone. Early warning signs are an increased redness of the gums around the tooth margins and bleeding of the gums during or after brushing or flossing. Many people attribute bleeding when brushing to scrubbing too hard with the toothbrush, and this might even be the case. However, a healthy non-inflamed gum does not bleed easily. Therefore, if you recognise bleeding during brushing, flossing or the use of interdental brushes, it is strongly recommended that you see your dentist to be screened for periodontal disease. Other possible symptoms include gum recession, swelling and inflammation at the gum margin, bad breath and metallic tastes (bleeding). The more advanced stage of periodontal diseases, Periodontitis, is characterised not only by an exacerbation of the inflammation of the gums but particularly by loss of the supporting bone. Symptoms of the advanced stages of periodontitis include drifting, tilting or rotation of teeth, more obvious gum recession with spaces opening between the teeth, gum abscesses, increasing tooth mobility or wobbling teeth, as well as discomfort when chewing and tooth loss.
• What causes Periodontal Disease? Periodontal disease is caused by plaque bacteria. Your mouth was colonised with bacteria the day you were born, as you exited the birth canal. The tooth surface is unique in that it is the only part of the body surface that is not constantly shedding. Specific bacteria in your mouth are able to adhere to the exposed tooth and tooth root surfaces. After adhering, the bacteria start to produce a sticky matrix layer that literally glues them to the tooth surfaces and protects them from being rinsed away by saliva or wiped away by normal tongue or lip movement. This adhesive layer allows a succession of other bacterial species to colonize the tooth surfaces and all these different bacteria, together with the adhesive matrix is what we call today the oral biofilm, previously known as dental plaque. When this maturing biofilm reaches a certain thickness, alterations in the bacterial composition of the biofilm are taking place, facilitated by changes in oxygen levels and nutrient supply. These changes favour the growth of more harmful bacteria and potentially the colonisation with highly pathogenic or virulent bacteria. These more pathogenic bacteria are specifically known to induce, promote and expedite the rate of progression of Periodontal disease. Some bacteria are able to migrate into the gum tissues and induce a more powerful inflammatory response, resulting in more extensive damage to the supporting periodontal tissues including gums and bone.
• Why do I have Periodontal Disease? Not all people develop the loss of bone that occurs with Periodontitis. Some people are more susceptible to periodontal disease than others. Possible reasons for greater susceptibility include genetic factors, insufficient oral hygiene, presence of specific pathogenic bacteria, smoking, diabetes and other systemic diseases, stress, obesity and certain medications. A thorough and detailed individual assessment of risk factors is important for each patient, to allow for customised treatment of the disease.
• How is Periodontal Disease treated? We are not able to address the individual genetic factors underlying susceptibility to periodontal disease at this point. The general treatment of Periodontal is focused on removal or control of the oral plaque biofilm and the associated bacteria. It is very important for patients to effectively remove as much as possible of these soft plaque deposits from above the gum line on a daily basis, by employing an effective brushing technique, performed at least twice per day. In one of your initial appointments, your Periodontist will therefore spend time to work with you to optimise your daily plaque control regime. Your Periodontist will assess your oral hygiene status and gum condition and will then provide you with a customised oral hygiene protocol, tailored to your individual needs. This will include detailed recommendations regarding tooth brush design and type, brushing technique, interdental cleaning aids, tooth paste and perhaps mouthwash, that fits best for your individual periodontal situation and needs. Your Periodontist will also re-evaluate your oral hygiene improvements and re-adjust the recommendations if required. It is of paramount importance for the long-term treatment success that the patient conducts and maintains effective daily plaque control. In order to make an accurate diagnosis, your periodontist will perform a comprehensive periodontal assessment, which involves an interview to collect necessary background information to determine your history. Numerous clinical measurements as well as a detailed radiographic evaluation (X-rays) are required, to determine the extent and severity of your periodontal disease. Your Periodontist will classify both severity (Stage) and progression rate (Grade) of your Periodontitis and will arrive at a prognosis for your dentition, which will form the basis of a detailed customised treatment plan. Patients with very advanced or aggressive periodontal disease may need some additional laboratory testing, such as testing of blood markers as well as further investigations undertaken by your general practitioner or medical specialist. Your periodontal treatment will, after establishing satisfactory tooth brushing technique, involve the non-surgical removal or reduction of hard and soft bacterial deposits (plaque and calculus) below the gum line by using a combination of hand curettes and power-driven instruments and this is called deep cleaning or debridement. This debridement is usually conducted under local anaesthesia to ensure patient comfort. The aim of the initial treatment is to reduce the numbers of pathogenic bacterial species and the volume of plaque and calculus as much as possible, to reduce or eliminate the inflammation in your periodontal tissues. This phase of treatment aims to stabilise