Periodontology

What is periodontology?

Periodontology is a field of dentistry that deals with periodontal diseases, i.e. diseases of the tissues surrounding the tooth and holding it in the bone. Periodontal diseases, along with caries, are the most frequently diagnosed diseases in the oral cavity.

A periodontist also diagnoses and treats changes in the mucous membrane of the oral cavity.

What does a periodontal consultation look like?

During the consultation, the periodontist assesses the condition of the periodontium based on the patient's medical history, clinical examination (including measurement of periodontal pockets) and panoramic X-ray. Sometimes, they recommend additional laboratory tests, such as blood count, hormone levels and glucose, to determine the cause of abnormalities and periodontal diseases.

Then, treatment and prevention options are analyzed.

What are the most common periodontal diseases?

The most commonly diagnosed are:

• gum inflammation
• periodontitis.

Gum inflammation

Gum inflammation is the first stage of abnormalities within the soft tissues. It manifests itself as swelling and redness of the gums. Bleeding during brushing appears. This should be the first signal for the patient about the need to visit the dental office.

This condition can occur due to insufficient oral hygiene, faulty fillings and ill-fitted prosthetic restorations, but it can also coexist with other diseases and require broader diagnostics.

Periodontitis

Periodontitis affects not only the gums, but also the deeper tissues. Paradoxically, as the symptoms move deeper, they may cease to be visible - for example, gum bleeding subsides. However, the inflammatory condition continues to develop and eventually leads to the loss of connective tissue attachment and bone of the dental process, and the teeth become loose.

How do periodontal diseases develop and who is at risk?

The occurrence of periodontal diseases is always due to dental plaque, which means that they are all of bacterial origin and prevention is most often based on the elimination of this plaque and deposits formed after its mineralization (tartar).

However, the risk of disease also depends on genetic predispositions, coexisting systemic diseases such as diabetes, hormonal disorders, taking certain medications, and smoking cigarettes. Periodontitis is favored by malocclusions (e.g. crowded teeth) and old, overhanging fillings.

When should I visit a periodontist?

The patient's attention should be drawn to gum bleeding (e.g. when brushing teeth or eating hard foods), redness and swelling of the gums, bad breath, loose teeth, exposure and hypersensitivity of the tooth necks. Such symptoms most often suggest that periodontal disease is developing and it is necessary to visit a periodontist.

The patient should also consult a periodontist when noticing worrying changes such as white, dark and red spots, blisters, erosions on the mucous membrane of the oral cavity (on the gums, cheek mucosa, palate, tongue, floor of the mouth).

In addition to the treatment and prevention of gum and periodontal inflammation, periodontology includes:

• covering gum recessions (exposed tooth necks),
• frenulum plastic surgery of the upper lip and tongue,
• treatment of changes on the mucous membrane.

What does periodontosis treatment look like?

The treatment of periodontitis varies depending on the stage of the disease. The periodontist performs teeth root cleaning (closed curettage, open curettage), and teeth that are already loose as a result of the periodontitis process can often be stabilized through so-called splinting.

In advanced cases, treatment of bone pockets is used (regenerative procedures with the implantation of biomaterials).

What does closed curettage involve?

Closed curettage is a procedure performed under local anesthesia, which involves cleaning the roots of teeth from subgingival calculus and granulation tissue containing bacteria.

Closed curettage is performed using appropriate tools (curettes), without cutting the gums. The mucous membrane is only deflected, exposing the roots of the teeth, and avoiding cutting the gums speeds up proper wound healing. Without cleaning the periodontal pockets, it would be impossible to reverse periodontitis. If the inflammatory changes affect the entire dental arch, the procedure is divided into several visits.

What does open curettage involve?

An open curettage is a microsurgical procedure performed under local anesthesia. It involves cutting the gums and exposing the roots of the teeth, which makes it possible to clean deep periodontal pockets of subgingival calculus, granulation tissue, and pathologically altered tissues. It is performed when the periodontal pockets are very deep and there is no other, non-invasive method of thorough gum cleaning. The procedure ends with the placement of stitches, which are removed after about 10 days.

Coverage of gum recession (defects, gum lowering)

Gum recession, also known as gum withdrawal, involves the exposure of tooth necks. The gum recedes, and the tooth appears to be getting longer as the tooth crown lengthens due to the exposure of the tooth root. The tooth becomes overly sensitive and prone to decay.

The causes of gum recession include: periodontitis, malocclusion, improper tooth brushing, overloads in the bite caused by the absence of other teeth, improper attachment of the lip frenulum, and so-called vestibule plaques of the oral cavity.

During a periodontal consultation, the doctor will determine the exact cause of gum recession and recommend appropriate therapy.

Periodontists

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