your periodontal disease, which will reduce the risk of further damage to your periodontal tissues from periodontal disease activity. The initial deep clean below the gum line is usually conducted in two to four appointments. Very advanced or aggressive periodontal disease might occasionally require the adjunctive use of antibiotics or other medications. To remove soft bacterial deposits (plaque) above and below the gum line, we use in our practice modern Airflow devices. These devices use a slurry of water, a fine powder and pressurized air and work in a similar way to a sandblaster or pressure washer. The benefit of AirFlow devices is that they are very useful for cleaning rough surfaces and areas that are difficult to access with regular instruments. Airflow machines clean efficiently and they are very gentle to tooth root surfaces as well as the gum and often don’t necessitate the use of local anaesthetic. After the initial non-surgical therapy has been completed, we allow for a six to eight week healing phase, after which your Periodontist will book you for a re-assessment to evaluate your progress and the treatment outcome. At this stage your periodontaist will decide whether other measures are required to stabilise your periodontal disease, such as periodontal surgery to address sites that are not responding to treatment. If the response to treatment has been satisfactory, you progress to the next phase of periodontal treatment, which is supportive periodontal care (SPC). We usually use AirFlow devices to complete the SPC, to minimise discomfort. The intervals between these SPC appointments depend on how stable the periodontal disease is after treatment and this depends on factors such as the patient’s individual healing response, which is often influenced by the presence of risk factors such as diabetes and smoking, as well as the quality of the patients oral home care. The supportive treatment intervals usually vary between three and twelve months.
• Is it possible to cure Periodontal Disease? The early stage of periodontal diseases, Gingivitis, can be usually “cured” and is completely reversible, subject to an early and appropriate treatment which consists of treatment to remove plaque and calculus from tooth surfaces and to assist the patient in developing an effective daily tooth brushing routine. Periodontitis, is not reversible and cannot be “cured” because susceptibility to periodontal disease is to a large extent genetic and there is no way for Periodontists to address the genetic factors underlying susceptibility to periodontal disease at this stage. However, if the patient maintains a satisfactory daily standard of plaque control, addresses risk factors that are within their control and has appropriate treatment for their periodontal disease including regular SPC, most patients with periodontal disease can be stabilised and further loss of tooth supporting tissues can be prevented or at least significantly reduced.
• What are the risk modifying factors for Periodontal Disease? Risk modifying factors are factors that can increase the susceptibility to contract periodontal disease as well as the rate of progression of an already existing periodontal disease, the end result being more extensive and more rapid loss of supporting bone and increased probability of tooth loss. Such risk factors are for example poor daily plaque control, the presence of specific pathogenic bacteria, smoking, diabetes, stress, other systemic diseases, specific medications or genetic factors. Your Periodontist will assess your individual risk factors during the initial assessment and discuss their impact on your periodontal condition as well as possible options to mitigate these factors, to reduce their impact on your periodontal health.
• What is Peri-Implant Disease? Similar to periodontal disease, which affects the supportive tissues around your teeth, peri-implant diseases affect the supportive tissues surrounding dental implants. We distinguish between two different types of peri-implant diseases: Peri-implant Mucositis and Peri-Implantitis. Peri-implant Mucositis is similar to Gingivitis mentioned above and is characterised by inflammation that is restricted to the soft tissues alone, without involvement of the supporting bone. The signs of peri-implantitis are increased redness of the gums around the implant margins and bleeding of the gums during or after brushing. Peri-Implantitis is similar to Periodontitis mentioned above, characterised not only by an exacerbation of the inflammation of the gums but particularly by an involvement of the implant fixture’s supporting bone. Symptoms of Peri-implantitis are more obvious gum recession and spaces opening around the dental implant, implant-related gum abscesses, and particularly progressive bone loss around the dental implant (seen on X-ray) and finally implant loss.
• What causes Peri-implant Diseases? The causes of Peri-implant Disease are more complex than those of Periodontal Disease. In most cases, bacterial infection as well as risk modifiers similar to Periodontal Disease are the underlying causes. However, in Peri-implant Diseases, technical problems with the implant or implant components, biological characteristics of the surrounding tissues as well as problems during or after the implant surgery can play a significant role. During the assessment, your Periodontist will investigate all possible causative factors and discuss how to manage them with you.
• How is Peri-implant Disease treated? There are usually many factors at play in Peri-implant Diseases. Therefore, the treatment of your Peri-implant Disease will be customised to your particular needs. Treatment can range from simple non-surgical debridement to complex surgical interventions, from replacement of single parts of the restoration or with very advanced disease, to the removal of the whole implant. Your Periodontist will discuss your individual treatment plan in detail with you.